Podcasts about rct

Dans cet épisode des Causeries de la Rade, l'équipe analyse le match nul obtenu au forceps au LOU, après 15 jours mouvementés par l'absence de Pierre Mignoni.Les Causeries analysent les causes et les conséquences de cette absence et la réorganisation que cela pourrait entraîner au RCT.Enfin, focus sur la réunion prévue cette semaine entre le club, la presse et les abonnés, dédiés à l'avenir de Mayol. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

Why does early breastfeeding position matter? Nancy and Barbara discuss one of their favorite topics with friend and colleague, IBCLC Rene Fisher. Whether you are talking about the starter position, laid back breastfeeding, or biological nurturing from Suzanne Colson, they all mean the same thing. Relax, lean back at a comfortable angle (not flat on your back), and place the baby tummy-to-tummy on the parent’s body. When this is done suddenly, the baby can move their body more easily, and many infant feeding reflexes are triggered, ensuring that at least one person knows what they are doing. Nancy discusses her experience improving breastfeeding practices at a Chicago-area hospital, and Rene shares her experiences with her own grandson, which made her a firm believer. Rene took this simple, time-saving technique back to her hospital on the East Coast, where it was a great success. Nancy’s ideas of adjusting your body, adjusting the baby, and adjusting the breast make it even easier to help families nurse easily and comfortably. As is known, changing hospital practice is not easy. Nancy and Rene share their wins and hurdles. There are three studies discussed in detail, which are listed below. Enjoy! Milinco 2020 (RCT): https://pubmed.ncbi.nlm.nih.gov/32248838/ Yin 2021 (RCT): https://pubmed.ncbi.nlm.nih.gov/33913745/ Wang 2021 (Meta-analysis): https://pubmed.ncbi.nlm.nih.gov/33761882/ The post All Things Breastfeeding Episode 107: Why Early Breastfeeding Positions Matter appeared first on The Breastfeeding Center of Ann Arbor.

Open up some scientific papers, and you'll hear electroconvulsive therapy described as the most effective treatment for depression (especially very severe depression). But open up others, and you'll see it described as completely useless—and a sad indictment on a medical establishment who've completely failed to provide proper evidence on it. Not only that, but they've exposed patients to serious side effects, like memory loss, for no good reason.Who's right? In this episode, we look into the most controversial psychiatric treatment since lobotomy.NEXT WEEK: we'll follow this with an episode on another controversial psychiatric treament: antidepressants.On this week's episode we discussed the article “The Perks of Being a Mole Rat”, from our sponsor, Works in Progress magazine. As ever, we're very grateful for their support. You can find many more excellent articles at worksinprogress.co.Show notes* 1937 article by Egas Moniz, lobotomy Nobel Prize-winner* Weird 1998 article defending him on the Nobel Prize website* Megan McArdle on Walter Freeman* The ECT scene in One Flew Over the Cuckoo's Nest* 2024 article discussing the possible mechanisms of ECT's effect* 2010 review about sham ECT studies* 2019 review of each individual sham ECT study and the meta-analyses that include them* 2022 response to the review* Response to the response* Contemporary news article about the controversy* 2021 article in defense of ECT* The parachute RCT* 2010 meta-analysis on cognitive effects* 2025 meta-analysis on autobiographical memory lossCreditsThe Science Fictions podcast is produced by Julian Mayers at Yada Yada Productions. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit sciencefictionspod.substack.com/subscribe

Day 2 features a loving-kindness affirmation practice—a single phrase to steady the mind and soften self-criticism. Inspired by the Gita's teaching of friendliness and compassion toward all beings and informed by modern RCT reviews of loving-kindness interventions. ABOUT THIS WEEK'S LOVING-KINDNESS JOURNEY Welcome to Loving-Kindness Meditation: A Daily Heart-Opening Series—a 7-day journey into the ancient practice of cultivating a steady, compassionate heart. This isn't "be positive" meditation, and it isn't personality-based inspiration. It's a classical inner training—rooted in timeless yogic reflections on maitrī (friendliness), compassion, joy, and equanimity—so your mind becomes clearer, your nervous system steadier, and your relationships more spacious. Across this week, you'll build a simple, repeatable heart practice using one focused technique each day: a loving-kindness visualization, a single phrase of kindness, calming breathwork, a heart-opening mudra, a heart-center (4th chakra) nurture practice, a layered "heart stack" you can use anytime, and a gentle weekly review to embody what you've learned. Come as you are—guarded, tender, hopeful, tired, or open. Loving-kindness doesn't require a perfect mood. It only asks for a sincere return. In just a few minutes each day, you'll practice opening the heart with steadiness—so compassion becomes less of an idea and more of a lived inner home. This is day 2 of a 7-day meditation series, "Loving-Kindness Meditation: A Daily Heart-Opening Series"  episodes 3465-3471. THIS WEEK'S CHALLENGE - "META-MICRO MISSION" Each day, send one tiny ripple of kindness: silently offer a loving-kindness phrase to yourself, a neutral person, and a difficult moment (not necessarily a difficult person). Keep it light—3 breaths each— and track your streak with a simple checkmark. THIS WEEK'S MEDITATION JOURNEY  Day 1:  Compassion Visualization Day 2:  Affirmation: "My heart is open and safe." Day 3:  Heart Coherent Breath: Inhale for 5, Exhale for 5, Repeat for 10 rounds. (Option: inhale "soften, exhale "kindness.") Day 4:  Lotus mudra for opening your heart Day 5:  Fourth chakra for love and gratitude Day 6:  Loving-Kindness Flow meditation, combining the week's techniques Day 7:  Weekly review meditation and closure SHARE YOUR MEDITATION JOURNEY WITH YOUR FELLOW MEDITATORS Let's connect and inspire each other! Please share a little about how meditation has helped you by reaching out to me at Mary@SipandOm.com or better yet -- direct message me on https://www.instagram.com/sip.and.om. We'd love to hear about your meditation ritual!  WAYS TO SUPPORT THE DAILY MEDITATION PODCAST SUBSCRIBE so you don't miss a single episode. Consistency is the KEY to a successful meditation ritual. SHARE the podcast with someone who could use a little extra support. I'd be honored if you left me a podcast review. If you do, please email me at Mary@sipandom.com and let me know a little about yourself and how meditation has helped you. I'd love to share your journey to inspire fellow meditators on the podcast! All meditations are created by Mary Meckley and are her original content. Please request permission to use any of Mary's content by sending an email to Mary@sipandom.com. FOR DAILY EXTRA SUPPORT OUTSIDE THE PODCAST Each day's meditation techniques are shared at: sip.and.om Instagram https://www.instagram.com/sip.and.om/ sip and om Facebook https://www.facebook.com/SipandOm/ SIP AND OM MEDITATION APP Looking for a little more support? If you're ready for a more in-depth meditation experience, allow Mary to guide you in daily 30-minute guided meditations on the Sip and Om meditation app. Give it a whirl for 7-days free! Receive access to 3,000+ 30-minute guided meditations customized around a weekly theme to help you manage emotions. Receive a Clarity Journal and a Slow Down Guide customized for each weekly theme.  2-Week's Free Access on iOS https://itunes.apple.com/us/app/sip-and-om/id1216664612?platform=iphone&preserveScrollPosition=true#platform/iphone All meditations are created by Mary Meckley and are her original content. Please request permission to use any of Mary's content by sending an email to Mary@sipandom.com.Let go of repetitive negative thoughts. Music composed by Christopher Lloyd Clark licensed by RoyaltyFreeMusic.com, and also by musician Greg Keller.

Les Causeries de la Rade reçoivent Anthony Couderc, Responsable R&D du Rugby Club Toulonnais, véritable Monsieur Data et Innovation du club.Il détaille son travail au sein du club pour collecter des données qui vont permettre au staff d'optimiser les entraînements et la préparation des matchs. Il explique aussi quels sont les joueurs du club qui défient les stats et quelles seront les prochaines innovations du RCT ! Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

THEY DID IT! The Seahawks won the Super Bowl and are World Champions! What. A. GAME! Join Mitch and Josh as they discuss their highlights, thoughts and emotions from the game. We'll also be talking about the amazing Super Bowl watch party held in partnership with the UK Seahawkers and we'll reveal how much money was raised for the Robin Cancer Trust!Help grow the 12 Talk Community by liking, subscribing, sharing and hitting the notification bell to stay up to date on new episodes and guest appearances. You can also follow us on our social media channels:

Dans cet épisode hors-série des Causeries, l'équipe revient sur un long échange qu'ils ont eu avec Pierre Mignoni, concernant la colère des supporters après la défaite à Pau. Ce hors-série est aussi l'occasion d'inviter Louis Morland, jeune centre du RCT, prêté à Oyonnax cette saison et qui réalise un superbe exercice. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

Welcome back to February's Papers of the Month! We start this month looking a the right place to perform a prehospital anaesthetic. Traditionally we've been taught it should be somewhere with 360-degree access to allow the greatest safety, which means intubating in an ambulance and other locations are a no-go. But does it actually reduce complications, and what about other locations and situations? This paper explores whether location is associated with outcomes, or whether it might actually be a reasonable and sometimes advantageous to forgo that 360 access. We've talked a lot about pad position in cardiac arrest recently, mainly in the context of DSD, but what about initial pad position? Our second paper may be even more important than DSD! This one takes a look at initial pad position, antero–lateral versus antero–posterior placement and asks whether initial pad position influences return of spontaneous circulation. Finally, we take on one of the most debated topics in emergency and critical care airway management, with choice of induction agent. We look at a brilliant RCT which compares Etomidate to Ketamine and their haemodynamic stability. This one challenges some widely held assumptions, in an attempt to provide some much-needed clarity in what we should be using. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

Send us a textDo Heterogeneous Treatment Effects Exist?For the last 50 years, we've designed cars to be safe...For the 50th-percentile male.Well, that's actually not 100% correct.According to Stanford's report, we introduced "female" crash test dummies in the 1960s, but...They were just scaled-down versions of male dummies and...Represented the 5th percentile of females in terms of body size and mass (aka the smallest 5% of women in the general population).These dummies also did not take into account female-typical injury tolerance, biomechanics, spinal alignment, and more.But...Does it matter for actual safety?In the episode, we cover:- Do heterogeneous treatment effects (different effects in different contexts) exist?- If so, can we actually detect them?- Is it more ethical to look for heterogeneous treatment effects or rather look at global averages?Video version available on the Youtube: https://youtu.be/V801RQTBpp4Recorded on Nov 12, 2025 in Malaga, Spain.------------------------------------------------------------------------------------------------------About RichardProfessor Richard Hahn, PhD, is a professor of statistics at Arizona State University (ASU). He develops novel statistical methods for analyzing data arising from the social sciences, including psychology, economics, education, and business. His current focus revolves around causal inference using regression tree models, as well as foundational issues in Bayesian statistics.Connect with Richard:- Richard on LinkedIn: https://www.linkedin.com/in/richard-hahn-a1096050/About StephenStephen Senn, PhD, is a statistician and consultant who specializes in drug development clinical trials. He is a former Group Head at Ciba-Geigy and has taught at the University of Glasgow and University College London (UCL). He is the author of "Statistical Issues in Drug Development," "Crossover Trials in Clinical Research," and "Dicing with Death."Connect with Stephen:- Stephen on LinkedIn: Support the showCausal Bandits PodcastCausal AI || Causal Machine Learning || Causal Inference & DiscoveryWeb: https://causalbanditspodcast.comConnect on LinkedIn: https://www.linkedin.com/in/aleksandermolak/Join Causal Python Weekly: https://causalpython.io The Causal Book: https://amzn.to/3QhsRz4

Dans cet épisode des Causeries de la Rade, l'équipe revient sur la victoire dans la douleur et au courage du RCT face au MHR qui était venu faire un coup.L'occasion également de reparler du départ de Thomas Adelaïde, qui a reçu un communiqué cinglant du RCT. Et enfin, les Causeries reviennent sur les déclarations de Jessica Casanova qui s'appuie sur le report du match pour réclamer un stade couvert ! Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

In this episode of the Hands-On, Hands-Off Podcast, Dr. Trenton Rehman sits down with Dr. Shane McClinton to discuss plantar heel pain and the role of physical therapy in both clinical outcomes and healthcare costs.Dr. McClinton walks through a series of studies stemming from his doctoral research, including a randomized clinical trial, a detailed case series, and a three-year cost-effectiveness analysis. Together, they explore how adding physical therapy to usual podiatry care impacts pain, function, quality of life, and long-term costs.Key themes include manual therapy, impairment-based exercise, proximal contributions to heel pain, interdisciplinary collaboration, and why plantar heel pain may deserve the same clinical mindset as low back pain.Key Takeaways (Listener-Facing)Plantar heel pain is a multidimensional condition with local and proximal contributors.Adding physical therapy to usual podiatry care improved outcomes and reduced costs over three years.Manual therapy and exercise were delivered pragmatically and tailored to impairments.Strengthening may be underutilized in plantar heel pain management.Collaboration between physical therapists and podiatrists benefits patients and reduces downstream burden.⏱️ TIMESTAMPED CHAPTERS (YouTube + Podcast)00:00 – Introduction to the episode and guest00:01 – Dr. Shane McClinton's background and research focus00:03 – Why plantar heel pain referrals to PT are low00:07 – Rationale for studying cost-effectiveness00:10 – Study design overview (RCT + pragmatic approach)00:15 – Description of podiatry-only vs podiatry + PT care00:17 – Inclusion and exclusion criteria00:22 – Case series: why eight different heel pain presentations00:26 – Manual therapy strategies used in the study00:30 – Clinical practice guidelines and decision-making00:32 – Pain mechanisms, education, and chronicity00:35 – Proximal vs local treatment decisions00:38 – Three-year cost-effectiveness results explained00:44 – Implications for referrals and collaboration00:48 – Final take-home message from Dr. McClinton

Dans cet épisode les Causeries de la Rade reviennent sur la victoire à Gloucester qui permet au RCT de se qualifier en huitième de finale de Champions Cup !Les deux courageux Fadas de Paris qui ont rejoint la ville anglaise à vélo sont également venus faire un coucou dans l'émission.L'émission détaille aussi les profils de Junior Kpoku et Huw Jones, avec l'éclairage d'un médecin du sport sur les blessures récentes de l'international Ecossais.Enfin le dossier de la semaine : quels joueurs manquent encore au RCT pour avoir un effectif complet la saison prochaine ? Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

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

In this episode of The Scope Forward Show, Praveen Suthrum speaks with Alex Noumidis, Co-founder and CEO of Nerva, a digital therapeutic platform for IBS (Irritable Bowel Syndrome) and other disorders of gut-brain interaction. They discuss the origins of Nerva, the science of psychophysiology, digital health adoption in GI, and the challenges of bringing behavioral therapies into mainstream gastroenterology. The conversation dives deep into the power of gut-directed hypnotherapy, its clinical validation, the bottlenecks in scaling access to GI psychology, and what it takes to build a product that patients actually use. They've seen 300,000 patients and plan to expand to all GI conditions. Recorded between Australia and Mumbai, this global conversation also reflects on the evolving landscape of GI care.*

Manche Atemwegserreger sind gefährlicher als bekannt. Doch man kann einiges tun, um nicht krank zu werden.Jährlich grüßen 200 Viren: Um Infekte kommt im Winterhalbjahr kaum jemand herum. Was weniger bekannt ist: Manche bergen erhebliche Risiken für Herz-Kreislauferkrankungen. Doch es gibt Tricks, wie man sein Ansteckungsrisiko senken kann. Synapsen-Host Korinna Hennig hat sich in Studien und Interviews auf die Suche nach Erkenntnissen jenseits von warm Anziehen und Hühnersuppe begeben. Im Gespräch mit Wissenschaftsredakteurin Melanie Stinn erklärt sie, warum manche Menschen fast ohne Symptome durch die Saison kommen, welche erstaunlichen Effekte sich mit antiallergischen Nasensprays erzielen lassen, was Hustentechniken sind und weshalb die Gefahren der Influenza auch von der Stiko unterschätzt werden. Eine Recherche mit Überraschungseffekten.HINTERGRUNDINFORMATIONENStudie zur Wirkung der Covid-Impfung auf Tumor-Patienten: https://www.nature.com/articles/s41586-025-09655-y Studie symptomatische und asymptomatische Infektionen bei Influenza: https://pmc.ncbi.nlm.nih.gov/articles/PMC7147921/ Studie zu extrazellulären Vesikeln in der Nasenschleimhaut bei Kälte: https://www.jacionline.org/article/S0091-6749(22)01423-3/fulltext RCT zu Effekten von Meerwassernasenspray: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(24)00140-1/fulltext Klinische Phase 2-Studie zu Nasenspray mit Azelastin: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2838335 Studie zu Caragellose-Nasenspray bei Krankenhauspersonal: https://pubmed.ncbi.nlm.nih.gov/34629893/ Studie zum diversen Mikrobiom: https://journals.asm.org/doi/10.1128/msystems.00031-18 Studie zu Probiotika in der pädiatrischen Notaufnahme: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831509 Studie zu Mäusen nach Antibiotikagabe: https://www.pnas.org/doi/10.1073/pnas.1019378108 Pneumologische Leitlinie zu Husten: https://register.awmf.org/assets/guidelines/020-003l_S2k_Fachaerztliche-Diagnostik-Therapie-erwachsene-Patienten-Husten__2025-02_1.pdf Hausärztliche Leitlinie zu Husten:https://www.degam.de/files/Inhalte/Leitlinien-Inhalte/Dokumente/DEGAM-S3-Leitlinien/053-013_Akuter%20und%20chronischer%20Husten/oeffentlich/053-013l_akuter%20und%20chronischer%20Husten_V3.1_18-01-22.pdf Studie zur Wirksamkeit von Honig bei Husten: https://publications.aap.org/pediatrics/article-abstract/130/3/465/30142/Effect-of-Honey-on-Nocturnal-Cough-and-Sleep?redirectedFrom=fulltext Daten zu Herzinfarkt-Risiko nach Influenza: https://pubmed.ncbi.nlm.nih.gov/38916418/ Studie zu Schlaganfall-Risiko nach Influenza: https://link.springer.com/article/10.1186/s12889-021-10916-4 Hier geht's zur Synapsenseite:https://www.ndr.de/nachrichten/podcastsynapsen100.htmlHabt ihr Feedback oder einen Lifehack aus der Welt der Wissenschaft? Schreibt uns gerne an synapsen@ndr.de.

Manche Atemwegserreger sind gefährlicher als bekannt. Doch man kann einiges tun, um nicht krank zu werden.Jährlich grüßen 200 Viren: Um Infekte kommt im Winterhalbjahr kaum jemand herum. Was weniger bekannt ist: Manche bergen erhebliche Risiken für Herz-Kreislauferkrankungen. Doch es gibt Tricks, wie man sein Ansteckungsrisiko senken kann. Synapsen-Host Korinna Hennig hat sich in Studien und Interviews auf die Suche nach Erkenntnissen jenseits von warm Anziehen und Hühnersuppe begeben. Im Gespräch mit Wissenschaftsredakteurin Melanie Stinn erklärt sie, warum manche Menschen fast ohne Symptome durch die Saison kommen, welche erstaunlichen Effekte sich mit antiallergischen Nasensprays erzielen lassen, was Hustentechniken sind und weshalb die Gefahren der Influenza auch von der Stiko unterschätzt werden. Eine Recherche mit Überraschungseffekten.HINTERGRUNDINFORMATIONENStudie zur Wirkung der Covid-Impfung auf Tumor-Patienten: https://www.nature.com/articles/s41586-025-09655-y Studie symptomatische und asymptomatische Infektionen bei Influenza: https://pmc.ncbi.nlm.nih.gov/articles/PMC7147921/ Studie zu extrazellulären Vesikeln in der Nasenschleimhaut bei Kälte: https://www.jacionline.org/article/S0091-6749(22)01423-3/fulltext RCT zu Effekten von Meerwassernasenspray: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(24)00140-1/fulltext Klinische Phase 2-Studie zu Nasenspray mit Azelastin: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2838335 Studie zu Caragellose-Nasenspray bei Krankenhauspersonal: https://pubmed.ncbi.nlm.nih.gov/34629893/ Studie zum diversen Mikrobiom: https://journals.asm.org/doi/10.1128/msystems.00031-18 Studie zu Probiotika in der pädiatrischen Notaufnahme: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831509 Studie zu Mäusen nach Antibiotikagabe: https://www.pnas.org/doi/10.1073/pnas.1019378108 Pneumologische Leitlinie zu Husten: https://register.awmf.org/assets/guidelines/020-003l_S2k_Fachaerztliche-Diagnostik-Therapie-erwachsene-Patienten-Husten__2025-02_1.pdf Hausärztliche Leitlinie zu Husten:https://www.degam.de/files/Inhalte/Leitlinien-Inhalte/Dokumente/DEGAM-S3-Leitlinien/053-013_Akuter%20und%20chronischer%20Husten/oeffentlich/053-013l_akuter%20und%20chronischer%20Husten_V3.1_18-01-22.pdf Studie zur Wirksamkeit von Honig bei Husten: https://publications.aap.org/pediatrics/article-abstract/130/3/465/30142/Effect-of-Honey-on-Nocturnal-Cough-and-Sleep?redirectedFrom=fulltext Daten zu Herzinfarkt-Risiko nach Influenza: https://pubmed.ncbi.nlm.nih.gov/38916418/ Studie zu Schlaganfall-Risiko nach Influenza: https://link.springer.com/article/10.1186/s12889-021-10916-4 Hier geht's zur Synapsenseite:https://www.ndr.de/nachrichten/podcastsynapsen100.htmlHabt ihr Feedback oder einen Lifehack aus der Welt der Wissenschaft? Schreibt uns gerne an synapsen@ndr.de.

Rick Bente, co-founder and CEO of Indomo, the company behind ClearPen, an investigational at home corticosteroid injection for inflammatory acne. Rick brings over two decades of experience in drug delivery and diagnostics with previous roles at Medtronic, Insulet and YourBio.In this episode we trace Rick's journey from insulin pumps, large volume wearable injectors and remote blood collection to tackling one of the most common yet under-served conditions in medicine: acne. Rick explains why dermatology has seen far less innovation than fields like diabetes, why 40 percent of acne sufferers in the US live with deep inflammatory lesions that topicals simply cannot reach and how ClearPen aims to replicate in-clinic injections safely in the home.We dig into how dermatologists and GPs perceive acne severity, the mental health burden of adult acne and why telehealth has become a critical tool when wait times to see a dermatologist can exceed three months. Rick also unpacks the technical and regulatory complexity of combination products, from tying drug and device design histories together to generating RCT-grade evidence that satisfies regulators, payers and prescribing physicians.Finally, we talk about the realities of building a direct-to-patient model in a regulated market, balancing unmet patient need with the gatekeeping role of clinicians and insurers, and Rick's own transition from corporate engineer to founder. He shares candid lessons on focusing beyond the patient to the full healthcare ecosystem, designing devices that are “hard to misuse” and why turning ideas into reality ultimately requires taking the leap.Timestamps[00:00:21] From insulin pumps and wearables to dermatology and ClearPen[00:02:27] Why acne and dermatology have been under-innovated compared to other MedTech fields[00:05:25] Acne beyond teenagers: genetics, adult breakouts and mental health impact[00:07:16] How dermatologists versus GPs understand acne severity and burden[00:09:27] Typical US acne care pathway and why Accutane was the last big breakthrough[00:11:54] Using telehealth to address three-month dermatologist wait times[00:15:16] Investigational at-home corticosteroid injections and designing for safe use[00:17:21] Biggest technical and regulatory challenges in drug-device combination products[00:19:59] Where founders go wrong with direct-to-patient models in healthcare[00:24:13] Moving from engineer to founder and building around value inflexion pointsConnect with Rick - ⁠⁠⁠https://www.linkedin.com/in/rick-bente/Learn more about Indomo - ⁠⁠⁠https://www.linkedin.com/company/indomotx/Get in touch with Karandeep Badwal - ⁠⁠⁠⁠https://www.linkedin.com/in/karandeepbadwal/ ⁠⁠⁠⁠Follow Karandeep on YouTube - ⁠⁠⁠⁠https://www.youtube.com/@KarandeepBadwal⁠⁠⁠⁠Subscribe to the Podcast

🧭 REBEL Rundown 📌 Key Points 💀 Mortality: No statistically significant difference in 28-day mortality between ketamine vs etomidate for intubation in critically ill patients, though there was a ~1% absolute difference favoring ketamine. 📉🫀⚠️ Hemodynamics: Ketamine induction was associated with more cardiovascular collapse, mainly driven by new/increased vasopressor use (dose escalation or addition of a vasoactive agent). 💉⬆️ Click here for Direct Download of the Podcast. 📝 Introduction Etomidate or ketamine? The debate over the ideal agent for emergency rapid sequence intubation (RSI) has raged for years with no clear winner. Etomidate has been touted in the past for its rapid onset and minimal intrinsic effects on hemodynamics. However, the drug is well known as a transient adrenal suppressant though the impact of this suppression isn’t clear. Ketamine has risen in recent years as an alternative, due to its perceived hemodynamic stability, analgesic properties and absence of adrenal suppression. Additionally, recent data points towards improved mortality when ketamine was selected over etomidate (Kotani 2023). High quality randomized controlled trials are needed to further elucidate which agent should be selected in critically ill patients. 🧾 Paper Casey JD et al. Ketamine or etomidate for tracheal intubation of critically ill adults. NEJM 2025. PMID: 41369227 🔙Previously Covered On REBEL REBEL EM: The EvK Trial: Ketamine vs Etomidate for Rapid Sequence IntubationREBEL EM: From Debate to Data: Emerging Insights into RSI Induction with Ketamine vs Etomidate ️ What They Did CLINICAL QUESTION In critically ill adults undergoing tracheal intubation, does the use of ketamine instead of etomidate result in improved 28 day mortality? STUDY DESIGN Multicenter, randomized, open-label trial in both emergency departments and ICUs. POPULATION Inclusion Criteria:Critically ill patients > 18 years of age undergoing tracheal intubation with the use of an induction agentExclusion Criteria:Known pregnancyPrisonersPrimary diagnosis of traumaNeed for immediate intubation precluding randomizationClinicians determined that the use of ketamine or etomidate was either necessary or contraindicated INTERVENTION & COMPARATOR Intervention (HFNC Group):Ketamine administered based on a provided nomogram: full dose (2.0 mg/kg), intermediate dose (1.5 mg/kg) or reduced dose (1.0 mg/kg)Comparator (BPAP Group):Etomidate administered based on a provided nomogram: full dose (0.3 mg/kg), intermediate dose (0.25 mg/kg) or reduced dose (0.2 mg/kg) OUTCOMES Primary: In-hospital death from any cause by day 28.Secondary:Cardiovascular collapse during intubation defined as SBP < 65 mm Hg, receipt of new or increased dose of vasopressors or cardiac arrest.Exploratory Procedural:Lowest systolic blood pressureLowest systolic blood pressure below 80 mmHgHighest systolic blood pressure above 180 mmHgLowest oxygen saturationLowest oxygen saturation below 80%Successful first attempt intubationTime from induction to intubationExploratory Clinical:Number of ventilator free daysVasopressor-free daysICU free days Safety: Systolic blood pressure at 24 hours after enrollmentOngoing receipt of vasopressors at 24 hours 📈 Results: 2365 patients were randomizedKetamine: 1176Etomidate: 1189> 99% of patients received the drug they were randomized to receiveNMBA: 69% of patients in both groups received rocuronium~ 95% of patients had video laryngoscopy for the primary intubation attempt 💥 Critical Results 💪 Strengths Multicenter ED + ICU cohort of critically ill patients → improves external validityStrong randomization → balanced baseline characteristicsRight population for the question → appropriately focused on a sick cohort where induction choice matters mostHigh protocol adherence → most patients received the agent they were randomized toExcellent follow-up → minimal loss to follow-up / outcome capture ⚠️ Limitations No blinding → potential performance/resuscitation biasTrauma excluded → limits applicability to peri-intubation trauma careCase-mix skewed toward septic shock → may reduce generalizability to other shock etiologiesPower assumptions → designed to detect a 5% mortality difference (possibly overly ambitious)Equipoise-only enrollment → excluded patients with clear indication/contraindication → selection bias + reduced real-world applicabilityComposite secondary outcome with non-equivalent endpoints (e.g., cardiac arrest vs vasopressor titration)Ketamine dosing by actual body weight (vs ideal) → may have increased dose/exposure in some patients 🗣️ Discussion The increase in cardiovascular collapse seen with ketamine was driven by the “new or increased vasopressor use” piece of the composite outcome not by the more clinically relevant severe hypotension (SBP < 65 mm Hg) or cardiac arrest.The increase in CV collapse is a secondary outcome and hypothesis generating onlyCare beyond induction agent isn’t clearly delineated and may have varied between groupsReasons why there was more CV collapse in the ketamine group:Patients in the etomidate group were more likely to be on pressors or have pressor increases prior to induction agent administrationKetamine has analgesic properties which may affect hemodynamics (etomidate does not have analgesic effects)The standard ketamine dose of 2 mg/kg is higher than the induction dose used by most (1-1.5 mg/kg)Ketamine dosing was based on actual body weight though ideal body weight dosing is more accepted. This may have resulted in unnecessarily large ketamine doses that may have had a greater effect on hemodynamics.This is a study of patients with clinical equipoisePatients who the clinician determined would clearly benefit from one agent or the other or in whom one agent or the other was contraindicated were excluded from the study.This may add a selection bias to the results.Clinicians were not blinded to the induction agent administeredThe absence of blinding can introduce bias.For instance, knowledge of the agent the patient was randomized to may result in different resuscitative treatment prior to intubation.An induction agent nomorgram was provided to allow clinicians to choose their induction dose depending on patient stability.A 5% difference in mortality may be overly ambitious. As Josh Farkas points out in his post on this article, PCI for STEMI only has a 3% absolute difference in mortality versus standard care.The 1% absolute difference in mortality while not statistically significant would be clinically significant if it was real. The study would have to be much larger to show a statistically significant 1% difference.About 2% of patients in each group received additional medications during induction (propofol, benzodiazepines, opiates). It is unclear why these agents were selected in specific cases and how they may have affected the outcomes in question. 📘 Author's Conclusion “Among critically ill adults undergoing tracheal intubation, the use of ketamine to induce anesthesia did not result in a significantly lower incidence of in-hospital death by day 28 than etomidate.“ 💬 Our Conclusion In this well done RCT, induction with ketamine did not result in a lower 28-day mortality when compared to induction with etomidate in critically ill adults. The secondary outcome of an increase in cardiovascular collapse is interesting and should be studied more in the future. 🚨 Clinical Bottom Line This data should not drive clinicians to abandon the use of ketamine in RSI. To the contrary, the study leaves open the possibility of a clinically meaningful difference in mortality favoring ketamine that may be borne out in a larger study. However, etomidate can be considered as a first-line option for RSI and may be the superior drug in patients at high-risk for cardiovascular decompensation. Post Peer Reviewed By: Post Peer Reviewed By: Mark Ramzy, DO (X: @MRamzyDO), Frank Lodeserto, MD and Anand Swaminathan, MD (X: @EMSwami) 📚 References Kotani Y et al. Etomidate as an induction agent for endotracheal intubation in critically ill patients: a meta-analysis of randomized trials J Crit Care 2023;77:154317. PMID: 37127020 👤Associate Author Anand Swaminathan MD, MPH All Things REBEL EM Meet The Team 🔎 Your Deep-Dive Starts Here The RSI Trial: Ketamine vs Etomidate in Rapid Sequence Intubation Etomidate or ketamine? The debate over the ideal agent for emergency rapid sequence ... Resuscitation Read More REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of ... Procedures and Skills Read More The post The RSI Trial: Ketamine vs Etomidate in Rapid Sequence Intubation appeared first on REBEL EM - Emergency Medicine Blog.

The Story Science Forgot: Why Psychotherapy Needs Narrative More Than Ever by Joel Blackstock LICSW-S MSW PIP no. 4135C-S | Dec 15, 2025 | 0 comments Joseph Campbell is arguably one of the most influential intellectuals of the twentieth century. If you have watched a Marvel movie or read a modern fantasy novel or sat in a screenwriter's workshop you have encountered his fingerprints. George Lucas explicitly credited Campbell's The Hero with a Thousand Faces as the structural backbone of Star Wars. Every major Hollywood studio has copies of his work floating around their development offices. Even filmmakers who actively deconstruct his monomyth model still have to be in conversation with Campbell to do so. You cannot escape him if you are telling stories in the Western tradition. But here is the thing about Joseph Campbell that we need to hold in our minds when we think about what psychology has become. He was a showman. He was a legitimate scholar but also someone who understood that the truth sometimes needs a little theatrical assistance. The Showman and the Bear Bones One of Campbell's favorite presentation techniques involved showing an image of ancient bear bones that were perhaps two million years old and discovered in a cave. The bones had been arranged in a particular way with pieces shoved back into the bear's mouth. Campbell would present this with his characteristic gravitas and explain that the ancients understood that nature must eat of itself. They knew that to take life is to participate in a cyclical loop of giving and receiving. The bear consuming itself was a ritual recognition that we are all food for something else. It is a beautiful interpretation. It is probably even partially true. We know through depth psychology and early anthropology that prehistoric humans were almost certainly trying to make meaning of existential realities. Ritual practices around death and consumption are well documented across cultures. Campbell was not fabricating this from nothing. But also come on Campbell. These are two million year old bones shoved in a hole. Maybe the jaw just collapsed that way. Maybe soil shifted. Maybe an animal disturbed them centuries after burial. He did not know. He could not know. And yet he presented it with the confidence of revealed truth. Here is why this matters. Campbell's influence is incalculable despite his methodological looseness. He told a story that resonated so deeply with something in the human psyche that it became the invisible architecture of our entire entertainment industry. He was not objectively right about those bear bones but he was pointing at something real about how humans make meaning. The story he told about that meaning making was more powerful than any peer reviewed paper could have been. We need to remember this when we think about psychotherapy and what it has become. The Dream I Had and the World I Found When I first entered the field of psychotherapy I had a fantasy. I thought I was going to be Joseph Campbell. I was going to find my way to someplace like Berkeley and immerse myself in the grand conversation between psychology and mythology and anthropology and philosophy. I imagined something like the Esalen Institute in the 1970s where Fritz Perls developed Gestalt therapy and where researchers and mystics and clinicians sat together in hot springs and argued about the nature of consciousness. Those places barely exist anymore. What I found instead was a competitive model built on H-indexes and impact factors. I found academic departments that had been siloed into increasingly narrow specializations. Each department defended its territorial boundaries against incursion from neighboring disciplines. The institute model where a psychologist might spend an afternoon talking to an anthropologist about ritual has been systematically dismantled. What we have instead are specialists who do not read outside their sub specialty and researchers whose entire careers depend on defending one narrow hypothesis. We have an incentive structure that actively punishes the kind of cross pollination that leads to genuine discovery. The Hollow Room: How the Biomedical Model Fails This is not just an academic inconvenience. It is a catastrophe for the human sciences and for the actual treatment of patients. There is a reason Freud stuck around. It is not because psychoanalysis was rigorously validated through randomized controlled trials. It is because as the science writer John Horgan observed old paradigms die only when better paradigms replace them. Freud lives on because science has not produced a theory of and therapy for the mind potent enough to render psychoanalysis obsolete once and for all. The biomedical model promised us a better story. It told us that humans are biological machines and that suffering is just a mechanical malfunction. It promised that if we could just find the right neurotransmitter or the right gene we could fix the machine. But look at what that looks like in practice. It looks like the 15 minute medication management appointment. A person comes in with their life falling apart. They are grieving a divorce or wrestling with the trauma of their childhood or facing a crisis of meaning. And the doctor looks at a checklist. They ask about sleep. They ask about appetite. They ask about energy levels. They treat the symptoms like check engine lights on a dashboard. They prescribe a pill to dim the lights and they send the person away. It looks like manualized Cognitive Behavioral Therapy. This is the gold standard of evidence based treatment. But in the vacuum of a manual it becomes absurd. A patient might be crying about the loss of a child and a therapist who is strictly adhering to the protocol has to redirect them to the agenda for Module 3 which is identifying cognitive distortions. The model has no room for the tragedy of the situation. It only has room for the erroneous thought that the patient is having about the tragedy. The result is that by most measures we are not actually helping people more effectively than we were fifty years ago. To understand the depth of this failure, we must look at the “smoking gun” of the psychiatric establishment: the STAR*D study. For nearly two decades, this massive, taxpayer-funded study was held up as the irrefutable proof that the “medication merry-go-round” worked. It cost $35 million and was cited thousands of times to justify the idea that if a patient didn't get better on one antidepressant, you simply switched them to another, and then another. The study claimed a “cumulative remission rate” of 67%. It told us that two-thirds of people would be cured if they just complied with the protocol. This was a lie built on methodological quicksand. A forensic re-analysis of the data (Pigott et al., 2023) revealed that the researchers had inflated their success rates through a series of stunning methodological sleights of hand. The original design called for the Hamilton Rating Scale for Depression (HRSD) to be the primary outcome measure. But when that scale wasn't showing the numbers they wanted, investigators switched to a secondary, unblinded, self-report questionnaire (the QIDS-SR) which painted a rosier picture. Furthermore, the re-analysis exposed that hundreds of patients who dropped out due to side effects were excluded from the failure count, effectively scrubbing the negative data. Even worse, over 900 patients who didn't even meet the minimum severity for depression were included to boost the numbers. When the data was re-analyzed using the study's original criteria and including all participants, the cumulative remission rate plummeted from 67% to 35%. But the most damning statistic is the sustained recovery rate. Of the 4,041 patients who entered the trial, only a tiny fraction achieved remission and actually stayed well. When accounting for dropouts and relapses over the one-year follow-up period, a mere 108 patients achieved remission and stayed well without relapsing. That is a sustained recovery rate of 2.7%. If a heart surgery or cancer treatment had a failure rate of 97.3%, it would be abandoned. Yet, this study was championed by investigators with deep financial ties to the pharmaceutical industry, and the results were codified into clinical guidelines that still rule the profession today. This is the indictment: we have built an entire system of care on a statistical fabrication, prioritizing the protection of the model over the healing of the human. I have big problems with Freud. I have big problems with classical psychoanalysis. I am more of a Jungian. But here is what the depth psychologists understood that the biomedical model forgot. Humans are not just biological machines. We are meaning making creatures who navigate the world through story. When you take away our stories you do not make us more rational. You make us lost. The Flock of Dodos This separation of science from narrative has hurt the researchers too. In his book The Ghost Lab journalist Matt Hongoltz-Hetling uses the flock of dodos metaphor to describe this phenomenon. He argues that specialized creatures that are perfectly adapted to narrow environments become extinct when conditions change. Academic science has become a flock of dodos. A neuroscientist studies one particular brain region. A psychologist studies one particular therapeutic intervention. An anthropologist studies one particular culture. Nobody is allowed to step back and ask what all of this means together. When you silo information into separate academic disciplines instead of organizing it into a holistic understanding you kill the narratives that are already there. You cannot see the story until you step back far enough to recognize the pattern. Heidegger and the AI Bubble One of the primary functions of a subjective narrative in an objective field like psychotherapy is that it lets us start with things we consider self evident. These are things that do not need evidence because they are the ground upon which evidence stands. Things like humanity is important. Things like we contain multiplicities and conflicting parts. Things like consciousness is a mystery. The biomedical model has no way to accommodate these self evident truths because they are not measurable. You cannot run a randomized controlled trial on human dignity. Martin Heidegger understood this trajectory. He warned that science and technology were becoming self justifying systems that asked only whether something could be done and never whether it should be done. We are watching this play out right now with Large Language Models and Artificial Intelligence. The tech industry is boiling seawater and consuming enormous amounts of our remaining resources to build ever larger systems. As Ed Zitron has documented the current AI boom is likely a bubble that will crash and burn. It may leave us with a Google monopoly on Gemini that will not actually help anybody. Should we be doing this? Should we be fundamentally restructuring our economy around technology whose benefits are speculative at best? The Heideggerian answer is that we are not even capable of asking these questions properly because we have lost the narrative framework within which “should” makes sense. When everything is reduced to capability and efficiency the concept of values disappears. The Perennial and the Possible Can we just recognize that having a livable planet is probably a self evidencing goal? Can we recognize that having a psychotherapy willing to engage with perennial philosophy might be more valuable than another meta analysis demonstrating small effect sizes for manualized interventions? This is what I mean by reintroducing narrative. I do not mean replacing evidence with myth. I mean recognizing that the facts do not speak for themselves. Data requires interpretation. Interpretation requires a framework. And frameworks are stories about what matters. The story science forgot is the story of science itself. It is the story of how inquiry emerged from human communities trying to understand their world. We can recover this story. We can rebuild the connections that the academic silos have severed. The path is there. It always has been. We just need to be brave enough to walk it. The Exodus of the Sick If academic science has become a flock of dodos clinical practice has become something arguably worse. It has become a reenactment of the Milgram experiment where the system plays the role of the authority figure and the patient plays the victim. We often remember Stanley Milgram's famous 1961 study as a lesson about the capacity for evil but its deeper lesson was about the capacity for distance. When the subject had to physically touch the victim compliance with the order to harm them dropped to 30 percent. The White Coat only retained its authority when it created a buffer between the human actions and their consequences.   Modern psychotherapy has built a massive administrative White Coat that separates the healer from the healed. This is not just a metaphor. It is a structural reality that is actively driving patients out of the profession and into the arms of pseudoscience. The Bureaucracy as Trauma For a patient in crisis the Evidence Based system often functions as a machine of exclusion. A study on healthcare administrative burdens reveals that the psychological cost of navigating billing and insurance denials and intake forms acts as a friction that hits the most vulnerable the hardest. We ask trauma survivors to retell their stories to three different intake coordinators before they ever see a therapist. This process is itself retraumatizing. When they finally reach a provider they are often met with the biomedical gaze which is a checklist driven assessment that reduces their complex narrative of suffering to a code for billing. As the Australian Psychological Society has noted the chemical imbalance theory and the medicalization of distress have failed to reduce stigma and have instead left patients feeling defective and unheard. The result is a profound Low Trust environment. Theodore Porter in his book Trust in Numbers argues that we only rely on strict mechanical numbers when we do not trust people. We use the DSM and manualized protocols because insurers do not trust clinicians to judge and clinicians do not trust themselves to deviate. The Great Split: Why Research and Practice Are Divorcing This creates a fundamental schism that explains why the profession feels like it is cracking in half. On one side you have the academic researchers who are incentivized by grant funding and publication metrics. To get these rewards they must isolate variables and create reproducible manualized protocols. This means they must strip away the very thing that makes therapy work which is the messy and unrepeatable human relationship. On the other side you have the clinicians who are incentivized by patient outcomes. They are in the room with the messiness. They see that the manualized protocol fails the complex trauma patient so they improvise. They integrate. They use intuition. The academic looks at the clinician and sees a cowboy who ignores the data. The clinician looks at the academic and sees a bureaucrat who has never treated a suicidal patient. This is why the research is no longer informing the practice. We have created two different languages. The researcher speaks in p-values and population averages while the clinician speaks in case studies and individual breakthroughs. Why Pseudoscience Wins the Trust War This low trust environment creates a vacuum that wellness influencers are all too happy to fill. We often mock the public for turning to unverified supplements and TikTok diagnosticians and quantum mysticism. But we have to ask what these influencers are providing that we are not. They are providing narrative. They are providing connection. They are providing a. parasocial yes but still, High Trust experience. A recent analysis suggests that wellness fads thrive not because people are stupid but because the influencers offer a feeling of personal validation that the medical system denies. Even AI chatbots are now being described by users as more humane than doctors because the AI listens to the whole story without looking at a watch or a checklist. When a patient is told by a doctor that their pain is idiopathic or psychosomatic because it does not show up on a lab test and then an influencer tells them I see you and I believe you and here is a story about why this is happening the patient will choose the influencer every time. The trust gap drives them away from care that might actually help and toward solutions that feel good but do nothing. The Clinician's Moral Injury This leaves the ethical psychotherapist in a state of moral injury. We are forced to participate in a system that we know is alienating the very people we are trying to help. We are trained to value the therapeutic alliance or the bond of trust above all else yet we work in a system designed to sever it with paperwork and time limits and standardized protocols. We have to put down the White Coat of administrative distance. We have to stop hiding behind the Evidence Based label when that label is being used to deny the reality of the person in front of us. Proposals for a Unified Future If we want to stop this exodus and heal the split we need specific structural changes. We cannot just hope for better insurance reimbursement. We need to change what we consider valid science. First we must re-legitimize the systematic case study. For a century the detailed narrative of a single patient was the gold standard of learning. We replaced it with the aggregate data of the randomized controlled trial. We need to bring it back. We need journals that publish rigorous detailed accounts of what actually happens in the room when a patient gets better. Second we need to build open source repositories for clinical observation. Currently the wisdom of the field is locked behind for profit paywalls or lost in the private notes of isolated therapists. We need a Wikipedia of Clinical Practice where thousands of clinicians can document what they are seeing in real time. If ten thousand therapists report that somatic processing helps complex trauma that is a data set that rivals any RCT. Third we need to teach philosophy and narrative in graduate school again. We are training technicians when we should be training healers. A therapist who knows how to read a spreadsheet but does not know how to understand a story is useless to a human being in crisis. If we do not offer a therapy that is human and narrative and deeply relational we will continue to lose our patients to those who do even if what they are offering is a lie. The Mirror and the Map: Why Math is a Story We often treat mathematics as if it were the bedrock of reality itself. We act as though a p-value is a piece of the universe, like a rock or a proton. But we must remember that math is not the thing itself. It is a representation of the thing. It is a map, not the territory. It is a mirror, not the face. Theodore Porter's work in Trust in Numbers reminds us that we reach for these mirrors when we do not trust our own eyes. But the mirror is useless without someone to look into it and interpret the reflection. Data by itself is pointless. It is a pile of bricks without an architect. It requires interpretation to become meaning, and interpretation is fundamentally a narrative act. When we try our best to make a purely objective study, we are still telling a story. We are saying, “These numbers represent this phenomenon.” Then another researcher comes along, looks at the same numbers, and tells a different story: “No, they represent that.” This conflict isn't a failure of science; it is science. The Storytellers of Science The greatest breakthroughs in history did not come from people who just crunched numbers. They came from people who could see the story the numbers were trying to tell. These stories are really damn interesting, often stranger and more beautiful than fiction. Consider August Kekulé. He didn't discover the structure of the benzene molecule by staring at a spreadsheet. He discovered it by dreaming of a snake eating its own tail—the Ouroboros. His subjective, narrative brain provided the image that unlocked the objective chemical reality. The data was there, but it needed a myth to make it intelligible. Look at Quantum Physics. The raw math of quantum mechanics is cold and abstract. But when physicists like Erwin Schrödinger or Werner Heisenberg looked at that data, they saw a story about uncertainty, about cats that are both alive and dead, about a universe that only decides what it is when it is observed. They didn't just calculate; they interpreted. They told a story about reality that was so radical it changed how we understand existence. Even in psychology, the data of the “talking cure” was messy and anecdotal until Freud and Jung gave us the language of the Unconscious and the Archetype. Were they objectively “right” in every detail? No. But they gave us a framework—a story—that allowed us to navigate the chaos of the human mind. They provided the map that allowed us to enter the territory. The Final Integration We have spent the last fifty years trying to strip this storytelling capacity out of our profession in a misguided attempt to be taken seriously by the “hard” sciences. In doing so, we have thrown away our most powerful tool. The brain is a story-processing machine. To treat it with checklists and spreadsheets is to deny its fundamental nature. We need to be brave enough to pick up the mirror again. We need to be brave enough to look at the data—whether it's the 2.7% recovery rate of STAR*D or the trembling pupil of a trauma patient—and ask, “What is the story here?” The path forward isn't about choosing between science and narrative. It is about realizing that science is a narrative. It is the grandest, most complex, most rigorous story we have ever tried to tell. And it is time we started telling it properly again.   More @ https://gettherapybirmingham.com/

This week’s Pulm PEEPs Pearls episode is a focused discussion between Furf and Monty about non-pharmacologic techniques for airway clearance in the non-Cystic Fibrosis bronchiectasis population. This is a focused, high-yield discussion of the key points about airway clearance, including practical tips and a discussion of the evidence. This episode was prepared in conjunction with George Doumat MD. Goerge is an internal medicine resident at UT Southwestern and joined us for a Pulm PEEPs – BMJ Thorax journal club episode. He is now acting as a Pulm PEEPs Editor for the Pulm PEEPs Pearls series. Key Learning Points 1) Why airway clearance matters in non-CF bronchiectasis Non-CF bronchiectasis is defined by irreversible bronchial dilation with impaired mucociliary clearance, leading to mucus retention. Retained sputum drives the classic vicious cycle: mucus → infection → neutrophilic inflammation → airway damage → worse clearance. Airway clearance techniques (ACTs) are meant to interrupt this cycle, primarily by improving mucus mobilization and symptom control. 2) What ACTs are trying to achieve clinically Main benefits are: More effective sputum clearance Reduced cough/dyspnea burden Improved activity tolerance and quality of life Effects on spirometry are usually small. Exacerbation reduction is possible, but evidence is mixed—some longer-term data suggest benefit for specific techniques. 3) The main ACT “families” and when to use them Breathing-based techniques (device-free, flexible) ACBT (Active Cycle of Breathing Technique): breath control → deep breaths with holds → huffing. Pros: portable, adaptable, good first-line option. Key requirement: teaching/coaching to get technique right. Autogenic drainage: controlled breathing at different lung volumes to move mucus from peripheral → central airways. Pros: no device, can work well once learned. Cons: more technically demanding, needs training and practice. PEP / Oscillatory PEP (stents airways + “vibrates” mucus loose) PEP: back-pressure helps prevent small airway collapse during exhalation; often paired with huff/cough. Oscillatory PEP (Flutter/Acapella/Aerobika): adds oscillation that many patients find easy and satisfying to use. Good fit for: people who benefit from airway stenting, want something portable, and prefer a device. Mechanical/manual techniques (help when patient can't self-clear well) HFCWO (“the vest”): external chest wall oscillation; helpful for high sputum volumes, dexterity limits, or difficulty coordinating breathing maneuvers. Postural drainage/percussion/vibration: caregiver/therapist-assisted options; still useful but consider: GERD/reflux risk with certain positions Hemoptysis risk with vigorous techniques 4) How to choose the “right” technique (the practical framework) There is no one-size-fits-all. Match the tool to the patient: Sputum burden (volume/viscosity) Strength, coordination, cognition, dexterity Comorbidities (GERD, hemoptysis history, severe obstruction/airway collapse) Lifestyle + portability (what they'll actually do) Cost/access and availability of respiratory therapy/physio support A key mindset from the script: this is not a lifetime contract—reassess and adjust over time with shared decision-making. 5) Evidence takeaways (what improves, what doesn't) ACTs reliably improve sputum expectoration and often symptoms/QoL. QoL/cough scores (e.g., SGRQ, LCQ) tend to improve modestly, particularly with oscillatory PEP and some vest studies. Lung function: typically minimal change; occasional short-term FEV₁ benefit is reported in some vest trials. Exacerbations: mixed overall; the script highlights a longer-term RCT of ELTGOL showing fewer exacerbations at 12 months vs placebo exercises. Safety: generally excellent; main cautions are hemoptysis and reflux (depending on technique/positioning). 6) Special population pearls Hemoptysis / fragile airways: start with gentle breathing-based ACTs (ACBT, controlled huffing); avoid overly vigorous oscillatory/manual methods if concerned. Severe obstruction or early airway collapse: PEP/oscillatory PEP can help by keeping small airways open on exhalation. Mobility/coordination barriers: consider HFCWO vest or simple oscillatory PEP devices to enable daily adherence. During exacerbations: keep it simple—1–2 reliable techniques, prioritize daily consistency, and re-check technique. 7) The “real” bottom line Start with simple, self-manageable options (often ACBT ± PEP). The “best” ACT is the one the patient will do consistently. Reassess technique and fit over time; education and demonstration are part of the therapy. References and Further Reading  Lee AL et al., “Airway clearance techniques for bronchiectasis,” Cochrane Database Syst Rev. 2015; PMC7175838. PMID: 26591003. Athanazio RA et al., “Airway Clearance Techniques in Bronchiectasis,” Front Med (Lausanne). 2020; PMC7674976. PMID: 33251032. Iacono R et al., “Mucociliary clearance techniques for treating non-cystic fibrosis bronchiectasis,” Eur Rev Med Pharmacol Sci. 2015; PMID: 26078380. Polverino E et al., “European Respiratory Society statement on airway clearance techniques in bronchiectasis,” Eur Respir J. 2023; PMID: 37142337. Doumat G, Aksamit TR, Kanj AN. Bronchiectasis: A clinical review of inflammation. Respir Med. 2025 Aug;244:108179. doi: 10.1016/j.rmed.2025.108179. Epub 2025 May 25. PMID: 40425105.

Send us a textSummary: I separate cold-season fact from folklore so you know what truly prevents colds, what (slightly) shortens them, what eases symptoms—and what to skip. Save money, feel better, and keep it simple.What we coverHow common colds are and how long they last (2–3 per year on average; usually 5–7 days; cough can linger).Prevention audit: Vitamin C doesn't prevent colds in the general population (Cochrane), though it helped in physically stressed groups; handwashing probably helps (Cochrane) echinacea doesn't pan out (Cochrane) garlic didn't reduce colds but modestly reduced severity in one RCT (trial) gargling showed a very small signal (trial)Grandma's wisdom check: Short sleep (

 Join hosts Raj, Ashwin, and Eddie in this episode of Blood Cancer Talks as they welcome Dr. Luciano Costa, the first author of the NEJM manuscript on the MajesTEC-3 RCT, which was presented at ASH 2025. This episode dives deep into the trial's topline findings, capturing the nuances of the patient population, efficacy and safety data, and the future implications for treatment. The episode also examines the comparative efficacy of bispecific T-cell engagers versus CAR-T therapies, along with spirited discussion on the potential for fixed-duration treatment in myeloma care. Episode Highlights Main Topics Covered MajesTEC-3 Trial: Teclistamab-Daratumumab vs. Standard of Care Trial design and patient populationPrimary endpoint: Progression-free survival (PFS)MRD negativity rates and depth of responseOverall survival and safety profileClinical implications for treatment selectionTreatment Selection in Early Relapse Comparing MajesTEC-3 and CARTITUDE-4 patient populationsFramework for choosing between bispecific antibodies vs. CAR T-cell therapyManaging anti-CD38 exposed patientsLink to the NEJM paper: https://www.nejm.org/doi/abs/10.1056/NEJMoa2514663  

Welcome to January's Papers of the Month, which marks 10 years of the podcast! First up, we look at a large multicentre cohort study from the East of England examining the association between prehospital post-intubation hypotension and mortality in severe traumatic brain injury. Preventing secondary brain injury sits at the centre of what we're try to achieve in early TBI care, but this paper quantifies the impact of post-RSI hypotension in a dramatic way and the associated increase in 30-day mortality. Our second paper moves into the world of stable supraventricular tachycardia, asking whether an elevated troponin level in this cohort predicts short-term cardiovascular events. Troponin testing in SVT is common but debated: is it useful, or is it a diagnostic red herring? Finally, we look at BICARICU-2, a major multicentre RCT examining sodium bicarbonate for severe metabolic acidemia in patients with moderate–severe AKI. We explore what this means for bicarbonate use for this group of patient, both in terms of mortality rates and the need for renal replacement therapy. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

Top 5 Topics:- ***What TikTok Isn't Telling You About Your Teeth***- Why Smart Dentists Are Quitting Corporate Dentistry- This Is Why Your Dental Bill Feels Like a Scam:- Veneers, Crowns, and the Internet True/False Information About Your Teeth- Treatment Planning Before Procedure Selection Prevents Future MistakesQuotes & Wisdom:(00:30) “We need more diagnosticians. We need more people who focus on treatment planning… and work collaboratively with specialists to give people the best treatment.”(06:14) “The order of treatment planning is crucial. If you skip steps or try to do something too fast, that could really compromise something later down the road.”(10:04) “I never want to work 5 days clinically. I think 4 is plenty.”(10:25) “You've got to respect your team and you want them to get home to their families.”(28:35) “The same wave… that happened in medicine is happening in dentistry.”(28:35) “ROI isn't just money… ROI could be working four days a week… time with friends, family, travel… ROI is what you make of it.”(31:39) “You can't put a number on [time with the patient]. It's not just checking off a list—it's the art of forming the treatment plan.”(36:41) “You have to have thick skin… ‘I hate the dentist' isn't you—it's their prior experience.”(38:13) “The most important thing to be successful in dentistry is how well you can communicate.”Questions:(01:33) “How would you phase that?” (complex case: multiple RCT teeth + wisdom teeth + malalignment)(03:58) “Did he go to Mexico or Turkey for that treatment?”(09:59) “Why'd you pick Wednesday for your off-day in the week?”(12:08) “When did you start this? I want to know more about your background.”(15:14) “Still thinking about moving, or are you locked down in California now?”(18:55) “What initiated that start… and then you decided USC? What got you to look over there for residency?”(27:21) “Did either of those doctors you shadowed own their own practices? And what were the specifics of why they said ‘don't go into medicine'?”(58:20) “What is your take on this cavitation surgery?”Now available on:- Dr. Gallagher's Podcast & YouTube Channel- Dose of Dental Podcast #201My watch in this episode = Tag Heuer Aquaracer Calibre 16 Chrono- 11.2025

Ce lundi 15 décembre 2025, il y avait comme un avant-goût de Noël dans I Love Mes Cheveux : avec Sébastien Jacquelin, journaliste à RCT 99.5 et grand connaisseur de l’oeuvre de Louis de Funès, nous avons exploré les arcanes des scènes parfois très célèbres et parfois plus obscures dans lesquelles le grand acteur comique […] L'article ILMC S2 E09 : De Funès et le plurilinguisme est apparu en premier sur Radio Campus Tours - 99.5 FM.

We dive into what's actually happening in peri- and postmenopause (hormonally, neurologically, and physically) and how those changes show up on the bike. From fear on technical trails, to fatigue, difficulties concentrating, to the “hit by a truck” recovery days… none of this is random. This episode is science-based and NOT only for women

Send us a textMethods & challenges of establishing causal relationships in health research, emphasizing epidemiology, randomized trials, and genetic approaches.Topics:Epidemiology: Studies disease influences using observational designs like case-control and prospective cohorts, plus trials, to identify patterns and test hypotheses.Hierarchy of evidence critique: Rejects rigid pyramids favoring RCTs, as all studies can be biased; advocates triangulation integrating varied data types for robust conclusions.RCT strengths & weaknesses: Randomization balances confounders, but issues like poor blinding, attrition, or subversion can undermine results; large samples may yield spurious precision if biased.Confounding & reverse causation: Examples include yellow fingers and lung cancer (both from smoking) or early atherosclerosis inflating CRP-disease links; hard to fully control statistically.Nutrition epidemiology: Observational studies often overstate benefits (e.g., vitamin E for heart disease), leading to failed trials; incentives favor new findings over revisiting errors.Mendelian randomization: Uses genetic variants as proxies for exposures (e.g., ALDH2 for alcohol metabolism) to mimic randomization; reveals no heart benefits from alcohol, unlike observational data.Negative controls: Tests implausible outcomes (e.g., smoking and murder) or exposures (e.g., paternal smoking in pregnancy) to check for confounding artifacts.Evidence triangulation: Combines diverse studies with different biases (e.g., cross-cultural comparisons) for causality; applied to dismiss HDL-raising drugs despite initial promise.Practical Takeaways:Scrutinize health claims by checking for negative controls or variety in evidence sources to avoid mistaking correlation for causation.For personal decisions like alcohol intake, consider genetic studies showing risks at all levels, and aim for moderation or abstinence based on overall evidence.When evaluating supplements or diets, prioritize trials over observational data, and question media hype that ignores confounding factors.About the guest: Dr. George Davey Smith, MD, DSc is a professor of clinical epidemiology at the University of Bristol and director of the MRC Integrative Epidemiology Unit.*Not medical advice.Support the showAffiliates: Lumen device to optimize your metabolism for weight loss or athletic performance. MINDMATTER gets you 15% off. AquaTru: Water filtration devices that remove microplastics, metals, bacteria, and more from your drinking water. Through link, $100 off AquaTru Carafe, Classic & Under Sink Units; $300 off Freestanding models. Seed Oil Scout: Find restaurants with seed oil-free options, scan food products to see what they're hiding, with this easy-to-use mobile app. KetoCitra—Ketone body BHB + electrolytes formulated for kidney health. Use code MIND20 for 20% off any subscription (cancel anytime) For all the ways you can support my efforts

December brings us to the final Papers of the Month for 2025 and we're finishing the year with three studies that challenge assumptions across critical care and resuscitation! This time questioning the role of arterial lines in shock, looking at the true prognostic value of end-tidal CO₂ in cardiac arrest and finally to airway management in neonates. We start in the ICU with the EVERDAC trial, a large multicentre RCT exploring whether early arterial catheterisation in shock truly changes outcomes. This challenges some of the papers we've recently looked at recently which champion the benefit of early arterial line insertion! The EVERDAC trial looks at the effect they have on mortality and the results are pretty striking. Next, we move into the world of cardiac arrest with a systematic review and meta-analysis examining end-tidal CO₂ as a prognostic tool for ROSC. ETCO₂ is firmly embedded in ALS practice, but its real predictive power isn't completely clear, as we've seen in the recent ERC guidelines. This review pulls together studies with more than 3,000 patients and helps us understand more how much weight we should give to ETCO₂ and the way in which it's best utilised. Finally, we finish with a neonatal focus: a systematic review and meta-analysis comparing video versus direct laryngoscopy for urgent neonatal intubation. Success rates in NICU and delivery room intubation are notoriously low. This paper looks at the impact of video laryngoscopy on first pass success with some dramatic results, which raises important questions around training and resource allocation. Three papers, three very different patient groups, and three opportunities to reflect on how evidence continues to challenge our practice. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

Join hosts Eddie, Ashwin, and Raj as they welcome Dr. Michelle Yong and Dr. Gemma Reynolds, academic infectious diseases physicians from the Peter MacCallum Cancer Centre and the National Centre for Infections in Cancer, for an in-depth discussion on cytomegalovirus (CMV) management in immunocompromised hematology patients.Key Topics CoveredFundamentals of CMV ManagementDistinguishing CMV reactivation from CMV diseaseTreatment thresholds and target viral loadsProphylaxis strategies in non-allograft settingsValaciclovir dosing in general hematology populationsHigh-risk patient populationsFirst-Line TherapiesValganciclovir: advantages, disadvantages, and myelosuppressionFoscarnet: indications and monitoring strategiesTreatment-resistant CMVAllogeneic Transplant PatientsHigh-risk populations and timing of reactivationMonitoring protocols post-transplantRandomized Controlled TrialsAURORA Trial: Maribavir vs. ValganciclovirDesign: RCT comparing maribavir to valganciclovir for pre-emptive CMV therapy post-allogeneic transplant [https://pubmed.ncbi.nlm.nih.gov/38036487/]NEJM Letermovir Prophylaxis TrialDesign: Double-blind, placebo-controlled RCT of letermovir prophylaxis post-allogeneic transplant [https://pubmed.ncbi.nlm.nih.gov/29211658/]Emerging Patient PopulationsCMV in lymphoma and myeloma patients receiving CAR T-cell therapy and T-cell engaging bispecific antibodiesMonitoring and prophylaxis strategies for novel immunotherapiesImpact of CMV on post-CAR T mortality-https://pubmed.ncbi.nlm.nih.gov/40203190/

Episode Overview In this episode, Dr. David Rosenblum discusses the role of supplements and complementary strategies in the management of chronic pain. Drawing from clinical practice at AABP Integrative Pain Care, as well as his teaching and training programs, Dr. Rosenblum reviews how nutraceuticals, regenerative therapies, ultrasound-guided procedures, and neuromodulation can work together to improve patient outcomes and reduce opioid reliance. This episode also highlights educational opportunities and exam-prep resources for pain fellows, residents, anesthesiologists, physiatrists, and APPs looking to expand their interventional pain, ultrasound, and regenerative medicine skill sets. Key Topics Discussed Evidence and clinical rationale for select supplements in chronic pain management The role of ultrasound guidance in improving accuracy and safety in interventional pain procedures How regenerative medicine techniques such as PRP and BMAC are shaping personalized pain care Practical considerations when combining supplements with neuromodulation, RFA, or injections Patient case applications and real-world treatment planning Educational Offerings & Learning Opportunities PainExam / NRAP Academy Training & Programs: Neuromodulation & Regional Anesthesia Workshops Ultrasound-Guided Pain Procedures Regenerative Pain Medicine Training Virtual Pain Fellowship Pain Management Board Review & Question Banks Learn More / Register: www.AABPpain.com

James Benenati, Robert Lookstein, and Rachel Rosovsky discuss the STORM-PE trial, the first-of-its-kind RCT for acute intermediate-high risk pulmonary embolism (PE).

In this episode of Medsider Radio, we sat down with Kaitlin Maier, co-founder and CEO of Reia. Reia has developed a self-managed pessary — a collapsible device that empowers women to treat pelvic organ prolapse comfortably and independently. A mechanical engineering graduate of Dartmouth, Kaitlin previously worked at Sherpa Technology Group, developing patent strategies for leading life science and technology firms. In this conversation, Kaitlin shares how she and her co-founders turned a student project into an FDA-cleared product using resource constraints as a design advantage. She explains how to turn FDA feedback into forward momentum, why running an NIH-funded randomized controlled trial (RCT) strengthened both credibility and confidence, and how non-dilutive funding can buy the time and control founders need to build on their own terms.Before we dive into the discussion, I wanted to mention a few things:First, if you're into learning from medical device and health technology founders and CEOs, and want to know when new interviews are live, head over to Medsider.com and sign up for our free newsletter.Second, if you want to peek behind the curtain of the world's most successful startups, you should consider a Medsider premium membership. You'll learn the strategies and tactics that founders and CEOs use to build and grow companies like Silk Road Medical, AliveCor, Shockwave Medical, and hundreds more!We recently introduced some fantastic additions exclusively for Medsider premium members, including playbooks, which are curated collections of our top Medsider interviews on key topics like capital fundraising and risk mitigation, and 3 packages that will help you make use of our database of 750+ life science investors more efficiently for your fundraise and help you discover your next medical device or health technology investor!In addition to the entire back catalog of Medsider interviews over the past decade, premium members also get a copy of every volume of Medsider Mentors at no additional cost, including the latest Medsider Mentors Volume VII. If you're interested, go to medsider.com/subscribe to learn more.Lastly, if you'd rather read than listen, here's a link to the full interview with Kaitlin Maier.

I dette bonusafsnit sidder Ingrid alene i studiet for at tage videre fat på forrige afsnit – og et af de mest oversete temaer i psykiatrien: flygtninge og efterkommere med ubehandlede traumer. Med udgangspunkt i min egen historie fra borgerkrig i Rwanda til en sen PTSD-diagnose spørger jeg, hvorfor traumer behandles som integrationsproblem i stedet for som det, de er: et sundhedsproblem.Sammen med Thomas Rohden, næstformand i Region Hovedstaden og kritiker af tolkegebyret, fokuserer afsnittet bl.a. på disse konkrete knudepunkter: adgang til gratis og professionel tolkning, kultur- og traumeforståelse som en faglig kerneopgave, og øremærkede midler til traumebehandling i samarbejde med de aktører på området, der bærer hele traumebehandlingen, bl.a. DIGNITY, OASIS og RCT.Det her er ikke en nichefortælling, men et spørgsmål om folkesundhed og lighed i psykiatrien.Afsnittet er til dig, der bærer krigen i kroppen, til dig der arbejder i systemet – og til dig, der skal stemme ved kommunal- og regionalvalget i 2025 og fremadrettet vil holde politikerne op på mere end flotte ord.Tusind tak fordi I lytter med.Tak til Lasse Lund for vodcast og Jakob Ranum for studietidTak til Maria Svehag for SoMe.Tak til Awinbeh for jinglen og tak til Liv Habel for vores smukke coverbillede Hosted on Acast. See acast.com/privacy for more information.

Do the many clinical trials into high-dose vitamin C prove it can actually treat the common cold and cancer, rather than just boost the immune system? Why is there ongoing scepticism? Why are multifactorial chronic diseases so hard to study in clinical trials? What is the right dosage to get the best results from vitamin C?In this episode we have the often misunderstood topic of Vitamin C as an antioxidant to get clear on, particular the high-dose approach and particularly delivered intravenously. Despite a very clear consensus that Vitamin C is a great booster to immune function, research that shows that it helps fight the common cold or flu have been dismissed by doctors and medical researchers; as well as claims that higher doses can increase its efficacy. Other claims that Vitamin C can help fight cardio-vascular disease and even cancer have been with even greater scepticism. So what exactly can vitamin C do to assist our immune function to fight disease, and why is there so much confusion about the answer given the high quantity of clinical trials data?Fortunately today's guest has exactly the right skill set and research knowledge to separate the science from the here-say, medical doctor and orthomolecular medicine researcher, Dr. Richard Z Cheng. Dr. Cheng has a PhD in biochemistry and molecular biology; he's served as a doctor in the US military; he has consulted for the National Cancer Institute, and presented at the National Institute of Health (NIH); he has conducted clinical trials; He is the editor in Chief of the Orthmolecular Medicine New Service; He is also a fellow of the American Academy of Anti- Aging medicine; and has run anti-aging and regenerative medicine clinics in both China and the US for over 20 years.What we discuss:00:00 Intro05:15 Most animals produce Vitamin C in the body, but not primates.06:00 Oxidation & Redox: Giving or receiving an electron.11:00 After reducing oxidation the body recycles it back into vitamin C.14:00 Teamwork: sharing electrons between nutrients and vitamins.18:20 Conventional consensus: good for prevention but not treatment.21:00 Over 80K papers on Vit C on Pub Med!21:30 Linus Pauling Intravenous Vitamin C for cancer and heart disease.27:00 Shortening of common cold and lowering of symptoms - Harri Hemila.29:00 Low dose studies dilute the data on the efficacy of the high dose studies.31:00 Intravenous treatment allows much higher doses safely.33:00 Differences in absorption between IV and oral application.35:20 Pro-oxidant effect only possible at IV high dose.36:30 IV clinical trials.39:20 Cytokine storm cascades in acute respiratory distress.44:00 High Dose IV Vitamin C saved lives in China during Covid 19.50:00 Attacks following Richard's NIH presentation on Vitamin C during covid.57:00 Cardio vascular disease - Vit. C research history.01:01:00 Collagen Synthesis for vascular walls & Vitamin C deficiency.01:07:20 Is the taboo for life style medicine lifting?01:09:30 Issues of gold standard RCT trials not working for multifactorial integrative interventions.01:16:00 Recommendations for preventative use of Vitamin C for listeners. References:E Cameron & Linus Pauling - 'Supplemental ascorbate in the supportive treatment of cancer: Prolongation of survival times in terminal human cancer', 1976E.T. Creagan, 'Failure of high-dose vitamin C (ascorbic acid) therapy to benefit patients with advanced cancer', 1979Harri Hemilä - over 200 meta-analyses and clinical trialsPing Chen et al. 'Pharmacokinetic Evaluation of Intravenous Vitamin C'Richard Z Cheng, ‘Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)?'KU Cancer Center researchers announce study of high-dose intravenous vitamin C to treat muscle-invasive bladder cancer, 2024National Cancer Institute overview of IV Vitamin C cancer research.

In this solo episode, Darin reframes one of the most misunderstood forces in life — stress. Instead of seeing it as the enemy, he explores how stress is actually a messenger, guiding you back to alignment, safety, and awareness. Through science, spirituality, and lived experience, Darin breaks down how stress shows us where we're trying to control, where we're disconnected, and where our nervous system is calling for attention. He unpacks the layers of modern stress — from trauma and environment to community and purpose — and offers practical, embodied tools to restore calm, clarity, and resilience.     What You'll Learn 00:00:00 – Welcome to Super Life: Solutions for a Healthier Life and Better World 00:00:32 – Sponsor Spotlight: TheraSauna - Natural Healing Technologies (15% off with code Darrandai) 00:02:10 – The Super Life Podcast: Finding Contentment, Happiness, and Purpose 00:02:51 – Today's Topic: Stress - Reframing Stress as an Ally and Dashboard Light 00:04:54 – The "No Choice" Universe: Reconnecting to Infinite Possibilities 00:05:16 – The Reality of Stress: Statistics and the Impact of Chronic Stress 00:06:21 – Stress is Layered: Beyond a Single Cause, Addressing Chronic Stress 00:08:29 – Solutions for a Super Life: Safety over Calm and the Vagal Response 00:09:38 – The Inner Dialogue Layer: Trauma, Unconsciousness, and Spiritual Bypassing 00:11:47 – The Social Field Layer: Relationships, Community, and Finding Your Way Home 00:14:20 – Sponsor Spotlight: Bite Toothpaste - Sustainable, Non-Toxic Tabs (20% off with code Darin20) 00:16:35 – Creating Your Own Vision: Setting Boundaries with Media and Social Algorithms 00:17:29 – Finding Your Purpose: From Raising Children to Healing Injuries 00:18:35 – Environmental and Existential Stress Layers: Clutter, Noise, and Service 00:19:26 – Stress Load and Resiliency: Why Small Triggers Cause Blow-Ups 00:20:02 – Understanding the Dashboard Light: Acknowledging Unwillingness 00:20:35 – Safety as the Signal: Body Relaxation and Providing Inner Security 00:23:44 – Reframing Trauma: Was it the Protector You Needed at the Time? 00:25:00 – Releasing Trauma: Techniques, The Healing Code, and Waking the Tiger 00:26:06 – Finishing the Survival Response: Shaking, Crying, Screaming, and Stretching 00:26:38 – Stress as a Multiplier: Impact on Immune System, Heart, and Aging 00:28:10 – Stress Slows Repair: Inflammation, Cardiovascular Risk, and Cellular Aging 00:29:48 – The Integrative Approach: Changing Your Environments to Support Anti-Stress 00:30:07 – Actionable Stress Solutions: Circadian Rhythm, Nature, and Noise Reduction 00:30:44 – Actionable Stress Solutions: Gratitude, Conscious Breath, and Movement 00:31:32 – Energy Drains to Eliminate: Conflict, Clutter, Scrolling, and Late Caffeine 00:32:17 – Connecting to Greater Purpose: The Super Life Patreon Platform 00:32:54 – Morning/Night Questions: Letting Go, Creating, and Contributing 00:33:17 – Final Toolkit: Slow Breathing, Movement, Nature, Sauna, and Sleep 00:34:25 – The Invitation: Digging into all Layers of a Super Life on Patreon   Thank You to Our Sponsors Therasage: Go to www.therasage.com and use code DARIN at checkout for 15% off Bite Toothpaste: Go to trybite.com/DARIN20 or use code DARIN20 for 20% off your first order. Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences   Key Takeaway "Stress isn't your enemy — it's your compass. Every wave of tension points you back to what's asking for care, attention, and love. When you stop fighting stress and start listening to it, you don't just survive — you evolve."       Bibliography (selected, peer-reviewed) Sources: Gallup Global Emotions (2024); Gallup U.S. polling (2024); APA Stress in America (2023); Natarajan et al., Lancet Digital Health (2020); Orini et al., UK Biobank (2023); Martinez et al. (2022); Leiden University (2025). Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med.1991;325(9):606–612. New England Journal of Medicine Cohen S, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci USA. 2012;109(16):5995–5999. PNAS Kiecolt-Glaser JK, et al. Slowing of wound healing by psychological stress. Lancet. 1995;346(8984):1194–1196. The Lancet Kiecolt-Glaser JK, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing.Arch Gen Psychiatry. 2005;62(12):1377–1384. JAMA Network Tawakol A, et al. Relation between resting amygdalar activity and cardiovascular events. Lancet.2017;389(10071):834–845. The Lancet Epel ES, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA.2004;101(49):17312–17315. PNAS McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Arch Intern Med.1993;153(18):2093–2101. PubMed McEwen BS, Wingfield JC. Allostasis and allostatic load. Ann N Y Acad Sci. 1998;840:33–44. PubMed Felitti VJ, et al. Relationship of childhood abuse and household dysfunction to many leading causes of death in adults (ACE Study). Am J Prev Med. 1998;14(4):245–258. AJP Mon Online Edmondson D, et al. PTSD and cardiovascular disease. Ann Behav Med. 2017;51(3):316–327. PMC Afari N, et al. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis.Psychosom Med. 2014;76(1):2–11. PMC Goyal M, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–368. PMC Qiu Q, et al. Forest therapy: effects on blood pressure and salivary cortisol—a meta-analysis. Int J Environ Res Public Health. 2022;20(1):458. PMC Laukkanen T, et al. Sauna bathing and reduced fatal CVD and all-cause mortality. JAMA Intern Med.2015;175(4):542–548. JAMA Network Zureigat H, et al. Physical activity lowers CVD risk by reducing stress-related neural activity. J Am Coll Cardiol.2024;83(16):1532–1546. PMC Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med.2010;7(7):e1000316. PMC Chen Y-R, Hung K-W. EMDR for PTSD: meta-analysis of RCTs. PLoS One. 2014;9(8):e103676. PLOS Hoppen TH, et al. Network/pairwise meta-analysis of PTSD psychotherapies—TF-CBT highest efficacy overall.Psychol Med. 2023;53(14):6360–6374. PubMed van der Kolk BA, et al. Yoga as an adjunctive treatment for PTSD: RCT. J Clin Psychiatry. 2014;75(6):e559–e565. PubMed Kelly U, et al. Trauma-center trauma-sensitive yoga vs CPT in women veterans: RCT. JAMA Netw Open.2023;6(11):e2342214. JAMA Network Bentley TGK, et al. Breathing practices for stress and anxiety reduction: components that matter. Behav Sci (Basel). 2023;13(9):756. 

The term "hypnosis" was first described in 1843 byScottish surgeon James Braid, who published the book Neurypnology. He coined the term "hypnosis" from the Greek word for sleep to describe the trance-like state induced by focusing on a bright object. Self-hypnosis has nowbeen shown to aid in menopausal hot flash reduction! In this episode, we will review this brand new publication from JAMA Network which confirmed via a multicenter RCT that a simple daily hypnosis audio session was effective forsymptom relief. The study is the first to compare self-guided hypnosis with an active control condition (i.e. sham white noise control group). Listen in for details. 1.     Elkins G, Arring N, Morgan G, Lorenz T, Muniz V,Lafferty C, Scheffrahn K, Alldredge C, Barton D. Self-Administered Hypnosis vsSham Hypnosis for Hot Flashes: A Randomized Clinical Trial. JAMA Netw Open.2025 Nov 3;8(11):e2542537. doi: 10.1001/jamanetworkopen.2025.42537. PMID:41217756.2.     https://interestingengineering.com/health/hypnosis-lowers-menopause-hot-flashes 

In this Ask Me Anything episode, Vanessa breaks down your most common questions about the Protein-Sparing Modified Fast (PSMF) — one of the most powerful evidence-based tools for rapid fat loss and muscle preservation. NEW! Support your strength and muscle goals with PUORI Creatine+ — a clean, effective creatine monohydrate supplement enhanced with taurine. Get 20% off at puori.com/VANESSA You'll learn exactly how to calculate your macros, when to schedule refeeds, how to adapt PSMF for your menstrual cycle or menopause, and what recent human clinical studies reveal about high-protein, very-low-carb diets for fat loss, hormonal balance, and metabolic health. Vanessa also explains how ketosis is achieved even on a high-protein plan and how to track your fat-burning progress with Breath Ketones. OneSkin is powered by the breakthrough peptide OS-01, the first ingredient proven to reduce skin's biological age. I use the OS-01 Face and Eye formulas daily—they've transformed my skin's smoothness, firmness, and glow. Visit oneskin.co/VANESSA and use code VANESSA for 15% off your first purchase

Episode Overview In this episode, Dr. David Rosenblum discusses the role of supplements and complementary strategies in the management of chronic pain. Drawing from clinical practice at AABP Integrative Pain Care, as well as his teaching and training programs, Dr. Rosenblum reviews how nutraceuticals, regenerative therapies, ultrasound-guided procedures, and neuromodulation can work together to improve patient outcomes and reduce opioid reliance. This episode also highlights educational opportunities and exam-prep resources for pain fellows, residents, anesthesiologists, physiatrists, and APPs looking to expand their interventional pain, ultrasound, and regenerative medicine skill sets. Key Topics Discussed Evidence and clinical rationale for select supplements in chronic pain management The role of ultrasound guidance in improving accuracy and safety in interventional pain procedures How regenerative medicine techniques such as PRP and BMAC are shaping personalized pain care Practical considerations when combining supplements with neuromodulation, RFA, or injections Patient case applications and real-world treatment planning Educational Offerings & Learning Opportunities PainExam / NRAP Academy Training & Programs: Neuromodulation & Regional Anesthesia Workshops Ultrasound-Guided Pain Procedures Regenerative Pain Medicine Training Virtual Pain Fellowship Pain Management Board Review & Question Banks Learn More / Register: www.AABPpain.com

Do you routinely order prophylactic antibiotics at time ofsecond-degree laceration repair? Is there data for that? While the use of prophylacticantibiotics “is reasonable” (per ACOG PB 198) for OASIS lacerations, what doesthe data look like for second degree lacs? Well, the answer is both supportiveAND non-supportive of that practice! In this episode, we will cover a brand newpublication (RCT) from BMJ on this very issue, and also highlight a meta-analysisfrom Plos One (May 2025) that also examined this question. Listen in fordetails!1.     ACOG PB 1982.     Armstrong H, Whitehurst J, Morris RK, HodgettsMorton V, Man R; CHAPTER group. Antibiotic prophylaxis for childbirth-relatedperineal trauma: A systematic review and meta-analysis. PLoS One. 2025 May9;20(5):e0323267. doi: 10.1371/journal.pone.0323267. PMID: 40344566; PMCID:PMC12064200.3.     Risk of infection and wound dehiscence after useof prophylactic antibiotics in episiotomy or second degree tear (REPAIR study):single centre, double blind, placebo controlled randomised trial. BMJ 2025; 391doi: https://doi.org/10.1136/bmj-2025-084312 (Published 29 October 2025): BMJ2025;391:e084312

Episode Overview In this episode, Dr. David Rosenblum discusses the role of supplements and complementary strategies in the management of chronic pain. Drawing from clinical practice at AABP Integrative Pain Care, as well as his teaching and training programs, Dr. Rosenblum reviews how nutraceuticals, regenerative therapies, ultrasound-guided procedures, and neuromodulation can work together to improve patient outcomes and reduce opioid reliance. This episode also highlights educational opportunities and exam-prep resources for pain fellows, residents, anesthesiologists, physiatrists, and APPs looking to expand their interventional pain, ultrasound, and regenerative medicine skill sets. Key Topics Discussed Evidence and clinical rationale for select supplements in chronic pain management The role of ultrasound guidance in improving accuracy and safety in interventional pain procedures How regenerative medicine techniques such as PRP and BMAC are shaping personalized pain care Practical considerations when combining supplements with neuromodulation, RFA, or injections Patient case applications and real-world treatment planning Educational Offerings & Learning Opportunities PainExam / NRAP Academy Training & Programs: Neuromodulation & Regional Anesthesia Workshops Ultrasound-Guided Pain Procedures Regenerative Pain Medicine Training Virtual Pain Fellowship Pain Management Board Review & Question Banks Learn More / Register: www.AABPpain.com

Send us a textI unpack what “ultra-processed” really means, why these foods are so easy to overeat, what the best evidence shows (including metabolic-ward studies), and how I personally navigate them without fear or perfectionism. Key topics & evidence (in plain English):What counts as “ultra-processed”? I walk through the NOVA system—useful, not perfect—and where borderline items (frozen meals, boxed mixes) fit. See an overview of NOVA classifications here. How we got here: post-WWII abundance of refined flour, cheap sugars, oils, and a cultural push for convenience—now ~60% of the U.S. diet comes from UPFs (study). Additives: stabilizers, emulsifiers, preservatives, and colors are generally recognized as safe (GRAS). I explain why, on their own, they're probably not the main health issue. The bigger problem: UPFs are energy-dense, engineered for bliss (fat/sugar/salt + perfect texture), and easy to eat quickly—driving higher calorie intake.  • Metabolic-ward crossover trial: +~508 kcal/day when participants ate UPFs vs minimally processed (Cell 2019). • Overweight adults in a crossover design: +~814 kcal/day on the UPF week (PubMed). • Another recent crossover RCT reports ~300 kcal/day higher on UPFs (Nature Medicine 2025). What I recommend (and what I do):Prioritize whole foods most of the time; shop the perimeter; cook when you can. Canned tomatoes/beans and frozen fruits/peas are fine helpers. If weight, diabetes, or blood pressure are concerns, be extra cautious with UPFs—they're designed to be irresistible and calorie-dense. Moderation wins: I enjoy favorites (yes, even boxed mac 'n' cheese and crunchy peanut butter) without letting them dominate my plate. Takeaways you can use today:Build meals around minimally processed proteins, veggies, fruits, and beans; let convenience items support—not star—in your diet. Watch “calorie-dense + easy to overeat” combos (chips, sweets, fast food). If you have them, portion once, then put the package away. If symptoms or inflammation are puzzling you, try a short UPF-light experiment (2–4 weeks) and see how you feel. If this episode helped, please follow and leave a quick review—and share it with a friend who's curious about UPFs. For my newsletter and resources, visit drbobbylivelongandwell.com.

Send us a textVisit my websiteCan a positive mindset truly improve your health—or even help you beat disease? In this episode, Dr. Bobby and guest Sean McDevitt explore the evidence behind optimism, visualization, and prayer to uncover what really works.In today's episode of Live Long and Well, Dr. Bobby is joined by fitness and life coach Sean McDevitt to explore whether positive thinking can influence health outcomes. They dive into both anecdotal and clinical evidence, starting with sports psychology and then navigating the science behind mindset and disease. The conversation opens with laughter and smiles—literally. Inspired by Norman Cousins' Anatomy of an Illness, Dr. Bobby references a meta-analysis showing genuine smiling does, in fact, temporarily boost happiness, while artificial smiling (like holding a pen in your mouth) doesn't.They begin with sports, where 86 studies show that visualizing athletic success can improve performance in agility, strength, and game-specific skills. Next, they ask a deeper question: does having a positive attitude affect the progression of serious disease? A meta-analysis of 26 studies on life satisfaction and longevity suggests happy people may live longer—especially when it comes to heart health. Optimism, for instance, was linked to a 35% reduction in cardiovascular events and a 15% decrease in all-cause mortality.However, when it comes to cancer, the picture gets murkier. A review of 165 studies links stress to poorer survival, but a separate meta-analysis on coping styles found no consistent impact on recurrence or survival. One influential study on breast cancer patients even found that while helplessness predicted worse outcomes, having a “fighting spirit” made no significant difference (source). As Dr. Bobby notes, it's important not to burden patients with guilt if they can't “stay positive.”The critical question becomes: if you're not naturally optimistic, can you cultivate positivity—and will it help? Encouragingly, several intervention studies suggest it might. One trial showed cardiac markers improved after optimism training, and a meta-analysis of 56 RCTs found a 15% boost in immune function after psychological interventions. A small MS study linked mindfulness to better walking ability, and a large RCT on breast cancer showed a 45% drop in recurrence with stress-reduction and mood-enhancing strategies.Finally, the episode touches on spirituality. While many find comfort in prayer, evidence from an RCT of 800 ICU patients and a [meta-analysis] shows no significant impac

How Workshops Win: Emotion-First Public Speaking for Cash-Based PT Lead Gen In this episode, Doc Danny Matta lays out how to fill your schedule by getting in front of real people—workshops, talks, and small group education—and connecting emotionally before you ever ask for the appointment. He explains direct-response marketing for cash-based clinics, the “feelings before logic” rule, and a practical script stack (frustration → “imagine if” → personal story → action) that turns talks into patients. Quick Ask Help PT Biz move toward the mission of adding $1B in cash-based services to our profession: share this episode with a clinician friend or post it to your IG stories and tag Danny—he'll reshare it. Episode Summary Direct-response > referrals: Cash clinics grow fastest by going straight to the people (gyms, clubs, teams, parent groups), not by waiting on physician referrals. Workshops convert: Live education (in-person or virtual) is a predictable way to create trust and book consults. Feelings before facts: Lead with frustration, fear, and hope—the human stuff—then layer in the plan. Positive vision beats fear: “Imagine if…” scenarios help audiences see the future they want and move toward it. Stories sell: Personal experience (e.g., your own injury journey) creates instant credibility and connection. Let them say it: When attendees voice their own stakes and frustrations, commitment skyrockets. The Emotional Connection Framework Appeal to feelings before logic. Name the frustration in their language (“Isn't it frustrating when…?”) to open the door to change. Use “Imagine if…” Paint a clear, positive future state (pain-free golf trips, finishing workouts, keeping up with kids). Share something personal. Brief, relevant story that mirrors their journey (e.g., your own ACL rehab or chronic pain lesson). Make them feel the problem. Skip the RCT lecture; speak to missed experiences and what they're giving up. Elicit their why. Ask direct questions so they articulate what's at stake—then show the next step. Field Notes & Examples Workshops that work: Gyms, run clubs, golf leagues, youth sports parents, corporate wellness lunches, and private FB groups. The “gruff granddad” story: A patient's Disney scooter and coaster seatbelt moment became the emotional turning point—once he said it, change followed. Military → MobilityWOD/CrossFit reps: Coaching, audits, and “mystery shopper” feedback sharpened delivery—reps matter. Pro Tips You Can Use Today Book two talks this month. One in person, one virtual. Keep each to 25–30 minutes + Q&A. Script the open. 90 seconds: frustration opener → “imagine if” vision → your 20-second origin story. Give a simple plan. 3 steps max. Clear, doable, no jargon. Single CTA. “Grab a free 15-minute consult today”—QR code + signup sheet + link. Debrief after. What hook landed? What question came up most? Tighten the next talk. Notable Quotes “If you want action, connect emotionally first. Feelings open the door; logic walks them through it.” “I'd rather pull people toward the future they want than push them with fear. ‘Imagine if…' changes the room.” “When they say what hurts and what they want back, commitment follows.” Action Items Create a 1-page workshop outline: opener, 3 teaching points, 1 CTA. Make a list of 10 local/digital groups and pitch your talk this week. Design a QR code to your consult page and practice the closing script. Track: attendees → consults → plans of care. Iterate monthly. Programs Mentioned Clinical Rainmaker: Coaching + plan to get you full-time in your clinic. Mastermind: Scale beyond yourself into space, team, and systems. PT Biz Part-Time to Full-Time 5-Day Challenge (Free): Get crystal clear on expenses, visit targets, pricing, 3 go-full-time paths, and a one-page plan. Resources & Links PT Biz Website Free 5-Day PT Biz Challenge About Danny: Over 15 years in the profession—staff PT, active-duty military PT, cash-practice founder and exit—now helping 1,000+ clinicians start, grow, and scale cash-based practices with PT Biz.

Stress isn't just something to “manage” — it's a signal, a teacher, and often, an invitation to look deeper at our health, our choices, and our lives. In this solo episode, Darin reframes stress not as an enemy, but as a dashboard light pointing toward misalignments in our nervous system, environment, relationships, and purpose. Drawing on science, practical tools, and personal insight, Darin reveals how layered stress silently drains our vitality — and how to transform it into an ally for growth, healing, and deeper contentment. Whether it's hidden trauma, toxic environments, unresolved conflict, or the modern distractions constantly pulling at our attention, Darin lays out a roadmap to stop the leaks and reclaim the energy already within you. This episode is a powerful reminder: stress isn't the end of the story — it's the beginning of awareness, safety, and a super life.     What You'll Learn in This Episode [00:00] Introduction to the Super Life podcast [03:27] Why stress might not be your enemy [04:17] Stress as an ally: the signals it gives us about misalignment [04:32] The dashboard light metaphor: how stress reveals hidden issues [05:28] The illusion of “no choice” and the infinite possibilities always available [06:12] Global stress statistics and why most people underestimate their stress load [07:23] Hidden stress revealed through heart rate variability and physiology [08:23] Layered stress: how sleep, exercise, and poor choices compound each other [09:25] Safety vs. calm — why your nervous system craves safety first [10:15] Trauma and the unconscious mind: how old wounds drive our stress response [11:54] Inner narratives and negative self-talk as hidden stress multipliers [12:22] The role of community and your social field in stress and resilience [13:53] Relationships, honesty, and how your circle shapes your energy [14:55] Why boundaries around media and politics are vital for mental clarity [17:42] Finding micro-purpose when life feels overwhelming [18:52] Environmental layers of stress — light, air, and clutter [19:15] The existential layer: stress from living without service or purpose [20:12] Stress as a risk amplifier — how it undermines healing and health [20:55] The deeper truth of safety, connection, and higher power [23:00] Practical tools: breathing, grounding, nature, and conscious choices [24:01] Trauma reframed: not a problem, but a protector at the time [25:25] Lessons from Peter Levine and wild animals: releasing trauma physically [26:04] Questions to ask trauma: “What are you protecting me from?” [26:56] Stress as a multiplier of aging, disease, and poor outcomes [29:20] Why stress isn't a single cause — it's layered and chronic [30:18] Anti-stress strategies: circadian rhythm, nature, and gratitude [31:49] Energy leaks to avoid: clutter, poor food, scrolling, bad boundaries [32:22] What matters most: service, contribution, and alignment [33:28] Final toolkit: breathwork, movement, nature, sleep, and gratitude [34:38] The deeper invitation: step into sovereignty and live your SuperLife     Thank You to Our Sponsors: Manna Vitality: Go to mannavitality.com/  or use code DARIN20 for 20% off your order. Bite Toothpaste: Go to trybite.com/DARIN20 or use code DARIN20 for 20% off your first order.     Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences Check out my podcast with Dr. Amy Abbington     Key Takeaway “Stress is not the enemy. It's a dashboard light — a teacher showing you where you're out of alignment. When you reframe stress, you reclaim your energy and create space for healing, safety, and the joy of living a super life.”     Bibliography (selected, peer-reviewed) Sources: Gallup Global Emotions (2024); Gallup U.S. polling (2024); APA Stress in America (2023); Natarajan et al., Lancet Digital Health (2020); Orini et al., UK Biobank (2023); Martinez et al. (2022); Leiden University (2025). Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med.1991;325(9):606–612. New England Journal of Medicine Cohen S, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci USA. 2012;109(16):5995–5999. PNAS Kiecolt-Glaser JK, et al. Slowing of wound healing by psychological stress. Lancet. 1995;346(8984):1194–1196. The Lancet Kiecolt-Glaser JK, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing.Arch Gen Psychiatry. 2005;62(12):1377–1384. JAMA Network Tawakol A, et al. Relation between resting amygdalar activity and cardiovascular events. Lancet.2017;389(10071):834–845. The Lancet Epel ES, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA.2004;101(49):17312–17315. PNAS McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Arch Intern Med.1993;153(18):2093–2101. PubMed McEwen BS, Wingfield JC. Allostasis and allostatic load. Ann N Y Acad Sci. 1998;840:33–44. PubMed Felitti VJ, et al. Relationship of childhood abuse and household dysfunction to many leading causes of death in adults (ACE Study). Am J Prev Med. 1998;14(4):245–258. AJP Mon Online Edmondson D, et al. PTSD and cardiovascular disease. Ann Behav Med. 2017;51(3):316–327. PMC Afari N, et al. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis.Psychosom Med. 2014;76(1):2–11. PMC Goyal M, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–368. PMC Qiu Q, et al. Forest therapy: effects on blood pressure and salivary cortisol—a meta-analysis. Int J Environ Res Public Health. 2022;20(1):458. PMC Laukkanen T, et al. Sauna bathing and reduced fatal CVD and all-cause mortality. JAMA Intern Med.2015;175(4):542–548. JAMA Network Zureigat H, et al. Physical activity lowers CVD risk by reducing stress-related neural activity. J Am Coll Cardiol.2024;83(16):1532–1546. PMC Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med.2010;7(7):e1000316. PMC Chen Y-R, Hung K-W. EMDR for PTSD: meta-analysis of RCTs. PLoS One. 2014;9(8):e103676. PLOS Hoppen TH, et al. Network/pairwise meta-analysis of PTSD psychotherapies—TF-CBT highest efficacy overall.Psychol Med. 2023;53(14):6360–6374. PubMed van der Kolk BA, et al. Yoga as an adjunctive treatment for PTSD: RCT. J Clin Psychiatry. 2014;75(6):e559–e565. PubMed Kelly U, et al. Trauma-center trauma-sensitive yoga vs CPT in women veterans: RCT. JAMA Netw Open.2023;6(11):e2342214. JAMA Network Bentley TGK, et al. Breathing practices for stress and anxiety reduction: components that matter. Behav Sci (Basel). 2023;13(9):756. 

In this solo episode, Darin shares everything he's learned over nearly a decade of caring for his beloved German Shepherds, Chugga and Ella. From water quality to food choices, stress management, natural therapies, and even stem cells, Darin reveals the daily practices and integrative care strategies that keep his dogs thriving. With inspiration from Forever Dog authors Rodney Habib and Dr. Karen Becker, this episode is packed with actionable steps and powerful reminders about what it means to be a true steward for our animal companions. What You'll Learn in This Episode [00:00] Welcome and introduction – why this episode is dedicated to dogs and animal care [00:40] The bond with Chugga and Ella and why stewardship matters [01:16] Inspiration from The Forever Dog and leading longevity experts [01:38] Clean water: why filtration is critical for pets and how Darin prepares it [03:01] How much water your dog really needs and the danger of dehydration [03:38] A scary heatstroke story with Ella and the importance of paying attention [04:11] Daily care tips: washing bowls, using stainless steel, and avoiding bacteria buildup [04:43] Electrolytes, minerals, and using natural supplementation for dogs' hydration [05:35] Food choices: balancing plant-based with raw diets using Bramble and Viva Raw [07:01] The Dog Aging Project: why feeding once a day may extend longevity [08:12] Transitioning from kibble to raw: microbiome, gut diversity, and safety tips [09:47] Adding veggies, pumpkin, sweet potatoes, and berries for diversity and antioxidants [11:40] The importance of walks, exercise, and letting dogs sniff for cognitive health [12:27] Training, discipline, and running with Chugga on the mountain bike [13:32] How dogs mirror our stress and why managing your own health impacts theirs [14:01] Working with the endocannabinoid system, CBD, and reducing nervous tension [15:03] Natural therapies: PEMF mats, AmpCoil, red light, and energy balancing [16:08] Conventional vs naturopathic care—when to use both for acute and long-term health [17:00] Chugga's autoimmune challenges and the integrative approach to healing [18:20] Modalities used: stem cells, acupuncture, microbiome testing, ozone baths, and more [20:34] How pets reflect back our stress and why healing ourselves heals them too [22:07] Building a holistic health protocol: food, supplements, exercise, trauma release [23:05] Why meal timing and fasting windows can boost detox and longevity in dogs [25:11] Daily practices: washing bowls, diversifying food, hydration, and routines [26:29] The role of the endocannabinoid system in pets and humans alike [27:27] Alternative therapies: psychic readings, EFT, remote healing, and staying open [28:10] Back to basics: food, water, exercise, sleep, and trauma release for pets and people [28:41] Final reflections: stewardship, love, and why pets are free beings bonded to us Thank You to Our Sponsors: Our Place: Toxic-free, durable cookware that supports healthy cooking. Use code DARIN for 10% off at fromourplace.com. Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences Key Takeaway “Our dogs are barometers for our own well-being. When we reduce toxins, diversify food, manage stress, and honor them as family, they not only thrive longer — they remind us how to live better ourselves.” Bibliography / Sources Water & nutrition guidance WSAVA Global Nutrition—pet food selection & toolkit; Merck Veterinary Manual—typical daily water needs. WSAVA+1MSD Veterinary Manual Feeding frequency Bray EE et al. “Once-daily feeding is associated with better health in companion dogs” (Dog Aging Project, GeroScience 2022). PMCPubMedDog Aging Project Activity & cognition Dog Aging Project analyses on physical activity and cognitive health in older dogs (GeroScience 2022). ResearchGate Raw diets: microbiome & safety Sandri M. et al., BMC Vet Res 2016; Schmidt M. et al., PLOS ONE 2018; Xu J. et al., 2021; Davies RH. et al., 2019 (review on raw diets & pathogens). BioMed CentralPLOSPMC+1 Plant-based diets for dogs Knight A. et al., PLOS ONE 2022. PMC Microbiome testing (clinical tool) Texas A&M GI Lab—Dysbiosis Index overview. AVMA Owner–dog connection, stress & oxytocin Roth L. et al., Scientific Reports 2019 (stress synchrony); Wilson C. et al., PLOS ONE 2022 (dogs smell human stress); Nagasawa M. et al., Science 2015 (oxytocin gaze loop). NaturePMCPubMed Stem cells for canine OA Harman R. et al., Front Vet Sci 2016 (RCT, allogeneic ADSCs); Cuervo B. et al., Int J Mol Sci 2014 (randomized); VetEvidence 2022 (knowledge summary). FrontiersPMCVeterinary Evidence Acupuncture / gold bead studies & reviews Baker-Meuten A. et al., 2020 (prospective OA); Teixeira LR. et al., JAVMA 2016; Jaeger GT. et al., Vet Rec 2006. PMCAVMA JournalsPubMed Photobiomodulation (red light) AVMA Journals RCT in canine hip OA (2022). DVM 360 PEMF Randomized post-op pain/IVDD trial (NC State coverage); Front Vet Sci 2021 (targeted PEMF). NC State NewsFrontiers Chiropractic / manipulation Randomized Boxer puppy study (spondylosis); systematic review of manipulative therapies; AVMA policy context. PMC+1AVMA Ozone & IV Vitamin C Veterinary ozone therapy reviews (limited evidence); Merck Vet Manual—dogs synthesize vitamin C (routine IV-C not standard).  

Routine vaginal examinations (VEs) are a standard component of intrapartum care, traditionally performed at regular intervals to monitor cervical dilation, effacement, and fetal station, which are indicators of labor progression. Yet, the American College of Obstetricians and Gynecologists states that there is insufficient evidence to recommend a specific frequency for cervical examinations during labor, and examinations should be performed as clinically indicated. Now, a recently published RCT form AJOG MFM is adding additional credence to that. Can we space out clinical exams in otherwise “low-risk” laboring women to 8 hours? Listen in for details. 1. AJOG MFM: (08/18/25) Routine Vaginal Examination Scheduled At 8 vs 4 Hours In Multiparous Women In Early Spontaneous Labour: A Randomised Controlled Trial https://www.sciencedirect.com/science/article/abs/pii/S25899333250016122. Nashreen CM, Hamdan M, Hong J, et al.Routine Vaginal Examination to Assess Labor Progress at 8 Compared to 4 h After Early Amniotomy Following Foley Balloon Ripening in the Labor Induction of Nulliparas: A Randomized Trial. Acta Obstetricia Et Gynecologica Scandinavica. 2024;103(12):2475-2484. doi:10.1111/aogs.14975.3. First and Second Stage Labor Management: ACOG Clinical Practice Guideline No. 8. Obstetrics and Gynecology. 2024;143(1):144-162. doi:10.1097/AOG.0000000000005447.4. Moncrieff G, Gyte GM, Dahlen HG, et al. Routine Vaginal Examinations Compared to Other Methods for Assessing Progress of Labour to Improve Outcomes for Women and Babies at Term. The Cochrane Database of Systematic Reviews. 2022;3:CD010088. doi:10.1002/14651858.CD010088.pub3.5. Gluck, O., et al. (2020). The correlation between the number of vaginal examinations during active labor and febrile morbidity, a retrospective cohort study. [BMC Pregnancy and Childbirth]6. Pan, WL., Chen, LL. & Gau, ML. Accuracy of non-invasive methods for assessing the progress of labor in the first stage: a systematic review and meta-analysis. BMC Pregnancy Childbirth 22, 608 (2022). https://doi.org/10.1186/s12884-022-04938-y

Welcome to Season 2 of the Orthobullets Podcast. Today's show is Podiums, where we feature expert speakers from live medical events. Today's episode will feature ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Dr. Todd Albert and is titled⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ "⁠RCT on A vs P for Myelopathy.⁠"Follow⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Orthobullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on Social Media:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠LinkedIn⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Primary hyperparathyroidism is an underdiagnosed condition which leads to decreased bone mineral density, fracture, renal disease, among other symptoms that can decrease the quality of a patient's life. Moreover, once diagnosed, only a small fraction of patients with the diease end up being offered surgery. Whether it is because of misunderstood indications and benefits of surgery, non-localization of disease, or various other reasons, we thought it was worthwhile to review relevant literature. Hosts: Dr. Becky Sippel is an endowed professor of surgery at Division Chief of endocrine surgery at University of Wisconsin Madison and she is the most recent past president of the AAES.  She is an internationally recognized leader in the field of endocrine surgery. She has over 250 publications. She was the PI for a RCT which studies prophylactic central neck dissections which is a widely read and quoted study in endocrine surgery. Dr. Amanda Doubleday is a fellowship trained endocrine surgeon in private practice with an affiliation to UW Health. Her primary practice is with Waukesha Surgical Specialists in Waukesha WI.  Dr. Simon Holoubek is a fellowship trained endocrine surgeons affiliated with UW Health. He works for UW Health with privileges at UW Madison and UW Northern Illinois. His clinical interests are aggressive variants of thyroid cancer, parathyroid autofluorescence, and nerve monitoring.  Learning Objectives: 1 Understand the natural history of primary hyperparathyroidism and how the disease process can affect bone mineral density. 2 Learn about fracture risk associated with primary hyperparathyroidism. 3 Learn about decreased fracture risk in patients with primary hyperparathyroidism who have parathyroidectomy compared to those who are observed.  References: 1 Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008 Sep;93(9):3462-70. doi: 10.1210/jc.2007-1215. Epub 2008 Jun 10. PMID: 18544625; PMCID: PMC2567863. https://pubmed.ncbi.nlm.nih.gov/18544625/ 2 Frey S, Gérard M, Guillot P, Wargny M, Bach-Ngohou K, Bigot-Corbel E, Renaud Moreau N, Caillard C, Mirallié E, Cariou B, Blanchard C. Parathyroidectomy Improves Bone Density in Women With Primary Hyperparathyroidism and Preoperative Osteopenia. J Clin Endocrinol Metab. 2024 May 17;109(6):1494-1504. doi: 10.1210/clinem/dgad718. PMID: 38152848. https://pubmed.ncbi.nlm.nih.gov/38152848/ 3 VanderWalde LH, Liu IL, Haigh PI. Effect of bone mineral density and parathyroidectomy on fracture risk in primary hyperparathyroidism. World J Surg. 2009 Mar;33(3):406-11. doi: 10.1007/s00268-008-9720-8. PMID: 18763015. https://pubmed.ncbi.nlm.nih.gov/18763015/ 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://app.behindtheknife.org/listen