POPULARITY
Categories
53 episodes with randomized
11 episodes with randomized
14 episodes with randomized
18 episodes with randomized
12 episodes with randomized
6 episodes with randomized
5 episodes with randomized
4 episodes with randomized
5 episodes with randomized
5 episodes with randomized
19 episodes with randomized
6 episodes with randomized
3 episodes with randomized
5 episodes with randomized
7 episodes with randomized
3 episodes with randomized
4 episodes with randomized
5 episodes with randomized
3 episodes with randomized
7 episodes with randomized
3 episodes with randomized
2 episodes with randomized
2 episodes with randomized
3 episodes with randomized
3 episodes with randomized
3 episodes with randomized
4 episodes with randomized
On episode #95 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 11/20/25 – 12/3/25. Host: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Viral Early low-dose dexamethasone is associated with shorter acute symptom duration in Chikungunya virus infection: a retrospective cohort study (BMC Infectious Diseases) Noninferiority of One HPV Vaccine Dose to Two Doses (NEJM) Evidence to Action — Single-Dose HPV Vaccination and Cervical HPV Infection (NEJM) Daily Mosnodenvir as Dengue Prophylaxis in a Controlled Human InfectionModel (NEJM) Universal Hepatitis B Vaccination at Birth—Risks of Revising the recommendation (JAMA) Correlates of HIV-1 control after combination immunotherapy (Nature) Human-to-Human Rabies Transmission via Solid Organ Transplantation from a Donor with Undiagnosed Rabies — United States, October 2024–February 2025 (CDC: MMWR) Cytomegalovirus-specific cell-mediated immunity for prediction of post-prophylaxis CMV disease in a phase 3 trial of letermovir vs valganciclovir prophylaxis in donor CMV-seropositive recipient CMV-seronegative kidney transplant recipients (CID) An Analysis of Cytomegalovirus-Specific Cell-Mediated Immunity in a Phase 3, Randomized, Placebo-Controlled Trial of Letermovir Prophylaxis in Cytomegalovirus-Seropositive Recipients of an Allogeneic Hematopoietic Cell Transplant (CID) Bacterial Infectious Diseases Society of America (IDSA) Position Statement: Why IDSA Did Not Endorse the Community-Acquired Pneumonia Guidelines 2025 Update (CID) Lyme DiseaseIncidence in Massachusetts, 2012-2024 (JAMA: Open Network) Fungal The Last of US Season 2 (YouTube) Aspergillosis-Attributable Mortality in the United States: Analysis of Death CertificateData (CID) Oral itraconazole versus oral voriconazole for treatment-naive patients with chronic pulmonary aspergillosis in India (VICTOR-CPA trial): a single-centre, open-label, randomised, controlled, superiority trial (LANCET: Infectious Diseases) Parasitic Loa loa encephalopathy following treatment with benzimidazole derivatives: A systematic review (OFID) Music is by Ronald Jenkees Information on this podcast should not be considered as medical advice.
In this Thoracic Surgery episode of Behind the Knife we enjoy a conversation with world-renowned thoracic surgeon and educator, Dr. Stephen Yang, as he takes us through 30 years of experience divulging his personal tips, tricks, and pitfalls to avoid when tackling the technical nuances of mastering robotic segmentectomies. Hosts: Dr. Stephen C. Yang, MD - professor of surgery and medical oncology The Johns Hopkins Hospital Dr. Kyla D. Rakoczy, MD - PGY3 General Surgery Resident at The Johns Hopkins Hospital Learning Objectives: Understand the utility of segmentectomies for peripheral T1N0 non-small-cell-lung cancer How to prepare for robotic segmentectomy using CT scans and 3D reconstructions Learn where to place your ports and how to optimize intra-operative techniques to minimize complications after robotic segmentectomy References: Kang MW. Evolution of Lung Cancer Surgery: Historical Milestones, Current Strategy, and Future Innovations. J Chest Surg. 2025 May 5;58(3):79-84. doi: 10.5090/jcs.25.025. Epub 2025 Apr 15. PMID: 40230346; PMCID: PMC12066400. https://pubmed.ncbi.nlm.nih.gov/40230346/ Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995 Sep;60(3):615-22; discussion 622-3. doi: 10.1016/0003-4975(95)00537-u. PMID: 7677489. https://pubmed.ncbi.nlm.nih.gov/7677489/ Pastorino U, Valente M, Bedini V, Infante M, Tavecchio L, Ravasi G. Limited resection for Stage I lung cancer. Eur J Surg Oncol. 1991 Feb;17(1):42-6. PMID: 1995356. https://pubmed.ncbi.nlm.nih.gov/1995356/ Liu L, Aokage K, Chen C, Chen C, Chen L, Kim YH, Lee CY, Liu C, Liu CC, Nishio W, Suzuki K, Tan L, Tseng YL, Yotsukura M, Watanabe SI. Asia expert consensus on segmentectomy in non-small cell lung cancer: A modified Delphi study. JTCVS Open. 2023 Apr 7;14:483-501. doi: 10.1016/j.xjon.2023.03.013. PMID: 37425437; PMCID: PMC10328970. https://pubmed.ncbi.nlm.nih.gov/37425437/ Galvez C, Bolufer S, Lirio F, Recuero JL, Córcoles JM, Socci L, Cabañero A, López I, Sánchez D, Figueroa S, Salcedo JG, Campo-Cañaveral JL, Genovés M, Hernando F, Moldes M, Blanco A, Azcarate L, Rivo E, Viti A, Mongil R. "Complex segmentectomies: Comparison with simple and effect of experience on postoperative outcomes". Eur J Surg Oncol. 2025 Jul;51(7):109748. doi: 10.1016/j.ejso.2025.109748. Epub 2025 Mar 5. PMID: 40064065. https://pubmed.ncbi.nlm.nih.gov/40064065/ Perroni G, Veronesi G. Robotic segmentectomy: indication and technique. J Thorac Dis. 2020 Jun;12(6):3404-3410. doi: 10.21037/jtd.2020.02.53. PMID: 32642266; PMCID: PMC7330783. https://pubmed.ncbi.nlm.nih.gov/32642266/ Montagne, F., Dhainaut, C., & Benhamed, L. M. (n.d.). Pre-operative 3D reconstruction—let's first anticipate the surgical procedure. Video-Assisted Thoracic Surgery. Retrieved November 13, 2025, from https://vats.amegroups.org/article/view/7889/html Shimizu K, Nakazawa S, Nagashima T, Kuwano H, Mogi A. 3D-CT anatomy for VATS segmentectomy. J Vis Surg. 2017 Jul 1;3:88. doi: 10.21037/jovs.2017.05.10. PMID: 29078650; PMCID: PMC5637987. https://pubmed.ncbi.nlm.nih.gov/29078650/ Zhang O, Alzul R, Carelli M, Melfi F, Tian D, Cao C. Complications of Robotic Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy for Resectable Non-Small Cell Lung Cancer. J Pers Med. 2022 Aug 12;12(8):1311. doi: 10.3390/jpm12081311. PMID: 36013260; PMCID: PMC9410342. https://pubmed.ncbi.nlm.nih.gov/36013260/ Lee BE, Altorki N. Sub-Lobar Resection: The New Standard of Care for Early-Stage Lung Cancer. Cancers (Basel). 2023 May 25;15(11):2914. doi: 10.3390/cancers15112914. PMID: 37296877; PMCID: PMC10251869. https://pubmed.ncbi.nlm.nih.gov/37296877/ Zhang Y, Liu S, Han Y, Xiang J, Cerfolio RJ, Li H. Robotic Anatomical Segmentectomy: An Analysis of the Learning Curve. Ann Thorac Surg. 2019 May;107(5):1515-1522. doi: 10.1016/j.athoracsur.2018.11.041. Epub 2018 Dec 19. PMID: 30578780. https://pubmed.ncbi.nlm.nih.gov/30578780/ Peeters M, Jansen Y, Daemen JHT, van Roozendaal LM, De Leyn P, Hulsewé KWE, Vissers YLJ, de Loos ER. The use of intravenous indocyanine green in minimally invasive segmental lung resections: a systematic review. Transl Lung Cancer Res. 2024 Mar 29;13(3):612-622. doi: 10.21037/tlcr-23-807. Epub 2024 Mar 27. PMID: 38601441; PMCID: PMC11002498. https://pubmed.ncbi.nlm.nih.gov/38601441/ Altorki N, Wang X, Damman B, Mentlick J, Landreneau R, Wigle D, Jones DR, Conti M, Ashrafi AS, Liberman M, de Perrot M, Mitchell JD, Keenan R, Bauer T, Miller D, Stinchcombe TE. Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: A post hoc analysis of CALGB 140503 (Alliance). J Thorac Cardiovasc Surg. 2024 Jan;167(1):338-347.e1. doi: 10.1016/j.jtcvs.2023.07.008. Epub 2023 Jul 18. Erratum in: J Thorac Cardiovasc Surg. 2025 Apr;169(4):1181. doi: 10.1016/j.jtcvs.2024.12.011. PMID: 37473998; PMCID: PMC10794519. https://pubmed.ncbi.nlm.nih.gov/37473998/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
This week, join author Hans-Josef Feistritzer and Associate Editor Stefan James as they discuss the article "Peri-Interventional Anesthesia Strategies for Transcatheter Aortic Valve Implantation: A Multicenter, Randomized, Controlled, Noninferiority Trial." For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20251201.586148
Dr. Suresh Durgam (Intra-Cellular Therapies, a Johnson & Johnson Company, Bedminster, NJ) joins AJP Audio to discuss a phase 3 randomized controlled trial looking at the use of the antipsychotic medication lumateperone as adjunctive to antidepressant therapy in the treatment of patients with major depressive disorder. Afterwards, AJP Editor-in-Chief Dr. Ned Kalin discusses the rest of the December issue of the Journal. 00:48 Durgam interview 03:09 Mechanism of action 04:44 Patient-reported outcomes 06:31 Immediate clinical implications 07:32 Limitations 08:08 Further research 09:25 Kalin interview 09:38 Durgam et al. 13:09 Lin et al. 17:22 Brodsky et al. Transcript Be sure to let your colleagues know about the podcast, and please rate and review it on Apple Podcasts, Google Podcasts, Spotify, or wherever you listen to it. Subscribe to the podcast here. Listen to other podcasts produced by the American Psychiatric Association. Browse articles online. How authors may submit their work. Follow the journals of APA Publishing on Twitter. E-mail us at ajp@psych.org
Today, I am delighted to be joined by a friend and colleague, Mike Mutzel. Mike has a master's in Clinical Nutrition from the University of Bridgeport. He is a graduate of the IFM, applies functional medicine in clinical practice, and is a consultant lecturer who teaches leading-edge science in a concise format for progressive clinicians to prevent chronic diseases. In our discussion, Mike and I unpack the benefits of creatine monohydrate, highlighting the importance of ensuring the products we use are free of impurities. We explain how creatine monohydrate gets created, answer many listener questions, and describe current research specific to creatine monohydrate, discussing ways to support bone health, navigate dosing, and how to troubleshoot. This conversation with Mike Mutzel is truly invaluable, and I look forward to having him back on the podcast to dive a little deeper into the science. IN THIS EPISODE, YOU WILL LEARN: How creatine supports energy production across muscles, the brain, and other organ systems Why vegetarians and vegans should take creatine What to consider when choosing high-quality creatine supplements Dosing strategies based on diet, exercise, sleep, and individual needs How taking creatine with electrolytes while exercising can improve absorption Benefits of supplementing with amino acids alongside creatine for illness, recovery, or when protein intake is low Adjusting your creatine dosage for sleep, travel, or exercise demands How creatine supports bone and muscle health The value of creatine for the eyes and ears Connect with Cynthia Thurlow Follow on X, Instagram & LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Connect with Mike Mutzel On his website YouTube Instagram High Intensity Health Podcast Creatine Research: Creatine in Women's Health: Bridging the Gap From Menstruation Through Pregnancy to Menopause Effects of Creatine and Resistance Training on Bone Health in Postmenopausal Women Creatine Supplementation (3 g/d) and Bone Health in Older Women: A 2-Year, Randomized, Placebo-Controlled Trial Creatine Supplementation in Depression: A Review of Mechanisms, Efficacy, Clinical Outcomes, and Future Directions The Effects of 8-Week Creatine Hydrochloride and Creatine Ethyl Ester Supplementation on Cognition, Clinical Outcomes, and Brain Creatine Levels in Perimenopausal and Menopausal Women (CONCRET-MENOPA): A Randomized Controlled Trial
The FiltrateJoel Topf @kidneyboy.bsky.social (COI)Sophia Ambruso @sophia-kidney.bsky.socialSwapnil Hiremath @hswapnil.medsky.social and on LinkedInSpecial Guests Jonathan Barratt Professor of Renal Medicine, University of Leicester Google Scholar (COI: all the companies)Editing and Show Notes byNayan Arora @captainchloride.bsky.socialThe Kidney Connection written and performed by Tim YauShow NotesProteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy (Aliza Thompson, 2019 PubMed)The number, quality, and coverage of randomized controlled trials in nephrology (PubMed 2004)Updated here (PubMed | NephJC discussion)A Randomized, Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction (PubMed 2017)BLISS Belimumab in lupus nephritis (NephJC | PubMed) The Phase 2 trial of atacicept A phase 2b, randomized, double-blind, placebo-controlled, clinical trial of atacicept for treatment of IgA nephropathy (PubMed)The phase 3 trial of atacicept, the subject of this podcast A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (PubMed | NephJC)Christos' Bluesky post:https://bsky.app/profile/christosargyrop.bsky.social/post/3m5bsujwg3s2q The use of Gd-IgA1 in the Testing Trial Role of Systemic Glucocorticoids in Reducing IgA and Galactose-Deficient IgA1 Levels in IgA Nephropathy (PubMed)If you can't get enough Jon Barratt, take a look at his grand rounds at The University of Ottawa. Updates to the KDIGO Guidelines for the treatment of IgA nephropathy, with Prof Jonathan Barratt (YouTube)Tubular SecretionSwapnil Hiremath Pluribus on Apple TV (Wikipedia)Jon Barratt Lynyrd Skynyrd (Wikipedia) Slow Horses (Wikipedia) on AppleTVJoel Topf the new ASN
In this World Shared Practice Forum Podcast, Dr. Vinay Nadkarni discusses emergent tracheal intubation in pediatric critical care. Drawing from the NEAR4KIDS registry and comparing with recent adult-focused evidence, Dr. Nadkarni discusses the challenges of airway management in children, emphasizing the importance of patient-specific physiology. He highlights how patient positioning and equipment choices can improve intubation outcomes. Additionally, the episode explores the benefits of video laryngoscopy and apneic oxygenation. This content is pertinent for healthcare professionals seeking to enhance their understanding of pediatric airway management, offering practical insights supported by recent research. LEARNING OBJECTIVES - Compare pediatric and adult emergency tracheal intubation evidence and practices - Explore the role of the NEAR4KIDS registry in improving pediatric intubation practices - Identify effective strategies to enhance first-attempt success in tracheal intubations - Assess the impact of patient positioning and equipment choices on intubation outcomes - Evaluate the benefits of video laryngoscopy and apneic oxygenation in pediatric settings AUTHORS Vinay Nadkarni, MD, MS Professor, Anesthesiology Critical Care and Pediatrics University of Pennsylvania Perelman School of Medicine Jeffrey Burns, MD, MPH Emeritus Chief Division of Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Professor of Anesthesia Harvard Medical School DATE Initial publication date: November 25, 2025. ARTICLES REFERENCED - DeMasi SC, Casey JD, Semler MW. Evidence-based Emergency Tracheal Intubation. Am J Respir Crit Care Med. 2025;211(7):1156-1164. doi:10.1164/rccm.202411-2165CI - Garcia-Marcinkiewicz AG, Kovatsis PG, Hunyady AI, et al. First-attempt success rate of video laryngoscopy in small infants (VISI): a multicentre, randomised controlled trial. Lancet. 2020;396(10266):1905-1913. doi:10.1016/S0140-6736(20)32532-0 - Hagberg CA, Artime CA, Aziz MF, eds. Hagberg and Benumof's Airway Management. 5th ed. Philadelphia, PA: Elsevier; 2023. - Khanam D, Schoenfeld E, Ginsberg-Peltz J, et al. First-Pass Success of Intubations Using Video Versus Direct Laryngoscopy in Children With Limited Neck Mobility. Pediatr Emerg Care. 2024;40(6):454-458. doi:10.1097/PEC.0000000000003058 - Waheed S, Kapadia NN, Jawed DR, Raheem A, Khan MF. Randomized controlled trial to assess the effectiveness of apnoeic oxygenation in adults using a low-flow or high-flow nasal cannula with head side elevation during endotracheal intubation in the emergency department. BMC Res Notes. 2025 Jul 1;18(1):264. doi: 10.1186/s13104-025-07328-7. Erratum in: BMC Res Notes. 2025 Sep 8;18(1):384. doi: 10.1186/s13104-025-07412-y. PMID: 40598378; PMCID: PMC12219693. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/mr2657n4ckgpz7g3tw37gbx/202511_WSP_Nadkarni_transcript Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Nadkarni V, Burns JP. Pediatric Intubation Practices: Insights from NEAR4KIDS. 11/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/pediatric-intubation-practices-insights-from-near4kids-by-v-nadkarni-openpediatrics.
The VICTORY Trial - A Randomized, Multicenter, Non-Inferiority Comparison
This week, join author Jonas Oldgren and Associate Editor Torbjørn Omland as they discuss the article "Biomarker-Based ABC-AF Risk Scores for Personalized Treatment to Reduce Stroke or Death in Atrial Fibrillation: A Registry-Based Multicenter, Randomized, Controlled Study." For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20251124.61165
Broadcast from KSQD, Santa Cruz on 11-13-2025: Dr. Dawn discusses a New England Journal of Medicine study examining radiation exposure from medical imaging in over 4 million children showing increased hematological cancer risk. Head and brain CTs deliver highest bone marrow doses, with under-1-year-olds receiving 20 milligrays compared to background radiation of 1 milligray yearly. The study found 3,000 cancers in 4 million children over roughly 10 years, with relative risk increasing 1.6-fold per CT scan. However, methodological flaws include combining US and Canadian cohorts with different data quality, potential reverse causation where imaging detected pre-existing cancers, and arbitrary 6-month latency assumptions are significant flaws in this study.. Despite small absolute risk increases given low baseline cancer rates, she encourages parents to question necessity of repeat scans and request alternatives like MRI when appropriate. She reports on cutting-edge CRISPR therapy using lipid nanoparticles to deliver molecular scissors targeting the ANGPTL3 gene controlling LDL cholesterol production. Recent setbacks in several other CRISPR trials raise issues for unexplained liver toxicity. Concerns include off-target gene editing effects and partially repaired DNA creating mutated proteins triggering autoimmune reactions. Dr. Dawn emphasizes restricting gene therapy to life-threatening genetic diseases with no alternatives until safety improves. Stanford scientists used AI model Evo trained on 9 trillion gene samples to design 300 new bacteriophages from scratch, with 16 phages successfully killing E. coli bacteria. AI tools now predict protein structures, design custom drugs, create antivenoms, invent antibiotics, and break down PFAS forever chemicals. The research represents evolution through computation and requires guardrails on AI's ability to manipulate biological structures. An emailer shares the Rosencare model where hotel chain owner Harris Rosen created self-insured health coverage featuring direct provider contracting, imaging facilities charging one-third to one-half traditional costs, transparent pharmacy benefit management, and zero or $5 primary care copays. Employees receive proactive screening for colonoscopies, mammograms, cholesterol, diabetes, and hypertension during clinic visits. Ninety percent of medicines including insulin cost nothing, with remaining drugs $0-25, and hospital admissions cost flat $750. The model saved $600 million while providing superior preventive care by eliminating insurance middlemen and focusing on early chronic disease detection when 75-85% of costs originate. Dr. Dawn explains abdominophrenic dyssynergia causing bloating unrelated to gas or food. The diaphragm descends and abdominal wall muscles relax, pushing organs forward after meals. CT scans showed lettuce-related bloating involved no intestinal gas changes but demonstrated this abnormal muscle reflex. Randomized trials showed biofeedback training with chest-lifting and abdominal wall contracting exercises before and after eating for four weeks improved symptoms 66%. She warns that constant bloating in postmenopausal women unrelated to eating requires ovarian cancer screening. She discusses how genes drive personality using dopamine receptor gene DRD4 polymorphisms as an example. The 7-repeat variant present in 48% of Americans creates receptors binding dopamine poorly, associating with ADHD, pathological gambling, alcoholism, drug dependence, and bulimia, plus personality traits of novelty-seeking, impulsiveness, and optimism. The 2-repeat DRD4 variant common in Asia correlates with lower anger and higher forgiveness. DRD2 variations enhance the memory of negative outcomes, creating pessimistic bias and avoidance behavior. She presents the KETO trial showing "lean mass hyper-responder phenotype" where very low-carbohydrate dieters averaging age 55 maintained LDL cholesterol of 272 for five years but showed identical coronary artery calcium scores and plaque burden as matched controls with LDL under 150. Despite extreme LDL elevation, the very low insulin levels from carbohydrate restriction prevent LDL oxidation, the inflammatory "loading" process enabling arterial damage. She concludes with unusual cancer symptom where recurrent pain in specific body locations after alcohol consumption, lasting 1-2 days, occurs in 5% of Hodgkin lymphoma patients and in other cancers when alcohol induced blood vessel dilation and inflammatory chemical release in cancer-containing lymph nodes causes pain after drinking.
Carotid artery disease management has come a long way. From the days when every stroke meant an endarterectomy to a modern era defined by precision, evidence, and evolving technology. With advances in medical therapy and newer techniques like TCAR, the vascular surgeon has even more to consider when choosing the best treatment for carotid disease. Join us as we break down the major landmark trials NASCET, CREST and the Asymptomatic Carotid trials, and discuss how their findings shape our clinical decisions in practice today. Hosts: · Christian Hadeed -PGY 4 General Surgery, Brookdale Hospital Medical Center · Paul Haser -Division Chief, Vascular Surgery, Brookdale Hospital Medical Center · Andrew Harrington, Vascular surgery, Brookdale Hospital Medical Center · Lucio Flores, Vascular surgery, Brookdale Hospital Medical Center Learning Objectives: · Review the key findings and clinical implications of the NASCET, ACST, and CREST trials. · Discuss patient selection for carotid endarterectomy (CEA) vs carotid artery stenting (CAS). · Understand how age, calcification, and aortic arch anatomy affect stenting outcomes or choice between stent and CEA. · Identify how advances in medical therapy have influenced management of asymptomatic disease. · Discuss appropriate screening/ follow up plans for patients who do not meet criteria for intervention References: - North American Symptomatic Carotid Endarterectomy Trial Collaborators. (1991). Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. The New England Journal of Medicine, 325(7), 445–453. https://pubmed.ncbi.nlm.nih.gov/1852179/ - Brott, T. G., Hobson, R. W. II, Howard, G., Roubin, G. S., Clark, W. M., Brooks, W., ... & Howard, V. J. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. The New England Journal of Medicine, 363(1), 11–23. https://pubmed.ncbi.nlm.nih.gov/20505173/ - Halliday, A., Mansfield, A., Marro, J., Peto, C., Peto, R., Potter, J., & Thomas, D.; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. (2004). Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: Randomized controlled trial. The Lancet, 363(9420), 1491–1502. https://pubmed.ncbi.nlm.nih.gov/15135594/ - Halliday, A., Bulbulia, R., Bonati, L. H., Chester, J., Cradduck-Bamford, A., Peto, R., & Pan, H., & the ACST-2 Collaborative Group. (2021). Second asymptomatic carotid surgery trial (ACST-2): A randomised comparison of carotid artery stenting versus carotid endarterectomy. The Lancet, 398(10305), 1065-1073. https://doi.org/10.1016/S0140-6736(21)01910-3 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
Mindfulness Training and Stress Reactivity in Substance Abuse: Results from a Randomized, Controlled Stage I Pilot StudyIn this episode, Dr. Jud delves into groundbreaking research comparing mindfulness training (MT) and cognitive behavioral therapy (CBT) for individuals with substance use disorders. This pilot study investigates the role of mindfulness in managing stress and addiction, highlighting its potential to reduce psychological and physiological stress responses. Learn how MT could become a viable treatment option alongside traditional therapies, the challenges faced during the study, and what these findings mean for the future of addiction treatment.Reference: Brewer, J. A., Sinha, R., Chen, J. A., Michalsen, R. N., Babuscio, T. A., Nich, C., ... & Rounsaville, B. J. (2009). Mindfulness Training and Stress Reactivity in Substance Abuse: Results from a Randomized, Controlled Stage I Pilot Study. Substance Abuse, 30(4), 306-317. DOI: 10.1080/08897070903250241Let's connect on Instagram
Summary In this episode, Ryan Bucciantini and Jason Leydon discuss the importance of structured programming in training, contrasting systems versus chaos. They explore the role of variance in exercise selection and the need for individualized program design. The conversation highlights the significance of having a game plan, understanding the timeline of training seasons, and the pitfalls of constantly varied programming without purpose. They emphasize the value of mentorship and the challenges of online programming in the fitness industry. Takeaways Structured programming is crucial for effective training. Variance in exercise selection can enhance athlete development. Individualized program design is essential for progress. Constantly varied programming should have a purpose. Mentorship is valuable for developing programming skills. Online programming presents unique challenges. Understanding training season timelines is important. A game plan is necessary for successful training. Exercise variation should target specific athlete needs. Communication with athletes is key to program success. Topics Mastering Training Systems: From Chaos to Structure The Art of Exercise Variance in Programming Why Individualized Program Design Matters Avoiding the Pitfalls of Randomized Training Mentorship: A Key to Programming Success Navigating the Challenges of Online Programming Training Timelines: Planning for Success The Importance of a Game Plan in Training Targeted Exercise Variation for Athletes Effective Communication in Program Design Sound bites "Structured programming is crucial for effective training." "Variance in exercise selection enhances athlete development." "Individualized program design is essential for progress." "Constantly varied programming should have a purpose." "Mentorship is valuable for developing programming skills." "Online programming presents unique challenges." "Understanding training season timelines is important." "A game plan is necessary for successful training." "Exercise variation should target specific athlete needs." "Communication with athletes is key to program success." Chapters 00:00:00 Introduction to Training Systems 00:00:00 The Role of Variance in Exercise 00:00:00 Importance of Individualized Program Design 00:00:00 Challenges of Online Programming 00:00:00 Mentorship and Skill Development 00:00:00 Planning Training Timelines
Un nouvel épisode du Pharmascope est disponible! Dans ce 90ème épisode et la deuxième et dernière partie de notre série concernant l'usage du fer, Nicolas, Sébastien et Isabelle décortiquent les subtilités de la posologie optimale de fer. Les objectifs pour cet épisode sont les suivants: Comparer les avantages et les inconvénients des différentes posologies de fer possibles (prise intermittente, uniquotidienne, biquotidienne) Conseiller un patient lors de l'initiation d'un traitement de fer Expliquer dans quel contexte l'administration de fer intraveineux est indiqué Ressources pertinentes en lien avec l'épisode Lignes directrices Snook J et coll. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut. 2021;70:2030-51. British Columbia Ministry of Health. Iron Deficiency – Diagnosis and Management. BCGuidelines.ca. Avril 2019. Article de revue Pasricha S-R et coll. Iron deficiency. Lancet. 2021;397:233-48. Articles portant sur la posologie du fer oral Lee H et coll. Iron dosing frequency. Can Fam Physician. 2021;67:436. Rimon E et coll. Are we giving too much iron? Low-dose iron therapy is effective in octogenarians. Am J Med. 2005;118:1142-7. Fernandez-Gaxiola AC, De-Regil LM. Intermittent iron supplementation for reducing anaemia and its associated impairments in adolescent and adult menstruating women. Cochrane Database Syst Rev. 2019;1:CD009218. Düzen Oflas N et coll. Comparison of the effects of oral iron treatment every day and every other day in female patients with iron deficiency anaemia. Intern Med J. 2020;50:854-8. Kaundal R et coll. Randomized controlled trial of twice-daily versus alternate-day oral iron therapy in the treatment of iron-deficiency anemia. Ann Hematol. 2020;99:57-63. Utilisation du fer intraveineux Litton E et coll. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ. 2013;347:f4822. Ponikowski P et coll. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet. 2020;396:1895-1904.
Un nouvel épisode du pharmascope est maintenant disponible! Dans de ce 102ème épisode, Nicolas, Sébastien et Isabelle discuteront de vitamine B12. Dans ce premier épisode d'une série de deux, on discute de manifestations cliniques, d'évaluation biochimique, d'approche diagnostique et de bénéfices (ou pas) du traitement d'un déficit en vitamine B12. Les objectifs pour cet épisode sont les suivants: Identifier les patients avec une indication de doser la vitamine B12 Discuter de la fiabilité du dosage de la vitamine B12 Discuter de l'approche diagnostique du déficit en vitamine B12 Expliquer les bénéfices d'un supplément de vitamine B12 dans le traitement et la prévention de diverses conditions Ressources pertinentes en lien avec l'épisode Boughrassa F, Framarin A. Usage judicieux de 14 analyses biomédicales: Outil pratique. Institut national d'excellence en santé et services sociaux. Avril 2014. Solomon LR. Cobalamin-responsive disorders in the ambulatory care setting: unreliability of cobalamin, methylmalonic acid, and homocysteine testing. Blood. 2005;105:978-85. Hunt A, Harrington D, Robinson S. Vitamin B12 deficiency. BMJ. 2014;349:g5226. Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368:149-60. Didangelos T et coll. Vitamin B12 Supplementation in Diabetic Neuropathy: A 1-Year, Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients. 2021;13:395. Dangour AD et coll. Effects of vitamin B-12 supplementation on neurologic and cognitive function in older people: a randomized controlled trial. Am J Clin Nutr. 2015;102:639-47. McCleery J et coll. Vitamin and mineral supplementation for preventing dementia or delaying cognitive decline in people with mild cognitive impairment. Cochrane Database Syst Rev. 2018;11:CD011905. Rutjes AW et coll. Vitamin and mineral supplementation for maintaining cognitive function in cognitively healthy people in mid and late life. Cochrane Database Syst Rev. 2018;12:CD011906. Kwok T et coll. A randomized placebo-controlled trial of using B vitamins to prevent cognitive decline in older mild cognitive impairment patients. Clin Nutr. 2020;39:2399-2405. Kwok T et coll. A randomized placebo controlled trial of vitamin B12 supplementation to prevent cognitive decline in older diabetic people with borderline low serum vitamin B12. Clin Nutr. 2017;36:1509-1515. Van der Zwaluw NL et coll. Results of 2-year vitamin B treatment on cognitive performance: secondary data from an RCT. Neurology. 2014;83:2158-66. Almeida OP et coll. B vitamins to enhance treatment response to antidepressants in middle-aged and older adults: results from the B-VITAGE randomised, double-blind, placebo-controlled trial. Br J Psychiatry. 2014;205:450-7.
Un nouvel épisode du Pharmascope est disponible! Dans ce 165e épisode, Nicolas, Isabelle et Olivier discutent d'un sujet douloureux… La migraine! Dans cette dernière partie d'une série de trois épisodes, nous abordons la migraine chronique et la céphalée par abus médicamenteux Les objectifs pour cet épisode sont les suivants: Discuter de l'évaluation et du diagnostic de la migraine chronique et de la céphalée médicamenteuse Discuter de la prise en charge de la migraine chronique Discuter de la prise en charge de la céphalée d'abus médicamenteux Ressources pertinentes en lien avec l'épisode Ashina M. Migraine. N Engl J Med. 2020;383(19):1866-1876. Medrea I et coll. Updated Canadian Headache Society Migraine Prevention Guideline with Systematic Review and Meta-analysis. Can J Neurol Sci. 2024 Nov 7:1-23. Pozo-Rosich P et coll. Atogepant for the preventive treatment of chronic migraine (PROGRESS): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2023 Sep 2;402(10404):775-785. Chowdhury D et coll. TOP-PRO study: A randomized double-blind controlled trial of topiramate versus propranolol for prevention of chronic migraine. Cephalalgia. 2022 Apr;42(4-5):396-408. Dodick DW et coll.; PREEMPT Chronic Migraine Study Group. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010 Jun;50(6):921-36. Ashina S et coll. Medication overuse headache. Nat Rev Dis Primers. 2023 Feb 2;9(1):5. Rossi P et coll. Advice alone vs. structured detoxification programmes for medication overuse headache: a prospective, randomized, open-label trial in transformed migraine patients with low medical needs. Cephalalgia. 2006 Sep;26(9):1097-105. Hagen K et coll. Management of medication overuse headache: 1-year randomized multicentre open-label trial. Cephalalgia. 2009 Feb;29(2):221-32. Carlsen LN et coll. Comparison of 3 Treatment Strategies for Medication Overuse Headache: A Randomized Clinical Trial. JAMA Neurol. 2020 Sep 1;77(9):1069-1078. Tepper SJ et coll. Efficacy and Safety of Erenumab for Nonopioid Medication Overuse Headache in Chronic Migraine: A Phase 4, Randomized, Placebo-Controlled Trial. JAMA Neurol. 2024 Sep 16;81(11):1140-9. de Goffau MJ, Klaver ARE, Willemsen MG, Bindels PJE, Verhagen AP. The Effectiveness of Treatments for Patients With Medication Overuse Headache: A Systematic Review and Meta-Analysis. J Pain. 2017 Jun;18(6):615-627. Grazzi L et coll. Efficacy of mindfulness added to treatment as usual in patients with chronic migraine and medication overuse headache: a phase-III single-blind randomized-controlled trial (the MIND-CM study). J Headache Pain. 2023 Jul 14;24(1):86.
Whether to close the capsule at the conclusion of hip arthroscopy remains a matter of great debate. Prior data has been mixed. Dr. Bjarne Mygind-Klavsen from Aarhus University Hospital in Denmark joints us to discuss the results of his team's randomized controlled study comparing interportal capsulotomy closure versus no closure at 1 year following hip arthroscopy.
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Marc Pelletier, division chief of cardiac surgery for the Department of Surgery at Yale School of Medicine, about patient blood management. Chapters 00:00 Intro 01:45 EACTS 2025 07:19 JANS 1, HVD Management Guidelines 16:26 JANS 2, Low-Risk AVR Evidence 19:21 JANS 3, Warden Procedure Selection 20:36 JANS 4, Primary Repair of CAT 21:48 JANS 5, NEWTON-CABG Cardiolink-5 23:20 Video 1, Acute Aortic Syndrome 24:54 Video 2, Redo TVR Under Bypass 27:13 Video 3, Giant Tension Bulla 28:47 Dr. Pelletier Interview 34:25 Outro They delve into the Society of Thoracic Surgeons (STS) guidelines on patient blood management, along with key tips. They also explore preoperative optimization, provide an example, and discuss cell savers and reducing dead space during surgery. Additionally, they touch on postoperative transfusion and the importance of performing meticulous surgery. Joel also highlights recent JANS articles on the 2025 ESC/EACTS guidelines for the management of valvular heart disease, low-risk aortic valve replacement at the crossroads of evidence, ideal age and weight for the Warden procedure in patients with partial anomalous pulmonary venous return, a systematic meta-analysis of short- and long-term outcomes of the primary repair of common arterial trunk, and an international, randomized, double-blind, placebo-controlled trial on the effect of Evolocumab on saphenous vein graft patency after coronary artery bypass surgery. In addition, Joel explores the surgical treatment of acute aortic syndrome, a redo tricuspid valve replacement technique under right heart bypass for a previously repaired tricuspid valve, and thoracoscopic resection of a giant tension bulla. Before closing, Joel highlights upcoming events in CT surgery. JANS Items Mentioned 1.) 2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease: Developed by the Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) 2.) Low-Risk Aortic Valve Replacement at the Crossroads of Evidence 3.) Is There an Ideal Age or Weight for the Warden Procedure in Patients With Partial Anomalous Pulmonary Venous Return? 4.) Primary Repair of Common Arterial Trunk: A Systematic Meta-Analysis of Short- and Long-Term Outcomes 5.) Effect of Evolocumab on Saphenous Vein Graft Patency After Coronary Artery Bypass Surgery (NEWTON-CABG CardioLink-5): An International, Randomized, Double-Blind, Placebo-Controlled Trial CTSNet Content Mentioned 1.) Surgical Treatment of Acute Aortic Syndrome 2.) Redo Tricuspid Valve Replacement Technique Under Right Heart Bypass for a Previously Repaired Tricuspid Valve 3.) Thoracoscopic Resection of a Giant Tension Bulla Other Items Mentioned 1.) STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management 2.) Transcatheter vs Surgical Aortic Valve Replacement in Lower-Risk Patients: An Updated Meta-Analysis of Randomized Controlled Trials 3.) Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani 4.) Career Center 5.) CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
November 2025 Journal Club Podcast Title: Thrombectomy for Patients With Large-Volume Ischemic Stroke: A Systematic Review and Meta-Analysis of 6 Randomized Trials To read journal article: https://journals.lww.com/neurosurgery/fulltext/2025/11000/thrombectomy_for_patients_with_large_volume.5.aspx Author: Mark Harrigan Guest Faculty: David Altschul Moderator: Zachary Sorrentino Committee Co-Chair: Kimberly Hoang
Dans cet épisode, nous plongeons au cœur d'une thérapie qui suscite autant de curiosité que de controverse : l'EFT, ou Emotional Freedom Technique. Est-ce une approche révolutionnaire pour traiter traumatismes, anxiété et douleurs, ou une thérapie non scientifique aux affirmations miraculeuses ? Nous décortiquons les promesses de l'EFT, ses fondements théoriques basés sur les méridiens énergétiques, et la comparons à d'autres approches comme l'acupuncture et l'EMDR.
Episode Summary Bill and Pete get personal about a shared health detour—early-detected prostate cancer—and how “health meets wealth” shows up in real life. They unpack the emotional and practical steps (baselines, deltas, options, decisions), then pivot to Pete's new niche venture: Certified Exit Planning Advisor (CEPA) work and the launch of The Confident Exit podcast for business owners. Time-Stamped Show Notes 00:00 – Welcome & context Bill opens the show and explains they've been on a brief hiatus; Pete joins remotely from San Francisco (actual hotel room, not a virtual background). 00:43 – Where's Pete? Pete's calling in from San Francisco, CA; quick banter about travel and being “alongside on screen.” 01:13 – Why the hiatus It's “been a minute.” They tee up a candid health conversation and a new podcast announcement. 01:30 – Health Meets Wealth (Chapter call-back) Bill frames the pause through the lens of the book's “health meets wealth” theme. 01:39 – Pete's health journey (early detection) A year-long series of tests escalates from “yellow flag” to “red flags.” Diagnosis: prostate cancer, caught early. Pete opts for surgery (early May), good recovery, and gratitude for proactive care and skilled medical teams. 03:18 – Bill's parallel path Family history heightens vigilance. Bill tracks PSA trend (delta) even while within “normal,” leading to MRI → biopsy. 04:34 – Valentine's Day twist: both brothers end up getting biopsies the same day—unknowingly. 04:45 – Diagnosis details & options Bill's Gleason score is a bit lower; he explores alternatives (incl. TULSA-PRO) and clinical trials comparing it to standard surgery. Randomized to surgery; undergoes laparoscopic removal at end of July. Two months post-op at recording—healing well. 06:32 – The headspace & decision process Choosing among credible options; balancing personal values, family impact, and medical clarity. Pete's approach: execute step-by-step (don't over-project), while noting loved ones may process differently. 10:24 – September awareness It's Prostate Cancer Awareness Month; heightened appreciation this year. 10:36 – Community support: Blue Ribbon Soirée involvement becomes part of their ongoing advocacy. 10:51 – “Snakes on the runway” Bill's milestone moments: heart scare at 50; prostate surgery at 60. The “snake in the grass” metaphor from the book—find it, step over it, deal with it—and the humor (what happens at 70/80?). 11:35 – The big takeaway: baselines Be proactive: get baseline labs and track the delta annually. You owe it to yourself and your tribe (family, partners, employees). Tie-in to CYA360 themes: key-person health risk to a business. 12:54 – Bites & Insights + “Glimpse of the Future” At Horizon lunches, they use the handout to project yourself—and your tribe—forward in 5-year increments. Planning for your future self is easier when you visualize loved ones aging too. 15:28 – Cognitive risk in later years Stats awareness (e.g., dementia/Alzheimer's prevalence in the 80s) reminds listeners to pre-plan for wealth protection as cognition can decline—even for once-meticulous stewards. 16:26 – Making the future “feel real” Bill's example of projecting his daughter's milestones to make his future tangible (weddings, timing, costs). 17:16 – Time flies 59½ used to feel far away; now it's in view or in the rear-view. Keep thinking ahead; stay systematic about savings, investing, and health check-ups. 18:02 – Programming note: Pete's new focus This is Pete's last regular Runway Decade episode for a while. He's leaning into exit planning (CEPA) with a new podcast: The Confident Exit. 18:29 – Why exit planning now Background: client exits, Horizon's own acquisitions, and a maturing ecosystem (valuation, legal, tax). Show format returns to guests—experts surrounding business owners. 20:08 – Where to find it HorizonFG.com → Business Exit Planning page; podcast hosted there and on Apple/Libsyn. Three episodes recorded and rolling out. 20:34 – The niche Just like Runway Decade targets 50-somethings, The Confident Exit targets owners with most of their wealth locked in one illiquid asset—the business. Goal: help monetize and design “what's next.” 21:36 – Wrap & contacts Bill: bbush@horizonfg.com, RunwayDecade.com contact box, or HorizonFG.com. Pete: pbush@horizonfg.com; follow his exit-planning articles and podcast clips on LinkedIn and Horizon's site. Safe travels & sign-off. Key Takeaways Early detection saves futures: Get annual baselines and watch the trend (delta), not just “normal ranges.” Decisions are personal: Multiple credible pathways (surgery, radiation, ablation/TULSA-PRO, etc.); choose with your values, facts, and family in mind. Health ↔ wealth: Your wellbeing is a key-person risk to your family and business; plan accordingly. Future-you planning: Use “glimpse of the future” to make timelines, costs, and care needs real. New resource for owners: Check out Pete's The Confident Exit for valuation, legal, tax, and deal-prep insights. Pull Quotes / Sound Bites “Get a baseline on everything—and track the delta.” “Step over the snake: find the problem, choose the path, execute.” “Life goes fast—think ahead: health and wealth both reward early action.” Resources & Links Runway Decade site & contact: RunwayDecade.com Horizon Financial Group: HorizonFG.com → Business Exit Planning The Confident Exit podcast (Pete) — also on Apple/Libsyn Email: Bill — bbush@horizonfg.com | Pete — pbush@horizonfg.com Disclosure The views depicted in this material are for information purposes only and are not necessarily those of Cetera Advisors LLC. They should not be considered specific advice or recommendations for any individual. Neither Cetera Advisors LLC nor any of its representatives may give legal or tax advice. Bill Bush, Andy Bush, and Pete Bush are registered representatives offering securities and advisory services through Cetera Advisors LLC, member FINRA/SIPC, a broker-dealer, and registered investment advisor. Cetera is under separate ownership from any other named entity. 15015 Jamestown Boulevard, Suite 100, Baton Rouge, Louisiana, 70810.
Episode 181 Artificial Intelligence and Electronic Music Playlist Time Track Time Start Introduction 05:42 00.00 1. Cornelius Cardew, “Treatise: String Orchestra (2025). The first of three AI interpretations of a piece by Cardew composed between 1963 and 1967. The work was written as a graphic score. Produced by the team of Professor Shlomo Dubnov of the University of California at San Diego, they used as the basis for an improvisation Cardew's graphical musical score comprising 193 pages of lines, symbols, and various geometric or abstract shapes that largely stray from conventional musical notation (pages 1 to 33 were used). The recordings from Dubnov's team interpreted this graphic score with the help of Open AI's ChatGPT 40 and a program they developed themselves called Music Latent Diffusion Model (MusicLDM), an AI-like algorithm. The recordings show how AI can transform visual stimuli into sound and expand on their interpretation in an experimental music composition. This version is arranged for digital string orchestra. 11:23 05:54 2. Cornelius Cardew, “Treatise” Sinewave” (2025). This version from Dubrov's lab was arranged for sinewave generator. 11:15 17:10 3. Cornelius Cardew, “Treatise: Experimental” (2025). This version from Dubrov's lab was arranged for a mix of instruments defined as “experimental” by the team. 11:32 28:24 4. Valérie Philippin, “Extraits de recherche” (2024). Vocal interaction experiment conducted with vocalist Valérie Philippin while she was in artistic residence at European Research Council REACH project (ERC) at IRCAM. AI interaction in real-time using the Somax2 program. Voice: Valérie Philippin, Somax2 & electronics: Mikhail Malt. 03:52 39:48 5. Horse Lords and The Who/Men, “Zero Degree Machine” (2023). Horse Lords Concert at ERC REACH. Music using Somax2 to interact with the performers and add new parts and instruments in real time. If you hear something other than a guitar, drums, bass, and sax, then it was created by Somax2. You might detect loops of instruments (e.g., saxophone) as well because Somax2 adds to the mix. Horse Lords (Max Eilbacher bass/electronics, Sam Haberman percussion, Owen Gardner guitar, Andrew Bernstein percussion/saxophone). The Who/Men: Gérard Assayag, Mikhail Malt, Reach interactive AI: Somax2; Marco Fiorini, Reach interactive AI: Somax2 and electric guitar; Manuel Poletti, computer music production at IRCAM). The Who/Men are providing guidance for Somax2 in real-time, operating different instances of the program on their laptops. 18:45 43:42 6. PintoCreation “AI-generated Sci-Fi Sci-Fi and Visual Storytelling” (2025). This is just an example of how task-specific AI is being used to generate videos with electronic music soundtracks. This is an excerpt from one of the soundtracks for the many videos they have generated for their YouTube channel. 07:54 01:02:26 7. Artificial Intelligence Music, “Melodic Techno” (2025). Excerpt of AI-generated techno music found on this YouTube site. They explain that the music found here “was composed by an AI, meticulously trained on the nuances of this captivating genre.' I have no idea what AI engine was used, but this is just one example of how many music producers are getting onto the AI train. 06:51 01:10:17 8. Atmoscapia, “Calm Ambient” (2025). This is a purpose-built generative ambient music creator for “Films, Games, YouTube, and Creative Projects.” Billed as an “Instant Ambient Music Generator For Content Creators,” you use it by selecting styles and lengths up to an hour long. In this case, I chose the style “Calm, Meditative, Dreamy.” Two other categories are also provided for “Cinematic, Dramatic, Emotional” and “Dark, Horror, Suspense.” Those are the extent of the current choices in the free version. It delivers a soundtrack that you can download. 10:00 01:17:08 9. Thom Holmes, “Thom DeepAI Noise Music” (2025). In an attempt to generate something more experimental using an AI system, I turned to DeepAI and gave it the following instructions: “Experimental, noise sounds. No melody, no harmony, no rhythm. Randomized intervals of silence. Randomized mood swings.” It was short as I was not using the premium version, but it came closer than some other AI programs to creating a work that was more closely aligned with experimental. 1:45 01:41:49 Opening background music: Ambient music generated by the Atmoscapia AI system using the “Dark, Horror, Suspense” setting (excerpt). Introduction to the podcast voiced by Anne Benkovitz. Additional opening, closing, and other incidental music by Thom Holmes. My Books/eBooks: Electronic and Experimental Music, sixth edition, Routledge 2020. Also, Sound Art: Concepts and Practices, first edition, Routledge 2022. See my companion blog that I write for the Bob Moog Foundation. For a transcript, please see my blog, Noise and Notations. Original music by Thom Holmes can be found on iTunes and Bandcamp.
Continuing our AACPDM 2025 Preview series!Effect of high-frequency, low magnitude vibration on physical activity and physical function in children with cerebral palsy: a randomised controlled trialThis paper is a contender for the AACPDM's highest abstract honour - the Gayle G Arnold Award!There is still time to register for the conference in beautiful New Orleans - Visit https://www.aacpdm.org/events/2025 for all the details!
Why are we still treating acute uncomplicated diverticulitis with antibiotics? There is plenty of evidence from several randomized controlled trials demonstrating that symptomatic management alone yields similar results. If we should continue prescribing antibiotics for acute uncomplicated diverticulitis, which patients should undergo treatment and when? Join Drs. Jared Hendren, Elissa Dabaghi, Joseph Trunzo, Ajaratu Keshinro, and David Rosen as they discuss the management of uncomplicated diverticulitis while reviewing groundbreaking literature. Hosts: -Jared Hendren, MD Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio - Elissa Dabaghi, MD Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio - Joseph Trunzo, MD Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio Social Media Handle: X/Twitter @joseph_trunzo - Ajaratu Keshinro, MD Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio Social Media Handle: X/Twitter- @AJKesh - David Rosen, MD Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio Social Media Handle: X/Twitter- @davidrrosenmd Learning Objectives: By the end of this episode, listeners will be able to: 1. Identify criteria for managing acute uncomplicated diverticulitis without antibiotics based on recent literature 2. Define uncomplicated and complicated diverticulitis 3. Discuss nuanced management decisions of patients with uncomplicated diverticulitis to determine when antibiotics may be appropriate for management References: 1. Azhar, N., Aref, H., Brorsson, A., Lydrup, M.‑L., Jörgren, F., Schultz, J. K., & Buchwald, P. (2022). Management of acute uncomplicated diverticulitis without antibiotics: Compliance and outcomes – a retrospective cohort study. BMC Emergency Medicine, 22(1), Article 28. https://doi.org/10.1186/s12873‑022‑00584‑X 2. Mora‑López, L., Ruiz‑Edo, N., Estrada‑Ferrer, O., Piñana‑Campón, M. L., Labró‑Ciurans, M., Escuder‑Perez, J., Sales‑Mallafré, R., Rebasa‑Cladera, P., Navarro‑Soto, S., Serra‑Aracil, X., & DINAMO‑study Group. (2021). Efficacy and safety of nonantibiotic outpatient treatment in mild acute diverticulitis (DINAMO‑study): A multicentre, randomised, open‑label, noninferiority trial. Annals of Surgery, 274(5), e435–e442. https://doi.org/10.1097/SLA.0000000000005031 3. Daniels, L., Ünlü, Ç., de Korte, N., van Dieren, S., Stockmann, H. B., Vrouenraets, B. C., Consten, E. C., van der Hoeven, J. A., Eijsbouts, Q. A., Faneyte, I. F., Bemelman, W. A., Dijkgraaf, M. G., & Boermeester, M. A. (2017). Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT‑proven uncomplicated acute diverticulitis. British Journal of Surgery, 104(1), 52‑61. https://doi.org/10.1002/bjs.10309 4. Chabok, A., Påhlman, L., Hjern, F., Haapaniemi, S., & Smedh, K.; AVOD Study Group. (2012). Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. British Journal of Surgery, 99(4), 532–539. https://doi.org/10.1002/bjs.8688 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
Molly Jacobson speaks with Dr. Erica Ancier about Pulsed Electromagnetic Field (PEMF) therapy and its applications for dogs with cancer, chronic pain, arthritis, and more. They discuss the safety of PEMF therapy, how it works, its benefits, and how to use it at home to improve your dog's quality of life. Topics Covered: • What is PEMF therapy? • How PEMF therapy helps with pain relief, inflammation, and healing. • The debate about PEMF therapy and cancer safety. • Combining PEMF therapy with chemotherapy for better results. • Practical tips for using PEMF devices at home. • Dr. Ancier's personal experience using PEMF therapy for her dog. Key Takeaway: PEMF therapy is a safe, affordable, and effective tool to improve your dog's quality of life, especially when managing pain and inflammation. Your Voice Matters! If you have a question for our team, or if you want to share your own hopeful dog cancer story, we want to hear from you! Go to https://www.dogcancer.com/ask to submit your question or story, or call our Listener Line at +1 808-868-3200 to leave a question. Related Videos: https://www.youtube.com/watch?v=ZvA7W9XlciM https://www.youtube.com/watch?v=s2w5AyaLqrw Related Links: Assisi Animal Health/Zomedica https://assisianimalhealth.com/ Respond Systems https://respondsystems.com/pemf/ BEMER https://life.bemergroup.com/pemf-pulse-electro-magnetic-field/ Effect of Targeted Pulsed Electromagnetic Field Therapy on Canine Postoperative Hemilaminectomy: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial: https://meridian.allenpress.com/jaaha/article-abstract/55/2/83/184239/Effect-of-Targeted-Pulsed-Electromagnetic-Field?redirectedFrom=fulltext Chapters: 00:00 Introduction 00:30 - Dr. Ancier's Experience with PEMF Therapy 01:15 - What is PEMF Therapy? How It Works 03:00 - Benefits of PEMF: Pain Relief and Inflammation Reduction 04:45 - Controversy Around PEMF Therapy and Cancer Safety 06:30 - FDA-Approved Uses for PEMF in Humans and Dogs 08:15 - Situations to Avoid PEMF Therapy (Contraindications) 10:00 - Using PEMF Devices at Home: Tips and Safety 13:00 - Combining PEMF Therapy with Chemotherapy 16:00 - Practical Uses for PEMF: Arthritis, Recovery, and Anxiety 22:00 - Device Options: Loops, Mats, and Costs 25:30 - Longevity of Devices and Maintenance Tips 27:15 - Enhancing Quality of Life for Dogs with PEMF Therapy 30:00 - Closing Thoughts and Life Quality vs. Quantity Get to know Dr. Erica Ancier: https://www.dogcancer.com/people/erica-ancier-dvm-cva-ccrp/ For more details, articles, podcast episodes, and quality education, go to the episode page: https://www.dogcancer.com/podcast/ Learn more about your ad choices. Visit megaphone.fm/adchoices
I sat down with Dr. Layne Norton, PhD, one of the most respected names in evidence-based fitness and nutrition, to cut through the noise that dominates our feeds. If you've ever been confused by conflicting advice from influencers, or wondered how to separate hype from science, this conversation is for you.Layne walks us through how to actually read research, spot red flags, and apply the right evidence to your own health and performance. We talk about adherence, why consistency beats hacks, how to think about n=1 experimentation, and why muscle is way more than just something that moves your body—it's one of the most powerful protectors of long-term health.If you want to stop guessing and start making decisions that are backed by data (and not just feelings), you'll love this episode. Listen in, and you'll walk away with a practical blueprint for training smarter, fueling better, and staying resilient—without falling for the myths.Timeline Mitopure Gummies: GET 20% Off Now!
Los artículos que se tratan en el episodio de hoy están listados aquí: Legge, N., Schneuer, F. J., Shand, A. W., Fitzgerald, D., Popat, H., & Nassar, N. (2025). Educational Performance of Extremely Preterm Infants in Primary School. Pediatrics, 156(1), e2024069425. https://doi.org/10.1542/peds.2024-069425Dudeja, S., Saini, S. S., Sundaram, V., Dutta, S., Sachdeva, N., & Kumar, P. (2025). Early hydrocortisone versus placebo in neonatal shock- a double blind Randomized controlled trial. Journal of perinatology : official journal of the California Perinatal Association, 45(3), 342–349. https://doi.org/10.1038/s41372-025-02222-3Bienvenidos a La Incubadora: una conversación sobre neonatología y medicina basada en evidencia. Nuestros episodios ofrecen la dosis ideal (en mg/kg) de los más recientes avances para el neonato y para las increíbles personas que forman parte de la medicina neonatal.Soy tu host, Maria Flores Cordova, MD.Este podcast está presentado por los médicos neonatólogos Dani de Luis Rosell, Elena Itriago, Carolina Michel y Juliana Castellanos.No dudes en enviarnos preguntas, comentarios o sugerencias a nuestro correo electrónico: nicupodcast@gmail.comSíguenos en nuestras redes:Twitter: @incubadorapodInstagram: @laincubadorapodcastCreado originalmente por Ben Courchia MD y Daphna Yasova Barbeau MD http://www.the-incubator.org Bienvenidos a La Incubadora: una conversación sobre neonatología y medicina basada en evidencia. Nuestros episodios ofrecen la dosis ideal (en mg/kg) de los más recientes avances para el neonato y para las increíbles personas que forman parte de la medicina neonatal. Soy tu host, Maria Flores Cordova, MD. Este podcast está presentado por los médicos neonatólogos Dani de Luis Rosell, Elena Itriago, Carolina Michel y Juliana Castellanos. No dudes en enviarnos preguntas, comentarios o sugerencias a nuestro correo electrónico: nicupodcast@gmail.comSíguenos en nuestras redes:Twitter: @incubadorapodInstagram: @laincubadorapodcast Creado originalmente por Ben Courchia MD y Daphna Yasova Barbeau MD http://www.the-incubator.org
Send us a textBom-vindos ao episódio 61 do Podcast A Incubadora. Esse é o nosso Journal Club 40 – Especial Agosto Dourado. A cada quinze dias, trazemos uma seleção de artigos recentes em neonatologia para discussão em português, com o objetivo de tornar a literatura científica mais acessível para profissionais da área.Neste episódio, vamos conversar sobre quatro estudos que exploram diferentes dimensões do leite humano no cuidado neonatal:Potential Epigenetic Effects of Human Milk on Infants' Neurodevelopment - https://www.mdpi.com/2072-6643/15/16/3614Effect of Neonatal Unit Interventions Designed to Increase Breastfeeding in Preterm Infants: An Overview of Systematic Reviews - https://karger.com/neo/article/121/4/411/896932/Effect-of-Neonatal-Unit-Interventions-Designed-toSeverity of Bronchopulmonary Dysplasia in Infants Born Extremely Preterm and Randomized to Early Human Milk Fortification with a Donor Milk-Derived Fortifier for Two Weeks - https://www.jpeds.com/article/S0022-3476(25)00291-4/abstractNon-nutritional Use of Human Milk as a Therapeutic Agent in Neonates: Brain, Gut, and Immunologic Targets - https://pubmed.ncbi.nlm.nih.gov/39348773/ Não esqueça: você pode ter acesso aos artigos do nosso Journal Club no nosso site: https://www.the-incubator.org/podcast-1 Lembrando que o Podcast está no Instagram, @incubadora.podcast, onde a gente posta as figuras e tabelas de alguns artigos. Se estiver gostando do nosso Podcast, por favor dedique um pouquinho do seu tempo para deixar sua avaliação no seu aplicativo favorito e compartilhe com seus colegas. Isso é importante para a gente poder continuar produzindo os episódios. O nosso objetivo é democratizar a informação. Se quiser entrar em contato, nos mandar sugestões, comentários, críticas e elogios, manda um e-mail pra gente: incubadora@the-incubator.org
We recently hosted a session on the DHS's proposed rule to replace the current H-1B lottery with a weighted-based selection system. Although the rule has not yet been made public, there is speculation that it could prioritize H-1B cap registrations for occupations offering higher wages, potentially impacting future cap seasons starting in FY 2027.Partner and Attorney Min Kim and Client Services Manager Arianna Gonzalez, MBA explained what is known so far, how it compares to the 2021 proposal, and what employers should expect as the rule moves through the required notice and comment federal review process.Listen in to know more!
Program notes:0:40 Alteplase after stroke1:40 Expand time window2:40 Imaging crucial in use3:20 Use of health care and mortality in those with dementia4:20 Women used much less healthcare5:20 Focus on prevention in women5:50 IVF outcomes and weight loss6:50 Did not appear to increase success with IVF7:45 Ultraprocessed foods versus minimally processed foods8:45 Randomized to one diet or the other for 8 weeks9:45 Minimally processed foods improved risk factors10:45 Short period of study11:42 End
In this episode, Mo and Marc are joined by special guest Professor Ted Miclau (Orthopaedic Trauma Institute International Chair, UCSF Department of Orthopaedic Surgery) in a discussion focusing on innovations and recent work in fracture-healing. Link Gouhari F, Shariatpanahi ZV, Talebi S, Mehrvar A, Momeny M, Ehsani A, Ahmadi-Abdashti A, Zandi R. Therapeutic Effects of Bovine Colostrum on Bone Healing, Rehabilitation, and Postoperative Complications: A Prospective, Randomized, Double-Blinded Comparative Trial. J Bone Joint Surg Am. 2025 Apr 18;107(12):1307-1315. doi: 10.2106/JBJS.24.00542. PMID: 40249794. https://www.jbjs.org/reader.php?rsuite_id=bf628643-fcfe-4fc5-9f9e-b46db1bd70d2&source=The_Journal_of_Bone_and_Joint_Surgery/107/12/1307&topics=hp+ta#info Subspecialties: Basic Science Hip Orthopaedic Essentials Trauma Chapters (00:00:03) - Orthojoe Podcast(00:00:49) - Bovine Colostrum and Bone Healing(00:03:23) - Mental Fitness: Ted McLow(00:03:52) - Osteomyelitis and fracture healing(00:09:48) - Breastfeeding and hip fracture(00:11:20) - Hip Fracture and the International RCT
Oral methadone versus sublingual buprenorphine for the treatment of acute opioid withdrawal: A triple-blind, double-dummy, randomized control trial Drug and Alcohol Dependence Researchers compared oral methadone to sublingual buprenorphine for the management of acute opioid withdrawal. Patients at an inpatient drug treatment center in India were randomly assigned to receive either methadone or buprenorphine titrated over days 1-3 to control opioid withdrawal symptoms. Over days 4-10 medications were tapered and stopped by day 11. Completion of treatment was similar in both groups (83% methadone, 82% buprenorphine). Both subjective (SOWS) and objective (COWS) withdrawal symptoms decreased during the treatment, however the buprenorphine group had significantly greater withdrawal symptoms than the methadone group (p=0.009) at the end of treatment (day 10). Opioid craving also decreased in both groups with no significant difference between groups. Authors conclude that methadone is a safe and effective alternative to buprenorphine for management of opioid withdrawal. Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM
Join this channel to get access to early episodes!https://www.youtube.com/channel/UCzqhQ4tMBPu5c6F2S6uv0eg/join
Podcast Summary This episode of the Pain Exam Podcast, hosted by Dr. David Rosenblum, discusses an interesting article about Ketorolac injections for musculoskeletal conditions. The podcast covers: Ketorolac is an NSAID that provides analgesic and anti-inflammatory effects through inhibition of prostaglandin synthesis Multiple studies comparing Ketorolac injections to corticosteroids and hyaluronic acid for various conditions Research shows Ketorolac injections are equally effective as corticosteroids for subacromial conditions, adhesive capsulitis, carpal-metacarpal joint issues, and hip/knee osteoarthritis Ketorolac may be a safer alternative to steroids for certain patients, though it has its own contraindications for those with renal, gastrointestinal, or cardiovascular disease Dr. Rosenblum considers the potential of using Ketorolac injections directly at pain sites rather than intramuscularly Upcoming Courses and Conferences Ultrasound courses in New York and Costa Rica (check unwrappedpain.org) Private ultrasound sessions available Dr. Rosenblum will be speaking at Pain Week about ultrasound in pain practice and PRP Presenting at a primary care conference in London Teaching ultrasound at ISPN LAPSES conference in Chile (Dr. Rosenblum won't attend this year) Ketorolac Injections: An Effective Alternative for Musculoskeletal Pain Management Musculoskeletal conditions such as bursitis, adhesive capsulitis, and osteoarthritis affect millions and often require injectable therapies to reduce pain and inflammation. Traditionally, corticosteroid injections have been the mainstay treatment. However, concerns over side effects like tendon rupture, cartilage damage, and systemic hyperglycemia have prompted exploration of alternatives. A recent narrative review by Kiel et al. (2024) highlights ketorolac—a parenteral nonsteroidal anti-inflammatory drug (NSAID)—as a promising substitute for corticosteroids in musculoskeletal injections. Warning: OFF Label use of Ketorolac discussed. Please consult your physician. See full article for details. Subacromial Ketorolac Injections for Shoulder Pain Subacromial bursitis and impingement syndrome are common causes of shoulder pain and disability. Several randomized controlled trials have shown that subacromial ketorolac injections provide pain relief and functional improvement comparable to corticosteroids: Goyal et al. demonstrated significant reductions in pain scores after subacromial injection of 60 mg ketorolac versus 40 mg methylprednisolone, with no difference in outcomes between groups. Taheri et al. found similar short-term pain relief at 1 and 3 months with either ketorolac or corticosteroid subacromial injections. Kim et al. reported equivalent clinical improvement in rotator cuff syndrome patients receiving ketorolac or triamcinolone injections. Min et al. noted ketorolac led to better forward flexion and patient satisfaction at 4 weeks compared to corticosteroids. These studies support ketorolac as an effective agent for subacromial injection, offering an alternative for patients where corticosteroid use is limited. Intra-articular Ketorolac Injections for Adhesive Capsulitis and Osteoarthritis Adhesive capsulitis (frozen shoulder) and osteoarthritis of the hip, knee, and carpometacarpal joint are often treated with intra-articular corticosteroids. Ketorolac injections have shown comparable efficacy in these conditions: Akhtar et al. found intra-articular ketorolac significantly reduced shoulder pain at 4 weeks in adhesive capsulitis compared to hyaluronic acid. Ahn et al. reported similar pain relief between intra-articular ketorolac and corticosteroid injections in adhesive capsulitis, with ketorolac providing superior shoulder mobility at 3 and 6 months. Koh et al. showed that adding ketorolac to hyaluronic acid injections in carpometacarpal osteoarthritis resulted in faster onset of pain relief compared to hyaluronic acid alone. Park et al. observed equivalent functional improvements with intra-articular ketorolac or corticosteroids in hip osteoarthritis. Jurgensmeier et al. demonstrated similar symptom improvement at 1 and 3 months post-injection for ketorolac and triamcinolone in hip and knee osteoarthritis. Xu et al. and Bellamy et al. confirmed ketorolac's comparable pain relief and functional benefits to corticosteroids for knee osteoarthritis, with ketorolac being more cost-effective. Lee et al. noted quicker pain reduction with intra-articular ketorolac combined with hyaluronic acid versus hyaluronic acid alone in knee osteoarthritis. aSafety and Pharmacologic Considerations Ketorolac's anti-inflammatory action stems from cyclooxygenase inhibition, reducing prostaglandin synthesis. Its half-life is approximately 5.2–5.6 hours, and it is metabolized in the liver. Unlike corticosteroids, ketorolac avoids systemic hyperglycemia and cartilage damage risks. Animal and in vitro studies suggest ketorolac may protect cartilage by inhibiting inflammatory cytokines. While gastrointestinal, renal, and cardiovascular risks associated with NSAIDs remain considerations, localized intra-articular and subacromial ketorolac injections may limit systemic exposure and adverse effects. Mild, transient post-injection pain has been reported but resolves without intervention. Conclusion Ketorolac injections, administered intra-articularly or subacromially, are a safe, effective, and economical alternative to corticosteroids for managing common musculoskeletal conditions. Their comparable efficacy in reducing pain and improving function, combined with a more favorable side effect profile, makes ketorolac an appealing option for clinicians and patients alike. Further research is warranted to fully elucidate long-term safety and optimal dosing strategies. FAQS Ketorolac Injections for Musculoskeletal Conditions: Frequently Asked Questions Musculoskeletal pain from conditions like bursitis, adhesive capsulitis, and osteoarthritis often requires injectable treatments. Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is emerging as a promising alternative to corticosteroids. Below are common questions and answers based on a recent narrative review by Kiel et al. (2024). 1. What is ketorolac and how does it work? Ketorolac is a parenteral NSAID that reduces pain and inflammation by inhibiting cyclooxygenase enzymes, which decreases prostaglandin synthesis. It can be administered orally, intramuscularly, intravenously, or by injection directly into joints or around bursae. 2. How effective is ketorolac for musculoskeletal conditions? Studies show ketorolac injections provide significant pain relief and functional improvement comparable to corticosteroids in conditions like: Subacromial bursitis and shoulder impingement (subacromial injections) Adhesive capsulitis (frozen shoulder) (intra-articular injections) Osteoarthritis of the hip, knee, and thumb carpometacarpal joint (intra-articular injections) 3. What evidence supports subacromial ketorolac injections? Randomized controlled trials found: Goyal et al. and Taheri et al. reported similar pain reduction and functional outcomes between ketorolac and corticosteroids for subacromial injections. Kim et al. and Min et al. observed comparable or better patient satisfaction and shoulder mobility with ketorolac versus corticosteroids. 4. How does intra-articular ketorolac compare to corticosteroids for adhesive capsulitis? Akhtar et al. showed ketorolac reduced shoulder pain more than hyaluronic acid. Ahn et al. found ketorolac and corticosteroids equally effective for pain relief, with ketorolac providing better shoulder mobility at 3 and 6 months. 5. What about ketorolac for osteoarthritis? Ketorolac combined with hyaluronic acid provided faster pain relief than hyaluronic acid alone in thumb carpometacarpal joint osteoarthritis (Koh et al.). Intra-articular ketorolac had similar efficacy to corticosteroids in hip (Park et al., Jurgensmeier et al.) and knee osteoarthritis (Bellamy et al., Xu et al.). Ketorolac injections were more cost-effective compared to corticosteroids (Bellamy et al.). 6. Are ketorolac injections safe? Ketorolac's side effects are similar to other NSAIDs, mainly involving gastrointestinal, renal, and cardiovascular risks. However, localized intra-articular and subacromial injections may reduce systemic exposure. Animal studies suggest ketorolac does not harm cartilage and may protect against inflammatory damage. Mild, transient local pain post-injection is possible but usually resolves without treatment. 7. What are the limitations of ketorolac use? Ketorolac is not suitable for patients with: Renal impairment Gastrointestinal ulcers or bleeding risk Cardiovascular disease or hypertension NSAID hypersensitivity, especially in asthma or chronic urticaria patients Clinicians should assess individual risks before choosing ketorolac injections. 8. How does ketorolac's pharmacokinetics affect its use? Ketorolac has a plasma half-life of about 5.2 to 5.6 hours and is metabolized in the liver. Pharmacokinetics for subcutaneous or intra-articular administration are less defined but systemic absorption occurs. Its relatively short half-life supports repeated dosing if needed. 9. Why consider ketorolac over corticosteroids? Ketorolac avoids corticosteroid-associated risks such as tendon rupture, cartilage damage, and steroid-induced hyperglycemia. It is also more cost-effective, making it a favorable option for patients and healthcare systems. 10. What further research is needed? More large-scale, long-term studies are needed to fully understand ketorolac's intra-articular effects, optimal dosing, and safety profile compared to corticosteroids and other treatments. Summary: Ketorolac injections, whether intra-articular or subacromial, offer a safe, effective, and economical alternative to corticosteroids for managing various musculoskeletal conditions. This makes ketorolac an important option in pain management and inflammation control. Reference: Kiel J, Applewhite AI, Bertasi TGO, Bertasi RAO, Seemann LL, Costa LMC, Helmi H, Pujalte GGA. Ketorolac Injections for Musculoskeletal Conditions: A Narrative Review. Clinical Medicine & Research. 2024;22(1):19-27. DOI: https://doi.org/10.3121/cmr.2024.1847 Disclaimer: This Podcast, website and any content from NRAP Academy (PMRexam.com) otherwise known as Qbazaar.com, LLC is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.
Podcast Summary This episode of the Pain Exam Podcast, hosted by Dr. David Rosenblum, discusses an interesting article about Ketorolac injections for musculoskeletal conditions. The podcast covers: Ketorolac is an NSAID that provides analgesic and anti-inflammatory effects through inhibition of prostaglandin synthesis Multiple studies comparing Ketorolac injections to corticosteroids and hyaluronic acid for various conditions Research shows Ketorolac injections are equally effective as corticosteroids for subacromial conditions, adhesive capsulitis, carpal-metacarpal joint issues, and hip/knee osteoarthritis Ketorolac may be a safer alternative to steroids for certain patients, though it has its own contraindications for those with renal, gastrointestinal, or cardiovascular disease Dr. Rosenblum considers the potential of using Ketorolac injections directly at pain sites rather than intramuscularly Upcoming Courses and Conferences Ultrasound courses in New York and Costa Rica (check unwrappedpain.org) Private ultrasound sessions available Dr. Rosenblum will be speaking at Pain Week about ultrasound in pain practice and PRP Presenting at a primary care conference in London Teaching ultrasound at ISPN LAPS conference in Chile (Dr. Rosenblum won't attend this year) Ketorolac Injections: An Effective Alternative for Musculoskeletal Pain Management Musculoskeletal conditions such as bursitis, adhesive capsulitis, and osteoarthritis affect millions and often require injectable therapies to reduce pain and inflammation. Traditionally, corticosteroid injections have been the mainstay treatment. However, concerns over side effects like tendon rupture, cartilage damage, and systemic hyperglycemia have prompted exploration of alternatives. A recent narrative review by Kiel et al. (2024) highlights ketorolac—a parenteral nonsteroidal anti-inflammatory drug (NSAID)—as a promising substitute for corticosteroids in musculoskeletal injections. Warning: OFF Label use of Ketorolac discussed. Please consult your physician. See full article for details. Subacromial Ketorolac Injections for Shoulder Pain Subacromial bursitis and impingement syndrome are common causes of shoulder pain and disability. Several randomized controlled trials have shown that subacromial ketorolac injections provide pain relief and functional improvement comparable to corticosteroids: Goyal et al. demonstrated significant reductions in pain scores after subacromial injection of 60 mg ketorolac versus 40 mg methylprednisolone, with no difference in outcomes between groups. Taheri et al. found similar short-term pain relief at 1 and 3 months with either ketorolac or corticosteroid subacromial injections. Kim et al. reported equivalent clinical improvement in rotator cuff syndrome patients receiving ketorolac or triamcinolone injections. Min et al. noted ketorolac led to better forward flexion and patient satisfaction at 4 weeks compared to corticosteroids. These studies support ketorolac as an effective agent for subacromial injection, offering an alternative for patients where corticosteroid use is limited. Intra-articular Ketorolac Injections for Adhesive Capsulitis and Osteoarthritis Adhesive capsulitis (frozen shoulder) and osteoarthritis of the hip, knee, and carpometacarpal joint are often treated with intra-articular corticosteroids. Ketorolac injections have shown comparable efficacy in these conditions: Akhtar et al. found intra-articular ketorolac significantly reduced shoulder pain at 4 weeks in adhesive capsulitis compared to hyaluronic acid. Ahn et al. reported similar pain relief between intra-articular ketorolac and corticosteroid injections in adhesive capsulitis, with ketorolac providing superior shoulder mobility at 3 and 6 months. Koh et al. showed that adding ketorolac to hyaluronic acid injections in carpometacarpal osteoarthritis resulted in faster onset of pain relief compared to hyaluronic acid alone. Park et al. observed equivalent functional improvements with intra-articular ketorolac or corticosteroids in hip osteoarthritis. Jurgensmeier et al. demonstrated similar symptom improvement at 1 and 3 months post-injection for ketorolac and triamcinolone in hip and knee osteoarthritis. Xu et al. and Bellamy et al. confirmed ketorolac's comparable pain relief and functional benefits to corticosteroids for knee osteoarthritis, with ketorolac being more cost-effective. Lee et al. noted quicker pain reduction with intra-articular ketorolac combined with hyaluronic acid versus hyaluronic acid alone in knee osteoarthritis. aSafety and Pharmacologic Considerations Ketorolac's anti-inflammatory action stems from cyclooxygenase inhibition, reducing prostaglandin synthesis. Its half-life is approximately 5.2–5.6 hours, and it is metabolized in the liver. Unlike corticosteroids, ketorolac avoids systemic hyperglycemia and cartilage damage risks. Animal and in vitro studies suggest ketorolac may protect cartilage by inhibiting inflammatory cytokines. While gastrointestinal, renal, and cardiovascular risks associated with NSAIDs remain considerations, localized intra-articular and subacromial ketorolac injections may limit systemic exposure and adverse effects. Mild, transient post-injection pain has been reported but resolves without intervention. Conclusion Ketorolac injections, administered intra-articularly or subacromially, are a safe, effective, and economical alternative to corticosteroids for managing common musculoskeletal conditions. Their comparable efficacy in reducing pain and improving function, combined with a more favorable side effect profile, makes ketorolac an appealing option for clinicians and patients alike. Further research is warranted to fully elucidate long-term safety and optimal dosing strategies. FAQS Ketorolac Injections for Musculoskeletal Conditions: Frequently Asked Questions Musculoskeletal pain from conditions like bursitis, adhesive capsulitis, and osteoarthritis often requires injectable treatments. Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is emerging as a promising alternative to corticosteroids. Below are common questions and answers based on a recent narrative review by Kiel et al. (2024). 1. What is ketorolac and how does it work? Ketorolac is a parenteral NSAID that reduces pain and inflammation by inhibiting cyclooxygenase enzymes, which decreases prostaglandin synthesis. It can be administered orally, intramuscularly, intravenously, or by injection directly into joints or around bursae. 2. How effective is ketorolac for musculoskeletal conditions? Studies show ketorolac injections provide significant pain relief and functional improvement comparable to corticosteroids in conditions like: Subacromial bursitis and shoulder impingement (subacromial injections) Adhesive capsulitis (frozen shoulder) (intra-articular injections) Osteoarthritis of the hip, knee, and thumb carpometacarpal joint (intra-articular injections) 3. What evidence supports subacromial ketorolac injections? Randomized controlled trials found: Goyal et al. and Taheri et al. reported similar pain reduction and functional outcomes between ketorolac and corticosteroids for subacromial injections. Kim et al. and Min et al. observed comparable or better patient satisfaction and shoulder mobility with ketorolac versus corticosteroids. 4. How does intra-articular ketorolac compare to corticosteroids for adhesive capsulitis? Akhtar et al. showed ketorolac reduced shoulder pain more than hyaluronic acid. Ahn et al. found ketorolac and corticosteroids equally effective for pain relief, with ketorolac providing better shoulder mobility at 3 and 6 months. 5. What about ketorolac for osteoarthritis? Ketorolac combined with hyaluronic acid provided faster pain relief than hyaluronic acid alone in thumb carpometacarpal joint osteoarthritis (Koh et al.). Intra-articular ketorolac had similar efficacy to corticosteroids in hip (Park et al., Jurgensmeier et al.) and knee osteoarthritis (Bellamy et al., Xu et al.). Ketorolac injections were more cost-effective compared to corticosteroids (Bellamy et al.). 6. Are ketorolac injections safe? Ketorolac's side effects are similar to other NSAIDs, mainly involving gastrointestinal, renal, and cardiovascular risks. However, localized intra-articular and subacromial injections may reduce systemic exposure. Animal studies suggest ketorolac does not harm cartilage and may protect against inflammatory damage. Mild, transient local pain post-injection is possible but usually resolves without treatment. 7. What are the limitations of ketorolac use? Ketorolac is not suitable for patients with: Renal impairment Gastrointestinal ulcers or bleeding risk Cardiovascular disease or hypertension NSAID hypersensitivity, especially in asthma or chronic urticaria patients Clinicians should assess individual risks before choosing ketorolac injections. 8. How does ketorolac's pharmacokinetics affect its use? Ketorolac has a plasma half-life of about 5.2 to 5.6 hours and is metabolized in the liver. Pharmacokinetics for subcutaneous or intra-articular administration are less defined but systemic absorption occurs. Its relatively short half-life supports repeated dosing if needed. 9. Why consider ketorolac over corticosteroids? Ketorolac avoids corticosteroid-associated risks such as tendon rupture, cartilage damage, and steroid-induced hyperglycemia. It is also more cost-effective, making it a favorable option for patients and healthcare systems. 10. What further research is needed? More large-scale, long-term studies are needed to fully understand ketorolac's intra-articular effects, optimal dosing, and safety profile compared to corticosteroids and other treatments. Summary: Ketorolac injections, whether intra-articular or subacromial, offer a safe, effective, and economical alternative to corticosteroids for managing various musculoskeletal conditions. This makes ketorolac an important option in pain management and inflammation control. Reference: Kiel J, Applewhite AI, Bertasi TGO, Bertasi RAO, Seemann LL, Costa LMC, Helmi H, Pujalte GGA. Ketorolac Injections for Musculoskeletal Conditions: A Narrative Review. Clinical Medicine & Research. 2024;22(1):19-27. DOI: https://doi.org/10.3121/cmr.2024.1847 Disclaimer: This Podcast, website and any content from NRAP Academy (PMRexam.com) otherwise known as Qbazaar.com, LLC is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.
Podcast Summary This episode of the Pain Exam Podcast, hosted by Dr. David Rosenblum, discusses an interesting article about Ketorolac injections for musculoskeletal conditions. The podcast covers: Ketorolac is an NSAID that provides analgesic and anti-inflammatory effects through inhibition of prostaglandin synthesis Multiple studies comparing Ketorolac injections to corticosteroids and hyaluronic acid for various conditions Research shows Ketorolac injections are equally effective as corticosteroids for subacromial conditions, adhesive capsulitis, carpal-metacarpal joint issues, and hip/knee osteoarthritis Ketorolac may be a safer alternative to steroids for certain patients, though it has its own contraindications for those with renal, gastrointestinal, or cardiovascular disease Dr. Rosenblum considers the potential of using Ketorolac injections directly at pain sites rather than intramuscularly Upcoming Courses and Conferences Ultrasound courses in New York and Costa Rica (check unwrappedpain.org) Private ultrasound sessions available Dr. Rosenblum will be speaking at Pain Week about ultrasound in pain practice and PRP Presenting at a primary care conference in London Teaching ultrasound at ISPN LAPSES conference in Chile (Dr. Rosenblum won't attend this year) Ketorolac Injections: An Effective Alternative for Musculoskeletal Pain Management Musculoskeletal conditions such as bursitis, adhesive capsulitis, and osteoarthritis affect millions and often require injectable therapies to reduce pain and inflammation. Traditionally, corticosteroid injections have been the mainstay treatment. However, concerns over side effects like tendon rupture, cartilage damage, and systemic hyperglycemia have prompted exploration of alternatives. A recent narrative review by Kiel et al. (2024) highlights ketorolac—a parenteral nonsteroidal anti-inflammatory drug (NSAID)—as a promising substitute for corticosteroids in musculoskeletal injections. Warning: OFF Label use of Ketorolac discussed. Please consult your physician. See full article for details. Subacromial Ketorolac Injections for Shoulder Pain Subacromial bursitis and impingement syndrome are common causes of shoulder pain and disability. Several randomized controlled trials have shown that subacromial ketorolac injections provide pain relief and functional improvement comparable to corticosteroids: Goyal et al. demonstrated significant reductions in pain scores after subacromial injection of 60 mg ketorolac versus 40 mg methylprednisolone, with no difference in outcomes between groups. Taheri et al. found similar short-term pain relief at 1 and 3 months with either ketorolac or corticosteroid subacromial injections. Kim et al. reported equivalent clinical improvement in rotator cuff syndrome patients receiving ketorolac or triamcinolone injections. Min et al. noted ketorolac led to better forward flexion and patient satisfaction at 4 weeks compared to corticosteroids. These studies support ketorolac as an effective agent for subacromial injection, offering an alternative for patients where corticosteroid use is limited. Intra-articular Ketorolac Injections for Adhesive Capsulitis and Osteoarthritis Adhesive capsulitis (frozen shoulder) and osteoarthritis of the hip, knee, and carpometacarpal joint are often treated with intra-articular corticosteroids. Ketorolac injections have shown comparable efficacy in these conditions: Akhtar et al. found intra-articular ketorolac significantly reduced shoulder pain at 4 weeks in adhesive capsulitis compared to hyaluronic acid. Ahn et al. reported similar pain relief between intra-articular ketorolac and corticosteroid injections in adhesive capsulitis, with ketorolac providing superior shoulder mobility at 3 and 6 months. Koh et al. showed that adding ketorolac to hyaluronic acid injections in carpometacarpal osteoarthritis resulted in faster onset of pain relief compared to hyaluronic acid alone. Park et al. observed equivalent functional improvements with intra-articular ketorolac or corticosteroids in hip osteoarthritis. Jurgensmeier et al. demonstrated similar symptom improvement at 1 and 3 months post-injection for ketorolac and triamcinolone in hip and knee osteoarthritis. Xu et al. and Bellamy et al. confirmed ketorolac's comparable pain relief and functional benefits to corticosteroids for knee osteoarthritis, with ketorolac being more cost-effective. Lee et al. noted quicker pain reduction with intra-articular ketorolac combined with hyaluronic acid versus hyaluronic acid alone in knee osteoarthritis. aSafety and Pharmacologic Considerations Ketorolac's anti-inflammatory action stems from cyclooxygenase inhibition, reducing prostaglandin synthesis. Its half-life is approximately 5.2–5.6 hours, and it is metabolized in the liver. Unlike corticosteroids, ketorolac avoids systemic hyperglycemia and cartilage damage risks. Animal and in vitro studies suggest ketorolac may protect cartilage by inhibiting inflammatory cytokines. While gastrointestinal, renal, and cardiovascular risks associated with NSAIDs remain considerations, localized intra-articular and subacromial ketorolac injections may limit systemic exposure and adverse effects. Mild, transient post-injection pain has been reported but resolves without intervention. Conclusion Ketorolac injections, administered intra-articularly or subacromially, are a safe, effective, and economical alternative to corticosteroids for managing common musculoskeletal conditions. Their comparable efficacy in reducing pain and improving function, combined with a more favorable side effect profile, makes ketorolac an appealing option for clinicians and patients alike. Further research is warranted to fully elucidate long-term safety and optimal dosing strategies. FAQS Ketorolac Injections for Musculoskeletal Conditions: Frequently Asked Questions Musculoskeletal pain from conditions like bursitis, adhesive capsulitis, and osteoarthritis often requires injectable treatments. Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is emerging as a promising alternative to corticosteroids. Below are common questions and answers based on a recent narrative review by Kiel et al. (2024). 1. What is ketorolac and how does it work? Ketorolac is a parenteral NSAID that reduces pain and inflammation by inhibiting cyclooxygenase enzymes, which decreases prostaglandin synthesis. It can be administered orally, intramuscularly, intravenously, or by injection directly into joints or around bursae. 2. How effective is ketorolac for musculoskeletal conditions? Studies show ketorolac injections provide significant pain relief and functional improvement comparable to corticosteroids in conditions like: Subacromial bursitis and shoulder impingement (subacromial injections) Adhesive capsulitis (frozen shoulder) (intra-articular injections) Osteoarthritis of the hip, knee, and thumb carpometacarpal joint (intra-articular injections) 3. What evidence supports subacromial ketorolac injections? Randomized controlled trials found: Goyal et al. and Taheri et al. reported similar pain reduction and functional outcomes between ketorolac and corticosteroids for subacromial injections. Kim et al. and Min et al. observed comparable or better patient satisfaction and shoulder mobility with ketorolac versus corticosteroids. 4. How does intra-articular ketorolac compare to corticosteroids for adhesive capsulitis? Akhtar et al. showed ketorolac reduced shoulder pain more than hyaluronic acid. Ahn et al. found ketorolac and corticosteroids equally effective for pain relief, with ketorolac providing better shoulder mobility at 3 and 6 months. 5. What about ketorolac for osteoarthritis? Ketorolac combined with hyaluronic acid provided faster pain relief than hyaluronic acid alone in thumb carpometacarpal joint osteoarthritis (Koh et al.). Intra-articular ketorolac had similar efficacy to corticosteroids in hip (Park et al., Jurgensmeier et al.) and knee osteoarthritis (Bellamy et al., Xu et al.). Ketorolac injections were more cost-effective compared to corticosteroids (Bellamy et al.). 6. Are ketorolac injections safe? Ketorolac's side effects are similar to other NSAIDs, mainly involving gastrointestinal, renal, and cardiovascular risks. However, localized intra-articular and subacromial injections may reduce systemic exposure. Animal studies suggest ketorolac does not harm cartilage and may protect against inflammatory damage. Mild, transient local pain post-injection is possible but usually resolves without treatment. 7. What are the limitations of ketorolac use? Ketorolac is not suitable for patients with: Renal impairment Gastrointestinal ulcers or bleeding risk Cardiovascular disease or hypertension NSAID hypersensitivity, especially in asthma or chronic urticaria patients Clinicians should assess individual risks before choosing ketorolac injections. 8. How does ketorolac's pharmacokinetics affect its use? Ketorolac has a plasma half-life of about 5.2 to 5.6 hours and is metabolized in the liver. Pharmacokinetics for subcutaneous or intra-articular administration are less defined but systemic absorption occurs. Its relatively short half-life supports repeated dosing if needed. 9. Why consider ketorolac over corticosteroids? Ketorolac avoids corticosteroid-associated risks such as tendon rupture, cartilage damage, and steroid-induced hyperglycemia. It is also more cost-effective, making it a favorable option for patients and healthcare systems. 10. What further research is needed? More large-scale, long-term studies are needed to fully understand ketorolac's intra-articular effects, optimal dosing, and safety profile compared to corticosteroids and other treatments. Summary: Ketorolac injections, whether intra-articular or subacromial, offer a safe, effective, and economical alternative to corticosteroids for managing various musculoskeletal conditions. This makes ketorolac an important option in pain management and inflammation control. Reference: Kiel J, Applewhite AI, Bertasi TGO, Bertasi RAO, Seemann LL, Costa LMC, Helmi H, Pujalte GGA. Ketorolac Injections for Musculoskeletal Conditions: A Narrative Review. Clinical Medicine & Research. 2024;22(1):19-27. DOI: https://doi.org/10.3121/cmr.2024.1847 Disclaimer: This Podcast, website and any content from NRAP Academy (PMRexam.com) otherwise known as Qbazaar.com, LLC is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.
Divaka Perera, MD and F. Aaysha Cader, MBBS, MD, MSc, FACC discuss the SERIAL study, the first randomized comparison of Fractional Flow Reserve and Instantaneous Wave Free Ratio in serial coronary artery disease.
In this conversation, Dr. Elizabeth Klodas, a preventive cardiologist and founder of Step One Foods, discusses the critical role of nutrition in managing heart disease and the challenges faced in integrating dietary changes into medical practice. She shares her journey from traditional medicine to creating a food company aimed at reducing reliance on medications through nutrition. The discussion highlights the importance of randomized controlled trials in validating the effectiveness of food-based interventions, the impact of pharmaceuticals on healthcare, and the need for a shift in consumer perceptions towards whole food ingredients. Dr. Klodas emphasizes the potential for a healthier future where cardiologists are less needed due to preventive measures and lifestyle changes.Takeaways:Nutrition is often overlooked in favor of pharmaceuticals in healthcare.Patients are rarely asked about their diet by healthcare providers.Changing dietary habits can lead to significant health improvements.Pharmaceuticals are easier to prescribe than dietary changes.There is a lack of nutrition education in medical training.Step One Foods aims to fill nutritional gaps in patients' diets.Randomized controlled trials can validate the effectiveness of food products.Consumer perceptions of health foods can be influenced by marketing.The food industry often prioritizes cost over nutrition.A better world would mean fewer cardiologists needed due to preventive health measures.Sound bites:“There is very little to no nutrition education for physicians. As I look back on this I consider this educational malpractice.”“All the medical evidence of what we should be doing is very heavily pharma biased, because guidelines are based on randomized control clinical trials.”“So there's loads of reasons why nutrition is not used in clinical care the way it should be. None of that is an excuse though, because it works and it's so vital.”“What if I asked you to like eat this food twice a day and I otherwise left you alone? What started happening is people calling and saying, hey, my cholesterol dropped 39 points. Then I'm like, okay, we're gonna subject our products to a randomized control trial. Let's see. Let's prove it. Does this actually work?”“If I reduce, LDL, the bad cholesterol across the US population by an average of 9%, I will finally dethrone heart disease as our number one killer.”“In that trial, we replicated what people were calling in with our highest LDL reduction was close to 40 % in 30 days. That's a medication level cholesterol reduction. And we did that with food, without turning people's lives upside down.”“It's not just the nutrient of interest that's important. It's the delivery vehicle. You can stuff a bunch of fiber into a Twinkie. But in the end, you're still eating a Twinkie, right? Food and nutrition is complex.”“At Step One Foods I take the complexity out for people. I take whole food ingredients, each and every single one that has data behind it in terms health benefits, and put them in my foods.”“We are probably the most overfed and undernourished society in the history of our species.”“If you truly believe in your mission, you have to ignore all the no's.”Promo Offer:Code: BETTERWORLDLink: https://www.steponefoods.com/discount/BETTERWORLDOffer: 10% off first order for both one time and subscription orders. Offer can be stacked with the subscription discount to save 30% on their first order. Exclusions: Limited to one use per customer. Limited to a customer's first order and only applies to the first recurring order. Code must be entered at checkout for the discount to be applied. Links:Dr Elizabeth Klodas on LinkedIn - https://www.linkedin.com/in/eklodas/Step One Foods- https://www.steponefoods.com/Step One Foods on LinkedIn - https://www.linkedin.com/company/steponefoods/Step One Foods on Facebook - https://www.facebook.com/StepOneFoodsStep One Foods on Instagram - https://www.instagram.com/steponefoods/Step One Foods on YouTube - https://www.youtube.com/StepOneFoods…“Slay the Giant: The Power of Prevention in Defeating Heart Disease” book - https://www.steponefoods.com/products/slay-the-giant…Brands for a Better World Episode Archive - http://brandsforabetterworld.com/Brands for a Better World on LinkedIn - https://www.linkedin.com/company/brand-for-a-better-world/Modern Species - https://modernspecies.com/Modern Species on LinkedIn - https://www.linkedin.com/company/modern-species/Gage Mitchell on LinkedIn - https://www.linkedin.com/in/gagemitchell/…Print Magazine Design Podcasts - https://www.printmag.com/categories/printcast/…Heritage Radio Network - https://heritageradionetwork.org/Heritage Radio Network on LinkedIn - https://www.linkedin.com/company/heritage-radio-network/posts/Heritage Radio Network on Facebook - https://www.facebook.com/HeritageRadioNetworkHeritage Radio Network on X - https://x.com/Heritage_RadioHeritage Radio Network on Instagram - https://www.instagram.com/heritage_radio/Heritage Radio Network on Youtube - https://www.youtube.com/@heritage_radioChapters:03:00 Introduction to Preventive Cardiology and Nutrition05:58 The Shift from Nutrition to Medication in Healthcare08:45 The Role of Pharmaceuticals in Patient Care11:41 The Challenges of Nutrition Education in Medicine14:41 The Complexity of Food and Nutrition Science17:59 Step One Foods: A New Approach to Nutrition20:57 The Impact of Randomized Controlled Trials on Nutrition23:59 The Importance of Ingredient Quality in Food Products26:49 Pushback from the Medical and Food Industries29:52 The Insurance Industry's Role in Healthcare Costs32:52 Step One Foods: Product Overview and Benefits38:43 Introduction to Whole Foods and Health Claims40:56 The Importance of Real Ingredients42:56 Navigating Organic Ingredients and Supply Chain Challenges44:59 Stepwise Approach to Health and Nutrition48:58 Challenges in Scaling Food Production51:49 Milestones and Industry Changes56:55 Advice for Aspiring Food Entrepreneurs59:50 Personal Indulgences and Food Preferences01:03:00 Innovative Thinkers in Nutrition01:05:50 Vision for a Healthier WorldSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
What's best for skin closure at C-Section? Staples or suture? This debate has raged for over 20 years. Past data has shown greater odds of wound complications with metal staples compared to suture. But new a meta-analysis from June 2025 is challenging the prior results. In this episode, we will explore the data from 2010 to present day. PLUS, we will summarize a separate meta-analysis examining if wound dressing removal is tied to any wound complication. This was just published July 15, 2025 in the “Pink” journal. Listen in for details. 1. 2010: Basha SL, Rochon ML, Quiñones JN, Coassolo KM, Rust OA, Smulian JC. Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery. Am J Obstet Gynecol. 2010 Sep;203(3):285.e1-8. doi: 10.1016/j.ajog.2010.07.011. PMID: 20816153.2. 2015: Mackeen AD, Schuster M, Berghella V. Suture versus staples for skin closure after cesarean: a metaanalysis. Am J Obstet Gynecol. 2015 May;212(5):621.e1-10. doi: 10.1016/j.ajog.2014.12.020. Epub 2014 Dec 19. PMID: 25530592.3. Jan 2025: Gabbai D, Jacoby C, Gilboa I, Maslovitz S, Yogev Y, Attali E. Comparison of complications and surgery outcomes in skin closure methods following cesarean sections. Arch Gynecol Obstet. 2025 Jul;312(1):125-129. doi: 10.1007/s00404-024-07911-6. Epub 2025 Jan 25. PMID: 39862268; PMCID: PMC12176926.4. June 2025: Post-cesarean skin closure with metal staples versus subcuticular suture in obese patients: A systematic review and meta-analysis of randomized controlled trials. Luis Sanchez-Ramos et al (Univ Florida). https://onlinelibrary.wiley.com/doi/pdf/10.1002/pmf2.700615. DRESSING REMOVAL: July 15, 2025: Leshae A Cenac, Serena Guerra, Alicia Huckaby, Gabriele Saccone, Vincenzo Berghella. Early Wound Dressing (soft gauze/tape dressing) Removal after Cesarean Delivery: A Meta-Analysis of Randomized Trials: Short title: early wound dressing removal after cesarean, American Journal of Obstetrics & Gynecology MFM, 2025; https://doi.org/10.1016/j.ajogmf.2025.101739.6. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
Dr. John Fleetham chats with Dr. Jaclyn Smith and Dr. Imran Satia about their articles, "Camlipixant in Refractory Chronic Cough: A Phase 2b, Randomized, Placebo-controlled Trial (SOOTHE)" and "Camlipixant: A New Hope for Refractory Chronic Cough?"
FACT (fentanyl And Crushed Ticagrelor) PCI: A Randomized Control Trial of Patients Undergoing Percutaneous Coronary Intervention Who Receive Ticagrelor and Fentanyl
For full review of the trials, please visit https://cardiologytrials.substack.com/ Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe
Outline00:00 - Intro00:42 - “Research should be fun”02:02 - Early steps in research09:00 - Book writing and meeting C. Desoer18:33 - Control synthesis via the factorization approach25:46 - The graph metric 29:27 - Robotics and CAIR36:00 - Randomized algorithms40:41 - On learning44:05 - Neural networks48:40 - Tata, hidden Markov models, and large deviations theory55:48 - Picking problems and role of luck58:07 - Compressed sensing and non-convex optimization01:02:17 - Interplay between control and machine learning01:09:10 - Advice to future students01:13:29 - Future of controlLinksSagar's website: https://tinyurl.com/4hwruajsHilbert: https://tinyurl.com/ykpdh929Feedback Systems: https://tinyurl.com/2k3jsdatHow to Write Mathematics: https://tinyurl.com/35794bv9Nonlinear systems: https://tinyurl.com/2fdtnjcmC. Desoer: https://tinyurl.com/svhknrenControl Systems Synthesis — A Factorization Approach: https://tinyurl.com/59wdc4svAryabhata: https://tinyurl.com/43x6hfhpA Brief History of the Graph Topology: https://tinyurl.com/49uftzdkRobot Dynamics and Control: https://tinyurl.com/5b4cmt7mCAIR: https://tinyurl.com/rajdtxaxRandomized algorithms for robust controller synthesis using statistical learning theory: https://tinyurl.com/wanpyeucR. Tempo: https://tinyurl.com/jkufdwarVC dimension: https://tinyurl.com/mvwk8afmLearning and Generalisation: https://tinyurl.com/2s3mzh8hAre Analog Neural Networks Better Than Binary Neural Networks? https://tinyurl.com/3fnk27xcHidden Markov Processes: https://tinyurl.com/t5frrvfzAn Introduction to Compressed Sensing: https://tinyurl.com/fc6a8eerSupport the showPodcast infoPodcast website: https://www.incontrolpodcast.com/Apple Podcasts: https://tinyurl.com/5n84j85jSpotify: https://tinyurl.com/4rwztj3cRSS: https://tinyurl.com/yc2fcv4yYoutube: https://tinyurl.com/bdbvhsj6Facebook: https://tinyurl.com/3z24yr43Twitter: https://twitter.com/IncontrolPInstagram: https://tinyurl.com/35cu4kr4Acknowledgments and sponsorsThis episode was supported by the National Centre of Competence in Research on «Dependable, ubiquitous automation» and the IFAC Activity fund. The podcast benefits from the help of an incredibly talented and passionate team. Special thanks to L. Seward, E. Cahard, F. Banis, F. Dörfler, J. Lygeros, ETH studio and mirrorlake . Music was composed by A New Element.
In this keynote episode, Professor Sebastian Schneeweiss from Harvard Medical School shares groundbreaking insights from his extensive research into emulating randomized controlled trials (RCTs) using real-world data (RWD). Recorded live at The Effective Statistician Conference 2024, this talk explores whether non-randomized studies based on electronic health records and claims data can reach conclusions as reliable as those from traditional RCTs. Prof. Schneeweiss, also Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital, walks us through the RCT DUPLICATE project, a major FDA-funded initiative that evaluated whether regulatory decisions could be replicated through high-quality real-world evidence (RWE). From the successes to the limitations—and everything in between—this episode is packed with lessons for statisticians, regulators, and pharmaceutical leaders interested in the future of data-driven healthcare decisions.
Host Dr. Ben Young invites Drs. Roni Levin and Evan Silverstein to review the current state of amblyopia treatment, ranging from the mainstays of patching and atropine drops to novel advances such as dichoptic therapy. Below are some references regarding dichoptic therapy that were discussed in this episode: Xiao S, Angjeli E, Wu HC, Gaier ED, et al. Luminopia Pivotal Trial Group. Randomized controlled trial of a dichoptic digital therapeutic for amblyopia. Ophthalmology. 2022 Jan;129(1):77-85. Wygnanski-Jaffe T, Kushner BJ, Moshkovitz A, Belkin M, Yehezkel O. CureSight Pivotal Trial Group. An eye-tracking-based dichoptic home treatment for amblyopia: A multicenter randomized clinical trial. Ophthalmology. 2023 Mar;130(3):274-285. Koc I, Bagheri S, Chau RK, Hoyek S, et al. Cost-effectiveness analysis of digital therapeutics for amblyopia. Ophthalmology. 2025 Jun;132(6):654-660. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.
N Engl J Med 2001;344:1651-1658Background: The MERIT-HF trial demonstrated the efficacy of the selective beta blocker metoprolol CR/XL for well selected patients with chronic systolic heart failure who were on optimal therapy with an ACEi and diuretic. The trial randomized nearly 4,000 patients and was stopped early due to the benefit of the drug on all-cause mortality but it also reduced major morbidity as indicated by significant reductions in hospitalization. It represented the first large scale trial to show a morbidity and mortality benefit for beta blockers in patients with chronic systolic heart failure. Prior to MERIT-HF, the nonselective beta blocker carvedilol reduced morbidity and mortality in a smaller trial of patients with chronic stable heart failure. Limitations of the trial included its size and the fact that it was not originally designed to test mortality. Furthermore, it was stopped early without clearly prespecified stopping rules and 8% of total patients selected for participation in the trial were excluded prior to randomization after a 2 week, open-label run-in phase with the study drug. During the run-in period, 24 patients (2%) experienced worsening heart failure or death and were excluded from participation in the trial - the difference in total deaths between groups was 9 when the trial was stopped. In our opinion, the results of this trial were far from definitive and there are theoretical reasons why selective and nonselective beta blockers could have different effects on cardiac outcomes.The primary difference between selective and nonselective beta blockers lies in their specificity of action; while both types block adrenaline from binding to beta receptors on nerves, selective beta blockers primarily affect those found in the heart whereas nonselective ones also impact those located in the lungs and blood vessels. In the lungs, adrenaline causes bronchodilation and in the blood vessels, vasoconstriction. Thus, nonselective beta blockers also reduce afterload, which can improve cardiac hemodynamics in the failing heart.The Carvedilol Prospective Randomized Cumulative Survival Study was a large-scale trial that sought to test the hypothesis that the nonselective beta blocker carvedilol reduces mortality in patients with chronic stable heart failure who are on optimal treatment.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Patients: Patients with “severe chronic heart failure” were recruited from 334 sites in 21 countries. Severe chronic heart failure was defined by the presence of dyspnea or fatigue at rest or on minimal exertion for at least 2 months and a LVEF of
In the ruins of a fallen tower, the crew of the Little Snail found themselves (and their egos) battered and bruised. Worse, Elena, Veile, and Nicky found themselves missing one ingredient to the special stew that was their group: Jonathan! Where had he been taken? And could it, perhaps, lead them towards the eternal flame which they were sent to retrieve? This week on Perpetua: The Shadow of the Dragon Tower Pt. 4 Perpetua Guide [In Progress v.01] - Some Feedback [Page 01 of 03] Alukard83 Hey, this FAQ rules! Normally I buy the official guide but they want FIFTY dollars for this one, and I just don't have that sorta cash right now, so this is a lifesaver. HOWEVER, your map on the final puzzle area in the Dragon Tower isn't right at ALL. Not sure what you were on when you made it, but it's totally wrong. Otherwise, keep up the good work XD TheUnforgivenIII Yeah I was coming here to post the same thing. This guide sucks bigtime. In my opinion, it's PROOF you should not be releasing this guide without finishing the full game first, because you're going to be in such a hurry that you're going to make stupid mistakes like this (or maybe even make things up entirely, which is my guess.) Take the FAQ down because it doesn't have any REAL answers in it. CarlsSr That's not what OP said, Unforgiveniii. Your bias is showing. FriendOfNei Thanks for the kudos Alukard, but listen, I loaded the save FIVE TIMES and checked it again and again and it's right. I don't know what YOU'RE on but maybe you're the one who is mistaken. As for you, Unforgiven, you're not even worth my keystrokes. XxZelgadyskXx I'm not OP or the FAQ writer but we did some testing over in the IRC channel it turns out that the bomb placement is RANDOMIZED for every player. So the FAQ isn't *wrong* it's just not right for anyone except for Nei. n.n;;;; Hosted by Austin Walker (austinwalker.bsky.social) Featuring Ali Acampora (ali-online.bsky.social), Art Martinez-Tebbel (amtebbel.bsky.social), Jack de Quidt (notquitereal.bsky.social), and Andrew Lee Swan (swandre3000.bsky.social) Produced by Ali Acampora Music by Jack de Quidt (available on bandcamp) Cover Art by Ben McEntee (https://linktr.ee/benmce.art) With thanks to Amelia Renee, Arthur B., Aster Maragos, Bill Kaszubski, Cassie Jones, Clark, DB, Daniel Laloggia, Diana Crowley, Edwin Adelsberger, Emrys, Greg Cobb, Ian O'Dea, Ian Urbina, Irina A., Jack Shirai, Jake Strang, Katie Diekhaus, Ken George, Konisforce, Kristina Harris Esq, L Tantivy, Lawson Coleman, Mark Conner, Mike & Ruby, Muna A, Nat Knight, Olive Perry, Quinn Pollock, Robert Lasica, Shawn Drape, Shawn Hall, Summer Rose, TeganEden, Thomas Whitney, Voi, chocoube, deepFlaw, fen, & weakmint This episode was made with support from listeners like you! To support us, you can go to friendsatthetable.cash.
Drs. Amy Crockett (@amyhcrockett), Ben Ereshefsky (@brainofbpharm), and Pamela Bailey (@pamipenem) join Dr. Julie Ann Justo (@julie_justo) to discuss new treatment strategies for management of intraamniotic infections, also known as chorioamnionitis. They discuss whether it is time to move away from the combination of ampicillin, gentamicin, and/or clindamycin, alternative antibiotic regimens to consider, and stewardship strategies to approach this practice change at a local level. References: Basic stats/epi on chorioamnionitis: Romero R, et al. Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques. J Perinat Med. 2015 Jan;43(1):19-36. doi: 10.1515/jpm-2014-0249. PMID: 25720095. ACOG 2017 Guideline for IAI: Committee Opinion No. 712: Intrapartum Management of Intraamniotic Infection. Obstet Gynecol. 2017 Aug;130(2):e95-e101. doi: 10.1097/AOG.0000000000002236. PMID: 28742677. ACOG 2024 Update on clinical criteria for IAI: ACOG Clinical Practice Update: Update on Criteria for Suspected Diagnosis of Intraamniotic Infection. Obstetrics & Gynecology 144(1):p e17-e19, July 2024. doi: 10.1097/AOG.0000000000005593 Helpful review with more recent microorganisms : Jung E, et al. Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment. Am J Obstet Gynecol. 2024 Mar;230(3S):S807-S840. doi: 10.1016/j.ajog.2023.02.002. PMID: 38233317. Cochrane Review: Chapman E, et al. Antibiotic regimens for management of intra-amniotic infection. Cochrane Database Syst Rev. 2014 Dec 19;2014(12):CD010976. doi: 10.1002/14651858.CD010976.pub2. PMID: 25526426. Helpful recent review on intrapartum infections: Bailey, P, et al_._ Out with the Old, In with the New: A Review of the Treatment of Intrapartum Infections. Curr Infect Dis Rep. 2024;26:107–113 doi: 10.1007/s11908-024-00838-8. Role of genital mycoplasmas in IAI: Romero R, et al. Evidence that intra-amniotic infections are often the result of an ascending invasion - a molecular microbiological study. J Perinat Med. 2019 Nov 26;47(9):915-931. doi: 10.1515/jpm-2019-0297. PMID: 31693497. Regimens without enterococcal coverage with similar clinical outcomes: Blanco JD, et al. Randomized comparison of ceftazidime versus clindamycin-tobramycin in the treatment of obstetrical and gynecological infections. Antimicrob Agents Chemother. 1983 Oct;24(4):500-4. doi: 10.1128/AAC.24.4.500. PMID: 6360038. Bookstaver PB, et al. A review of antibiotic use in pregnancy. Pharmacotherapy. 2015 Nov;35(11):1052-62. doi: 10.1002/phar.1649. PMID: 26598097. Updated review in pregnancy, includes data on frequency of antibiotic use in pregnancy: Nguyen J, et al. A review of antibiotic safety in pregnancy-2025 update. Pharmacotherapy. 2025 Apr;45(4):227-237. doi: 10.1002/phar.70010. Epub 2025 Mar 19. PMID: 40105039. Locksmith GJ, et al. High compared with standard gentamicin dosing for chorioamnionitis: a comparison of maternal and fetal serum drug levels. Obstet Gynecol. 2005 Mar;105(3):473-9. doi: 10.1097/01.AOG.0000151106.87930.1a. PMID: 15738010. Clindamycin CDI Risk: Miller AC, et al. Comparison of Different Antibiotics and the Risk for Community-Associated Clostridioides difficile Infection: A Case-Control Study. Open Forum Infect Dis. 2023 Aug 5;10(8):ofad413. doi: 10.1093/ofid/ofad413. PMID: 37622034. Impact of penicillin allergy on clindamycin use & cites 47% clindamycin resistance per CDC among GBS: Snider JB, et al. Antibiotic choice for Group B Streptococcus prophylaxis in mothers with reported penicillin allergy and associated newborn outcomes. BMC Pregnancy Childbirth. 2023 May 30;23(1):400. doi: 10.1186/s12884-023-05697-0. PMID: 37254067. Clindamycin anaerobic coverage data: Hastey CJ, et al. Changes in the antibiotic susceptibility of anaerobic bacteria from 2007-2009 to 2010-2012 based on the CLSI methodology. Anaerobe. 2016 Dec;42:27-30. doi: 10.1016/j.anaerobe.2016.07.003. PMID: 27427465. Older PK study of ampicillin & gentamicin for chorioamnionitis: Gilstrap LC 3rd, Bawdon RE, Burris J. Antibiotic concentration in maternal blood, cord blood, and placental membranes in chorioamnionitis. Obstet Gynecol. 1988 Jul;72(1):124-5. PMID: 3380500. Paper putting out the call for modernization of OB/Gyn antibiotic regimens: Pek Z, Heil E, Wilson E. Getting With the Times: A Review of Peripartum Infections and Proposed Modernized Treatment Regimens. Open Forum Infect Dis. 2022 Sep 5;9(9):ofac460. doi: 10.1093/ofid/ofac460. PMID: 36168554. Vanderbilt University Medical Center experience with modernizing OB/Gyn infection regimens: Smiley C, et al. Implementing Updated Intraamniotic Infection Guidelines at a Large Academic Medical Center. Open Forum Infect Dis. 2024 Sep 5;11(9):ofae475. doi: 10.1093/ofid/ofae475. PMID: 39252868. Prisma Health/University of South Carolina experience with modernizing OB/Gyn infection regimens: Bailey P, et al. Cefoxitin for Intra-amniotic Infections and Endometritis: A Retrospective Comparison to Traditional Antimicrobial Therapy Regimens Within a Healthcare System. Clin Infect Dis. 2024 Jul 19;79(1):247-254. doi: 10.1093/cid/ciae042. PMID: 38297884.
The FiltrateJoel TopfAC GomezSophia AmbrusoNayan AroraSpecial Guest Charles Edelstein, MD, PhD Professor, Medicine-Renal Med Diseases/HypertensionExtra-Special GuestMichelle Rheault, MD Professor of Pediatrics, University of MinnesotaEditing bySimon and Joel TopfThe Kidney Connection written and performed by by Tim YauShow NotesKDIGO ADPKD Guidelines:WebsiteGuideline PDFExecutive Summary PDFNephJC coverageConsortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP)Hy's Law (Wikipedia) has three components:ALT or AST by 3-fold or greater above the upper limit of normalAnd total serum bilirubin of greater than 2× the upper limit of normal, without findings of cholestasis (defined as serum alkaline phosphatase activity less than 2× the upper limit of normal)And no other reason can be found to explain the combination of increased aminotransferase and serum total bilirubin, such as viral hepatitis, alcohol abuse, ischemia, preexisting liver disease, or another drug capable of causing the observed injuryMeeting this definition yields a very high risk of fulminant kidney failure (76% in one series)Clinical Pattern of Tolvaptan-Associated Liver Injury in Subjects with Autosomal Dominant Polycystic Kidney Disease: Analysis of Clinical Trials Database (PubMed) Two of 957 patients on tolvaptan met Hy's law criteria. None had fulminant kidney failure.Effects of Hydrochlorothiazide and Metformin on Aquaresis and Nephroprotection by a Vasopressin V2 Receptor Antagonist in ADPKD: A Randomized Crossover Trial (PubMed) Patients had a baseline urine volume on tolvaptan of 6.9 L/24 h. Urine volume decreased to 5.1 L/24 h with hydrochlorothiazide and to 5.4 L/24 h on metformin.TEMPO 3:4 Tolvaptan in Patients with Autosomal Dominant Polycystic Kidney Disease (NEJM)Reprise Trial Tolvaptan in Later-Stage Autosomal Dominant Polycystic Kidney Disease ( NEJM | NephJC )Unified ultrasonographic diagnostic criteria for polycystic kidney disease by Edelstein in JASN (PubMed)Tolvaptan and Kidney Function Decline in Older Individuals With Autosomal Dominant Polycystic Kidney Disease: A Pooled Analysis of Randomized Clinical Trials and Observational Studies (PubMed)Charles' draft choice Recommendation 4.1.1.1: We recommend initiating tolvaptan treatment in adults with ADPKD with an estimated glomerular filtration rate (eGFR) ‡25 ml/min per 1.73 m2 who are at risk for rapidly progressive disease (1B).Sophia's draft choice Recommendation 1.4.2.1: We recommend employing the Mayo Imaging Classi cation (MIC) to predict future decline in kidney function and the timing of kidney failure (1B).Progression to kidney failure in ADPKD: the PROPKD score underestimates the risk assessed by the Mayo imaging classification (Frontiers of Science)AC's draft choice Recommendation 9.2.1: We recommend targeting BP to ≤ 50th percentile for age, sex, and height or ≤ 110/70 mm Hg in adolescents in the setting of ADPKD and high BP (1D).HALT-PKD Blood Pressure in Early Autosomal Dominant Polycystic Kidney Disease (NEJM)Nayan's draft choice Recommendation 6.1.2: We recommend screening for ICA in people with ADPKD and a personal history of SAH or a positive family history of ICA, SAH, or unexplained sudden death in those eligible for treatment and who have a reasonable life expectancy (1D).Screening for Intracranial Aneurysms in Patients with Autosomal Dominant Polycystic Kidney Disease (CJASN)Surgical Clipping Versus Endovascular Coiling in the Management of Intracranial Aneurysms (PubMed) Clipping is associated with a higher rate of occlusion of the aneurysm and lower rates of residual and recurrent aneurysms, whereas coiling is associated with lower morbidity and mortality and a better postoperative course.Joel's editorial pick Recommendation 6.1.1: We recommend informing adults with ADPKD about the increased risk for intracranial aneurysms (ICAs) and subarachnoid hemorrhage (1C).Joel's first draft pick The bring out your dead pick:Recommendation 4.3.1: We recommend not using mammalian target of rapamycin (mTOR) inhibitors to slow kidney disease progression in people with ADPKD (1C).Recommendation 4.4.1: We suggest not using statins specfiically to slow kidney disease progression in people with ADPKD (2D).Recommendation 4.5.1: We recommend not using metformin specifically to slow the rate of disease progression in people with ADPKD who do not have diabetes (1B).Recommendation 4.6.1: We suggest that somatostatin analogues should not be prescribed for the sole purpose of decreasing eGFR decline in people with ADPKD (2B).Perfect match: mTOR inhibitors and tuberous sclerosis complex (Orphanet Journal of Rare Diseases)Navitor Pharmaceuticals Announces Janssen Has Acquired Anakuria Therapeutics, Inc. (BioSpace) This is press release about acquiring the mTor1 inhibitor.Joel's second draft pick Recommendation 4.2.1.1: We suggest adapting water intake, spread throughout the day, to achieve at least 2–3 liters of water intake per day in people with ADPKD and an eGFR ≥ 30 ml/min per 1.73 m2 without contraindications to excreting a solute load (2D).Nayan's bonus draft Practice Point 4.7.1: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) should not be used to slow eGFR decline in people with ADPKD.Open-Label, Randomized, Controlled, Crossover Trial on the Effect of Dapagliflozin in Patients With ADPKD Receiving Tolvaptan (KIReports)SMART Trial of GLP-1ra in non-diabetics: Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes: a randomized double-blind placebo-controlled clinical trial (PubMed)Tubular SecretionsNayan: Landman on Paramount Plus (IMDB)Sophia: PassNayan: steps in with The Pitt on HBO (Wikipedia)Charles: The White Lotus, Yellowstone 1923, Poirot (IMDB)AC: The PittMichael Crichton's Estate Sends The Pitt to the Courtroom (Vulture)Joel: I Must Betray you by Ruta Sepetys (Amazon)
It's In the News.. a look at the top headlines and stories in the diabetes community. This week's top stories: Eli Lilly will start a lcinical trial for tirzepatide for people with type 1 diabetes, more details on Dexcom's 15 day G7 sensor, Ozepmic pill form tested, type 5 diabetes identified and more! Find out more about Moms' Night Out Please visit our Sponsors & Partners - they help make the show possible! Learn more about Gvoke Glucagon Gvoke HypoPen® (glucagon injection): Glucagon Injection For Very Low Blood Sugar (gvokeglucagon.com) Omnipod - Simplify Life Learn about Dexcom Check out VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com Reach out with questions or comments: info@diabetes-connections.com Episode transcription with links: Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and every other Friday I bring you a short episode with the top diabetes stories and headlines happening now. XX Our top story this week.. Eli Lilly takes the first steps toward getting tirzepatide approved for people with type 1 diabetes. Tirzepatide is sold under the brand names Mounjaro for type 2 and Zepbound for obesity. The main purpose of this study is to find out how well and how safely tirzepatide works in adults who have type 1 diabetes and obesity or are overweight. Participation in the study will last about 49 weeks. Official Title A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study Evaluating the Efficacy and Safety of Tirzepatide Once Weekly Compared to Placebo in Adult Participants With Type 1 Diabetes and Obesity or Overweight This is a big deal because, even though many people with type 1 are able to get a prescription for tirzepatide, it's not approved for T1D and so insurers won't usually cover it. https://clinicaltrials.gov/study/NCT06914895 XX The use of drugs like Ozempic, Wegovy and Zepbound in people with type 1 diabetes has risen sharply over the past decade, a new study finds, even though there's little information on the drugs' safety and effectiveness for the condition. The family of medications called GLP-1 receptor agonists includes drugs like Wegovy, Zepbound, Ozempic, Mounjaro and Victoza. But the clinical trials of these medications specifically excluded people with type 1 diabetes, who are dependent on the hormone insulin to survive because they can't make enough of their own. Drugmakers feared that using the GLP-1 medications with insulin might raise the chance of dangerously low blood sugar events, or hypoglycemia, and were unwilling to take the risk of studying them in people with type 1. For the study, which was published last month in the journal Diabetes, Obesity, and Metabolism, researchers at Johns Hopkins University reviewed the medical records of more than 200,000 people with type 1 diabetes from 2008 to 2023. They grouped the data in three-year periods, starting with October 2008 to September 2011 and ending with October 2020 to September 2023. GLP-1 medication use spiked, as well. Among adults with the highest category of obesity, about 4% used GLP-1 medications in 2008, and 33% did by 2023 – an 800% increase. But these are anecdotal reports and may not reflect instances in which people have side effects or complications like low blood sugar, which can be life-threatening. But Shin says what's really needed is information from randomized, double-blinded studies, in which participants are followed forward in time and given either a drug or a placebo. https://www.cnn.com/2025/04/09/health/glp-1-type-1-diabetes-study/index.html XX Later this month the FDA will conduct a final meeting regarding a new, investigational compound (sotagliflozin) soda-GLIFF-a-zin that has been shown to Improve QoL and Reduce Long-term Complications for people with type 1 diabetes (T1D). The patient advocacy group Taking Control of Your Diabetes (TCOYD.org) is working to inform the T1D community about sotagliflozin - and to encourage people to sign a Change.org petition directed towards FDA. Last fall, the FDA declined to approve sotagliflozin due to concerns about a potential increased risk of diabetic ketoacidosis (DKA), despite this being a condition that people with T1D on insulin face and manage daily. While TCOYD respects FDA's caution, the group stands by T1D patients and their physicians who, as a team, balance risks and benefits every day. https://tcoyd.org/petition/ XX Dexcom receives FDA approval for it's G7 with 15 day wear. We have an interview with Chief Operating Officer Jake Leach coming up on Tuesday – we talk about the planned roll out of this sensor, what else has changed, and the fine print in the press release – it says “A study was conducted to assess the sensor life where 73.9% of sensors lasted the full 15 days. When using the product per package labeling, approximately 26% of sensors may not last for the full 15 days. https://investors.dexcom.com/news/news-details/2025/Dexcom-G7-15-Day-Receives-FDA-Clearance-the-Longest-Lasting-Wearable-and-Most-Accurate-CGM-System/default.aspx?utm_source=www.diabetech.info&utm_medium=referral&utm_campaign=dexcom-g7-15-day-sensor-gets-fda-cleared-but-will-it-actually-last-that-long XX Glucotrack is joining something called FORGETDIABETES bionic pancreas initiative, - this is an European Union project that aims to develop a long-term automated insulin delivery system for type 1 diabetes patients. Glucotrack's Continuous Blood Glucose Monitor (CBGM) will be integrated into the system to provide real-time glucose readings. The initiative's goal is to create a bionic invisible pancreas that eliminates the need for therapeutic actions and reduces psychological burden. The architecture of BIP encompasses a ground-breaking, lifelong lasting implanted ip glucose nanosensor; a radically novel ip hormone delivery pump, with unique non-invasive hormone refill with a magnetic docking pill and non-invasive wireless battery recharge; an intelligent closed-loop hormone dosing algorithm, optimized for ip sensing and delivery, individualized, adaptive and equipped with advanced self-diagnostic algorithms. Pump refilling through a weekly oral recyclable drug pill will free T1D subjects from the burden of pain and awkward daily measurement and treatment actions. Wireless power transfer and data transmission to cloud-based data management system round-up to a revolutionary treatment device for this incurable chronic disease. key feature of BIP is to be fully-implantable and life-long lasting thanks to novel biocompatible and immune-optimized coatings guaranteeing long-term safety and stability https://www.stocktitan.net/news/GCTK/glucotrack-to-participate-in-forgetdiabetes-a-prominent-european-cjjldjb0dq7h.html XX A newly recognised form of diabetes, called Type 5, was announced this week at the World Congress of Diabetes 2025. A global task force will investigate this less-understood condition, which differs from Type 1 and Type 2 diabetes. Type 5 diabetes affects people who are underweight, lack a family history of diabetes and do not show the typical symptoms of Type 1 or Type 2 diabetes. The condition was first observed in the 1960s and referred to as J-type diabetes, after being detected in Jamaica. It was classified by the World Health Organisation in 1985, but removed in 1998 due to lack of physiological evidence. At the time, experts believed it to be a misdiagnosed case of Type 1 or 2 diabetes. New research has since confirmed that Type 5 is different. https://economictimes.indiatimes.com/news/new-updates/a-new-type-of-diabetes-has-been-found-by-scientists-and-it-doesnt-show-the-typical-symptoms-of-type-1-or-type-2/articleshow/120276658.cms?from=mdr XX Oral semaglutide cuts major heart risks in people with type 2 diabetes by 14%, offering a powerful pill-based option. A new clinical trial, co-led by endocrinologist and diabetes specialist John Buse, MD, PhD, and interventional cardiologist Matthew Cavender, MD, MPH, at the UNC School of Medicine, has demonstrated that the oral form of semaglutide significantly lowers the risk of cardiovascular events in individuals with type 2 diabetes, atherosclerotic cardiovascular disease, and/or chronic kidney disease. Results from the rather large, international trial were published in the New England Journal of Medicine and presented at the American College of Cardiology's Annual Scientific Session & Expo in Chicago, Illinois. The effect of oral semaglutide on cardiovascular outcomes was consistent with other clinical trials involving injectable semaglutide, but more trials are needed to determine if one method may be more effective than the other at reducing major cardiovascular events. https://scitechdaily.com/new-pill-form-of-semaglutide-shows-major-benefits-for-people-with-diabetes/ XX April 14 (UPI) -- The U.S. Food and Drug Administration on Monday warned consumers and pharmacies that fake versions of Ozempic, a drug to treat Type 2 diabetes, have been found in the United States. Novo Nordisk, the Danish-headquartered manufacturer, informed the FDA on April 3 that counterfeit 1-milligram injections of semaglutide were being distributed outside its authorized supply chain. The FDA and Novo Nordisk are testing the fake products to identify whether they're safe. Patients are asked to obtain Ozempic with a valid prescription through state-licensed pharmacies and check the product for any signs of counterfeiting. People in possession of the fake product are urged to call Novo Nordisk customer care at 800-727-6500 Monday through Friday from 8:30 a.m. to 6 p.m. EDT and report it to the FDA's criminal activity division's website. Side effects can be reported to FDA's MedWatch Safety Information and Adverse Event Reporting Program (800-FDA-1088 or www.fda.gov/medwatch) as well as to Novo Nordisk, at 800-727-6500. https://www.upi.com/Health_News/2025/04/14/FDA-fake-Ozempic-drugs-Novo-Nordisk/6841744666854/ XX Can a digital lifestyle modification program reduce diabetes risk? A new study shows that the lifestyle intervention significantly reduced 10-year diabetes risk among prediabetics by nearly 46% and increased the diabetes remission rate, highlighting the importance of lifestyle changes. However, the study was not a randomized trial, and participation in the lifestyle intervention was voluntary, which may introduce selection bias. The study evaluated 133,764 adults, categorizing them as diabetic (7.5%), prediabetic (36.2%), and healthy (56.3%), based on fasting glucose and HbA1c levels. https://www.news-medical.net/news/20250414/Digital-lifestyle-program-cuts-diabetes-risk-by-4625-in-prediabetics-study-of-130k2b-adults-reveals.aspx XX Chrissy Teigan is speaking out about her son's type 1 diagnosis – teaming up with Sanofi to encourage people to screen early for Type 1 diabetes. Teigen got a crash course in the risks of undiagnosed Type 1 diabetes when her 6-year-old son, Miles, was hospitalized with complications of the autoimmune disease last year. The family knew nothing about Type 1 diabetes when Miles was diagnosed during an unexpected medical emergency, Teigen said in a Tuesday announcement. “We were confused and scared when Miles was first diagnosed,” she said in a statement. “There is no doubt in my mind that knowing in advance would have made a positive impact for Miles, me, and our entire family. I want everyone to hear me when I say: stay proactive and talk to your doctor about getting yourself or your loved ones screened for type 1 diabetes today!” Teigen shared her family's story in a two-minute video on ScreenForType1.com, a Sanofi website that discusses how to get screened for the condition. Miles' diagnosis made Teigen feel like she “went from a mom to a doctor overnight,” she said. That experience is why Teigen said she is “begging you: Do this one thing, and screen yourself and your family for Type 1 diabetes.” https://www.fiercepharma.com/marketing/sanofi-signs-chrissy-teigen-diabetes-screening-campaign XX Dr. Richard Bernstein – best known for his advocacy around low carb diets for people with diabetes – died this week at the age of 90. Born in 1934 in Brooklyn, New York, he was diagnosed with type 1 at age 12. In the 1970s he adapted a blood glucose monitor for home use and helped pioneer home glucose monitoring. He published multiple books on Diabetes including the #1 selling Diabetes book on Amazon.Com “Dr. Bernstein's Diabetes Solution: A Complete Guide to Achieving Normal Blood Sugars” and “Diabetes Type II: Living a Long, Healthy Life Through Blood Sugar Normalization”. He practiced and saw patients right up until his death.
© 2020-2025 Ivy Podcast Discovery LLC
