Podcasts about rcts

Dr. Jonathan Howard and Wendy Orent examine the alarming elevation of wellness influencer Casey Means as Surgeon General nominee, despite lacking a medical license or conventional medical credibility. They delve into Vinay Prasad's appointment as head of vaccine regulation, scrutinizing his past critiques of RCT deficiencies—and the impossible standards he now sets for himself. The episode also investigates the troubling rise of an autism registry, likened to authoritarian categorization, and NIH's internal collapse under Jay Bhattacharya, whose leadership is marked by mass layoffs and denial of responsibility. With science policy veering into cronyism, dismantling, and performative governance, the episode argues that we're witnessing a historic erosion of public health leadership—led not by scientists, but social media provocateurs. Connect with us further on https://sciencebasedmedicine.org/author/jonathanhoward/  The Fine Print The content presented in the "We Want Them Infected" Podcast and associated book is intended for informational and educational purposes only.  The views and opinions expressed by the speakers, hosts, and guests on the podcast do not necessarily reflect the views of the creators, producers, or distributors. The information provided in this podcast should not be considered as a substitute for professional medical, scientific, or legal advice. Listeners and readers are encouraged to consult with relevant experts and authorities for specific guidance and information. The creators of the podcast and book have made reasonable efforts to ensure that the information provided is accurate and up to date. However, as the field of medical science and the understanding of the COVID-19 pandemic continue to evolve, there may be new developments and insights that are not covered in this content. The creators are not responsible for any errors or omissions in the content or for any actions taken based on the information provided. They disclaim any liability for any loss, injury, or damage incurred by individuals who rely on the content. Listeners and readers are urged to use their judgment and conduct their own research when interpreting the information presented in the "We Want Them Infected" podcast and book. It is essential to stay informed about the latest updates, guidelines, and recommendations related to COVID-19 and vaccination from reputable sources, such as government health agencies and medical professionals. By accessing and using the content, you acknowledge and accept the terms of this disclaimer. Please consult with appropriate experts and authorities for specific guidance on matters related to health, science, and the COVID-19 pandemic.

Monk Fruit Extract: Zero-Calorie Sweetener, Surprising Benefits? Ep. 1241 MAY 2025A recent PRISMA-guided systematic review published in Nutrients synthesized findings from randomized controlled trials (RCTs) to assess the impact of monk fruit extract (MFE) on metabolic health, lipid profiles, inflammation, and regulatory considerations. The review included a number of RCTs (note: while some search results indicated 10, others mentioned 5 included studies; refer to the final published article for the definitive number). The findings indicate that MFE may help reduce postprandial glucose levels (by 10–18% in included studies) and insulin responses (by 12–22%). Some studies also reported reductions in inflammatory markers such as IL-6 and TNF-α. No severe adverse effects were observed in the reviewed trials. The review also notes that MFE is approved for use in the United States and China, with its status under review in the European Union. The authors suggest MFE shows potential as a functional food ingredient for metabolic health, though they highlight the need for long-term clinical trials and a harmonized regulatory framework to confirm its long-term safety and efficacy within sustainable health strategies. Disclaimers:"This information is for educational purposes only and should not be interpreted as medical advice.""This video discusses a systematic review of randomized controlled trials. While this represents a high level of evidence, individual results may vary, and further research is always ongoing.""Always consult with a qualified healthcare professional before making any changes to your diet, supplement regimen, or treatment plan, especially if you have a medical condition or are taking medications.""This channel does not provide medical advice."#MonkFruitExtract #MetabolicHealth #SystematicReview #RandomizedControlledTrials #SustainableHealthKaim U, Labus K. Monk Fruit Extract and Sustainable Health: A PRISMA-Guided Systematic Review of Randomized Controlled Trials. Nutrients. 2025; 17(9):1433. https://doi.org/10.3390/nu17091433Alchepharma,Ralph Turchiano,citation,research,study,Monk fruit extract,Siraitia grosvenorii,mogrosides,metabolic health,glycemic control,insulin response,inflammation,blood glucose,type 2 diabetes,natural sweeteners,low-calorie sweeteners,functional foods,dietary supplements,clinical trials,systematic review,PRISMA,nutritional science,dietary interventions,sugar substitutes,glucose metabolism,insulin sensitivity,inflammatory markers,regulatory status

New treatment alert! The FDA recently approved Tapinarof, applied as a cream, for kids 2 years and up. We ask Dr. Leon Kircik from Icahn School of Medicine, NY, who led the clinical trials about the safety, efficacy and side effects of Tapinarof. And because we are parents too, we ask: How quickly does it work? Can you start/stop it as needed? How easy will it be to access? And more. If you like our podcast, please consider supporting it with a tax deductible donation. Research discussedTapinarof Improved Outcomes and Sleep for Patients and Families in Two Phase 3 Atopic Dermatitis Trials in Adults and ChildrenMaximal usage trial of tapinarof cream 1% once daily in pediatric patients down to 2 years of age with extensive atopic dermatitisTapinarof cream 1% once daily: Significant efficacy in the treatment of moderate to severe atopic dermatitis in adults and children down to 2 years of age in the pivotal phase 3 ADORING trialsTapinarof cream in the treatment of atopic dermatitis in children and adults a systematic review and meta-analysisEfficacy and safety of Ruxolitinib, Crisaborole, and Tapinarof for mild-to-moderate atopic dermatitis: a Bayesian network analysis of RCTs

Become a client: https://www.dcfitness.la/enrollment-form I'm debunking the dairy myth for the 8 millionth time with peer reviewed legit research RCTs

This podcast was created using NotebookLM. This podcast underscores the significant underrepresentation of older adults in clinical trials, particularly randomized controlled trials (RCTs), despite their increasing population and the high prevalence of chronic diseases within this demographic. 

Today, we have a fascinating discussion focusing on therapy after lumbar disc herniation surgery. We delve into a massive study that brings together findings from 55 randomized controlled trials, shedding new light on the best approaches to post-surgical rehab and the role of physical therapy. With significant implications for your chiropractic practice, we'll explore key insights on how physical therapy post-surgery can reduce pain, improve function, boost return-to-work rates, and even lower anxiety.Episode Notes: Physical therapies after surgery for lumbar disc herniation- evidence synthesis from 55 randomized controlled trials (RCTs) and a total of 4,311 patientsThe Best Objective Assessment of the Cervical Spine- Provide reliable assessments and exercises for Neuromuscular Control, Proprioception, Range of Motion, and Sensorimotor-Integration. Learn more at NeckCare.comTurncloud EHR- Minimalist design, without being sparse. Practical, yet elegant. Turncloud's design was to find the most efficient path in a day in the life of a chiropractic office. Connect with their team at www.turncloud.com Patient Pilot by The Smart Chiropractor is the fastest, easiest to generate weekly patient reactivations on autopilot…without spending any money on advertising. Click here to schedule a call with our team.Our members use research to GROW their practice. Are you interested in increasing your referrals? Discover the best chiropractic marketing you aren't currently using right here!

Not all salts are created equal!

In this episode, the NCETM's Dr Jen Shearman, Paul Rowlandson and Sue Evans discuss the upcoming EEF-funded trials of two important Maths Hubs programmes in 2025/26. The conversation explores the role of external evaluation, the challenges of conducting randomised controlled trials (RCTs), and what the findings could mean for maths education. A transcript (PDF) of this episode is available to download. Show notes Taking part in the discussion: Jen Shearman, Director for Evaluation and Impact, NCETM Sue Evans, Assistant Director for Primary, NCETM Paul Rowlandson, Assistant Director for School and Professional Development, NCETM Julia Thomson, Senior Communications and Marketing Manager, NCETM. Episode chapters 00:00 Introduction and welcome 01:12 Meet the team and overview of the EEF trials 01:57 Understanding the EEF and its role 03:31 The NCETM's involvement with the EEF 06:11 Introduction to the SKTM Secondary Non-specialist Teachers Programme 09:28 Introduction to the Mastering Number at Reception and KS1 Programme 12:02 Challenges in conducting the trials 22:01 Hopes and expectations from the trials 31:04 Conclusion and how to get involved. Useful links Specialist Knowledge for Teaching Mathematics Secondary Non-specialist Teachers Programme Mastering Number at Reception and KS1 Mastering Number at KS2 Blog post on the EEF trials: Going for gold standard Evaluating our programmes in 2025/26 EEF trial of the Secondary Non-specialist Teachers SKTM Programme EEF trial of the Mastering Number at Reception and KS1 Programme TIMMS 2023 Report Coordinating mathematical success: the mathematics subject report (2023) Explore previous episodes of the NCETM podcast in our archive.

Join JACC Associate Editor Khurram Nasir, MBBS, FACC, and author Rohan Khera, MD, FACC, as they discuss the latest study on tirzepatide presented at ACC.25 and published in JACC. Tirzepatide, a dual GIP/GLP-1 receptor agonist, exerts pleiotropic effects on cardiometabolic health. This study evaluated its efficacy in improving cardiometabolic outcomes in individuals with T2D. An individual participant data meta-analysis was conducted, pooling data from seven Phase 3 RCTs comparing tirzepatide with placebo or standard antihyperglycemic agents. The study outcomes included cardiometabolic components of metabolic syndrome (MetS), elevated BMI, and MetS. Tirzepatide significantly reduced the odds of these abnormalities and effectively resolved MetS, with superior efficacy observed in younger individuals and those not on baseline SGLT2is. These findings support the potential of tirzepatide to improve cardiometabolic health in T2D.

Send us a textIn this episode, I had the pleasure of speaking with Dr Ilana Levene, who is now a Neonatology subspeciality trainee at Oxford, England. Ilana has done some fantastic work on exploring the important topic of human milk expression. She described her randomized control trial in using relaxing techniques to facilitate human milk expression in the NICU. She shared the challenges that she had in conducting her RCT. We also talked about RCTs with negative results and how negative results are also important in conducting research. Ilana has now created a website with printables for parents and staff in the NICU on human milk expression. This can be assessed for free here : http://www.hifn.org/printable . Ilana also shared her interest in perinatal equity and shared details on her project Spectrum which involves gathering photos of the lactating breast conditions/chest from people with a wide spectrum of skincolours. These will be provided as a free educational image library. Currently she is chairing a priority setting partnership for LGBTQIA+ perinatal care. As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Welcome to Mad In America Radio. My name is Bob Whitaker, and today my guest is Italian psychiatrist, Giovanni Fava. From 1992 to 2022, Dr. Fava edited the journal Psychotherapy and Psychosomatics. We will be talking about the importance of that journal and what may be lost now that the publisher, Karger, may be taking it in a new direction. Here's why this journal, under Dr. Fava's leadership, was so important to us all. When psychiatry talks about how its drug treatments are evidence-based, it points to RCTs and meta-analyses of those RCTs as proof that its drugs are more effective than placebo. However, Psychotherapy and Psychosomatics under Dr. Fava's guidance presented a very different evidence base to its readers. First, his journal told of how clinical experiences should govern our understanding of the impact of psychiatric treatments, particularly over longer periods of time. Second, his journal told of how RCTs and meta-analyses when used to direct clinical practices can lead to harm. Third, his journal told of the corrupting influence of pharmaceutical money on the creation of psychiatric diagnoses and drug trials. When Dr. Fava became editor of Psychotherapy and Psychosomatics in 1992, it had a low impact factor. When he resigned as editor in 2022, it had an impact factor that made it one of the most influential journals in psychiatry and psychology. He left the journal in good hands in 2022 and he remained involved as an honorary editor. However, in December, Karger fired one of the two editors in chief, Dr. Fava then resigned as honorary editor, and most of the editorial board resigned as well. The future of this journal, which had been so essential to our understanding of the impact of psychiatric treatments is now unclear. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. https://www.madinamerica.com/donate/ To find the Mad in America podcast on your preferred podcast player, click here: https://pod.link/1212789850 © Mad in America 2025. Produced by James Moore https://www.jmaudio.org

Dr. Ebony Hoskins and Dr. Andreas Obermair discuss the surgical management of gynecologic cancers, including the role of minimally invasive surgery, approaches in fertility preservation, and the nuances of surgical debulking. TRANSCRIPT Dr. Ebony Hoskins: Hello and welcome to the ASCO Daily News Podcast, I'm Dr. Ebony Hoskins. I'm a gynecologic oncologist at MedStar Washington Hospital Center in Washington, DC, and your guest host of the ASCO Daily News Podcast. Today we'll be discussing the surgical management of gynecologic cancer, including the role of minimally invasive surgery (MIS), approaches in fertility preservation, and the nuances of surgical debulking, timing, and its impact on outcomes. I am delighted to welcome Dr. Andreas Obermair for today's discussion. Dr. Obermair is an internationally renowned gynecologic oncologist, a professor of gynecologic oncology at the University of Queensland, and the head of the Queensland Center for Gynecologic Cancer Research. Our full disclosures are available in the transcript of this episode. Dr. Obermair, it's great speaking with you today. Dr. Andreas Obermair: Thank you so much for inviting me to this podcast. Dr. Ebony Hoskins: I am very excited.  I looked at your paper and I thought, gosh, is everything surgical? This is everything that I deal with daily in terms of cancer in counseling patients. What prompted this review regarding GYN cancer management? Dr. Andreas Obermair: Yes, our article was published in the ASCO Educational Book; it is volume 44 in 2024. And this article covers some key aspects of targeted precision surgical management principles in endometrial cancer, cervical cancer, and ovarian cancer. While surgery is considered the cornerstone of gynecologic cancer treatment, sometimes research doesn't necessarily reflect that. And so I think ASCO asked us to; so it was not just me, there was a team of colleagues from different parts of the United States and Australia to reflect on surgical aspects of gynecologic cancer care and I feel super passionate about that because I do believe that surgery has a lot to offer. Surgical interventions need to be defined and overall, I see the research that I'm doing as part of my daily job to go towards precision surgery. And I think that is, well, that is something that I'm increasingly passionate for. Dr. Ebony Hoskins: Well, I think we should get into it. One thing that comes to mind is the innovation of minimally invasive surgery in endometrial cancer. I always reflect on when I started my fellowship, I guess it's been about 15 years ago, all of our endometrial cancer patients had a midline vertical incision, increased risk of abscess, infections and a long hospital stay. Do you mind commenting on how you see management of endometrial cancer today? Dr. Andreas Obermair: Thank you very much for giving the historical perspective because the generation of gynecologic oncologists today, they may not even know what we dealt with, what problems we had to solve. So like you, when I was a fellow in gynecologic oncology, we did midline or lower crosswise incisions, the length of stay was, five days, seven days, but we had patients in hospital because of complications for 28 days. We took them back to the operating theaters because those are patients with a BMI of 40 plus, 45, 50 and so forth. So we really needed to solve problems. And then I was exposed to a mentor who taught minimal invasive surgery. And in Australia he was one of the first ones who embarked on that. And I can remember, I was mesmerized by this operation, like not only how logical this procedure was, but also we did rounds afterwards. And I saw these women after surgery and I saw them sitting upright, lipstick on, having had a full meal at the end of the day. And I thought, wow, this is the most rewarding experience that I have to round these patients after surgery. And so I was thinking, how could I help to establish this operation as standard? Like a standard that other people would accept this is better. And so I thought we needed to do a trial on this. And then it took a long time. It took a long time to get the support for the [LACE - Laparoscopic Approach to Cancer of the Endometrium] trial. And in this context, I just also wanted to remind us all that there were concerns about minimal invasive surgery in endometrial cancer at the time. So for example, one of the concerns was when I submitted my grant funding applications, people said, “Well, even if we fund you, wouldn't be able to do this trial because there are actually no surgeons who actually do minimally invasive surgery.” And at the time, for example, in Australia, there were maybe five people, a handful of people who were able to do this operation, right? This was about 20 years ago. The other concern people had was they were saying, could minimally invasive surgery for endometrial cancer, could that cause port side metastasis because there were case reports. So there were a lot of things that we didn't know anyway. We did this trial and I'm super happy we did this trial. We started in 2005, and it took five years to enroll. At the same time, GOG LAP2 was ramping up and the LACE trial and GOG LAP2 then got published and provided the foundations for minimally invasive surgery in endometrial cancer. I'm super happy that we have randomized data about that because now when we go back and now when people have concerns about this, should we do minimally invasive surgery in P53 mutant tumors, I'm saying, well, we actually have data on that. We could go back, we could actually do more research on that if we wanted to, but our treatment recommendations are standing on solid feet. Dr. Ebony Hoskins: Well, my patients are thankful. I see patients all the time and they have high risk and morbidly obese, lots of medical issues and actually I send them home most the same day. And I think, you know, I'm very appreciative of that research, because we obviously practice evidence-based and it's certainly a game changer. Let's go along the lines of MIS and cervical cancer. And this is going back to the LACC [Laparoscopic Approach to Cervical Cancer] trial.  I remember, again, one of these early adopters of use of robotic surgery and laparoscopic surgery for radical hysterectomy and thought it was so cool. You know, we can see all the anatomy well and then have the data to show that we actually had a decreased survival. And I even see that most recent updated data just showing it still continued. Can you talk a little bit about why you think there is a difference? I know there's ongoing trials, but still interested in kind of why do you think there's a survival difference? Dr. Andreas Obermair:  So Ebony, I hope you don't mind me going back a step. So the LACC study was developed from the LACE trial. So we thought we wanted to reproduce the LACE data/LAP2 data. We wanted to reproduce that in cervix cancer. And people were saying, why do you do that? Like, why would that be different in any way? We recognize that minimally invasive radical hysterectomy is not a standard. We're not going to enroll patients in a randomized trial where we open and do a laparotomy on half the patients. So I think the lesson that really needs to be learned here is that any surgical intervention that we do, we should put on good evidence footing because otherwise we're really running the risk of jeopardizing patients' outcomes. So, that was number one and LACC started two years after LACE started. So LACC started in 2007, and I just wanted to acknowledge the LACC principal investigator, Dr. Pedro Ramirez, who at the time worked at MD Anderson. And we incidentally realized that we had a common interest. The findings came totally unexpected and came as an utter shock to both of us. We did not expect this. We expected to see very similar disease-free and overall survival data as we saw in the endometrial cancer cohort. Now LACC was not designed to check why there was a difference in disease-free survival. So this is very important to understand. We did not expect it. Like, so there was no point checking why that is the case. My personal idea, and I think it is fair enough if we share personal ideas, and this is not even a hypothesis I want to say, this is just a personal idea is that in endometrial cancer, we're dealing with a tumor where most of the time the cancer is surrounded by a myometrial shell. And most of the time the cancer would not get into outside contact with the peritoneal cavity. Whereas in cervix cancer, this is very different because in cervix cancer, we need to manipulate the cervix and the tumor is right at the outside there. So I personally don't use a uterine manipulator. I believe in the United States, uterine manipulators are used all the time. My experience is not in this area, so I can't comment on that. But I would think that the manipulation of the cervix and the contact of the cervix to the free peritoneal cavity could be one of the reasons. But again, this is simply a personal opinion. Dr. Ebony Hoskins: Well, I appreciate it. Dr. Andreas Obermair: Ebony at the end of the day, right, medicine is empirical science, and empirical science means that we just make observations, we make observations, we measure them, and we pass them on. And we made an observation. And, and while we're saying that, and yes, you're absolutely right, the final [LACC] reports were published in JCO recently. And I'm very grateful to the JCO editorial team that they accepted the paper, and they communicated the results because this is obviously very important. At the same time, I would like to say that there are now three or four RCTs that challenge the LACC data. These RCTs are ongoing, and a lot of people will be looking forward to having these results available. Dr. Ebony Hoskins: Very good. In early-stage cervical cancer, the SHAPE trial looked at simple versus radical hysterectomy in low-risk cervical cancer patients. And as well all know, simple hysterectomy was not inferior to radical hysterectomy with respect to the pelvic recurrence rate and any complications related to surgery such as urinary incontinence and retention. My question for you is have you changed your practice in early-stage cervical cancer, say a patient with stage 1B1 adenocarcinoma with a positive margin on conization, would you still offer this patient a radical hysterectomy or would you consider a simple hysterectomy? Dr. Andreas Obermair:  I think this is a very important topic, right? Because I think the challenge of SHAPE is to understand the inclusion criteria. That's the main challenge. And most people simplify it to 2 cm, which is one of the inclusion criteria but there are two others and that includes the depth of invasion. Dr. Marie Plante has been very clear. Marie Plante is the first author of the SHAPE trial that's been published in the New England Journal of Medicine only recently and Marie has been very clear upfront that we need to consider all three inclusion criteria and only then the inclusion criteria of SHAPE apply. So at the end of the day, I think what the SHAPE trial is telling us that small tumors that would strictly fulfill the criteria of a 1B or 1B1 cancer of the cervix can be considered for a standard type 1 or PIVA type 1 or whatever classification we're trying to use will be eligible. And that makes a lot of sense. I personally not only look at the size, I also look at the location of the tumor. I would be very keen that I avoid going through tumor tissue because for example, if you have a tumor that is, you know, located very much in one corner of the cervix and then you do a standard hysterectomy and then you have a positive tumor margin that would be obviously, most people would agree it would be an unwanted outcome. So I'd be very keen checking the location, the size of the tumor, the depths of invasion and maybe then if the tumor for example is on one side of the cervix you can do a standard approach on the contralateral side but maybe do a little bit more of a margin, a parametrial margin on the other side. Or if a tumor is maybe on the posterior cervical lip, then you don't need to worry so much about the anterior cervical margin, maybe take the rectum down and maybe try to get a little bit of a vaginal margin and the margin on the uterus saccals. Just really to make sure that you do have margins because typically if we get it right, survival outcomes of clinical stage 1 early cervix cancer 1B1 1B 2 are actually really good. It is a very important thing that we get the treatment right. In my practice, I use a software to record my treatment outcomes and my margins. And I would encourage all colleagues to be cognizant and to be responsible and accountable to introduce accountable clinical practice, to check on the margins and check on the number on the percentage of patients who require postoperative radiation treatment or chemo radiation. Dr. Ebony Hoskins: Very good. I have so many questions for you. I don't know the statistics in Australia, but here, there's increased rising of endometrial cancer and certainly we're seeing it in younger women. And fertility always comes up in terms of kind of what to do. And I look at the guidelines and, see if I can help some of the women if they have early-stage endometrial cancer. Your thoughts on what your practice is on use of someone who may meet criteria, if you will. The criteria I use is grade 1 endometrioid adenocarcinoma. No myometria invasion. I try to get MRI'd and make sure that there's no disease outside the endometrium. And then if they make criteria, I typically would do an IUD. Can you tell me what your practice is and where you've had success? Dr. Andreas Obermair: So, we initiated the feMMe clinical trial that was published in 2021 and it was presented in a Plenary at one of the SGO meetings. I think it was in 2021, and we've shown complete pathological response rates after levonorgestrel intrauterine device treatment. And so in brief, we enrolled patients with endometrial hyperplasia with atypia, but also patients with grade 1 endometrial adenocarcinoma. Patients with endometrial hyperplasia with atypia had, in our series, had an 85 % chance of developing a complete pathological response. And that was defined as the complete absence of any atypia or cancer. So endometrial hyperplasia with atypia responded in about 85%. In endometrial cancer, it was about half, it was about 45, 50%. In my clinical practice, like as you, I see patients, you know, five days a week. So I'm looking after many patients who are now five years down from conservative treatment of endometrial cancer. There are a lot of young women who want to get pregnant, and we had babies, and we celebrate the babies obviously because as gynecologist obstetricians it couldn't get better than that, right, if our cancer patients have babies afterwards. But we're also treating women who are really unfit for surgery and who are frail and where a laparoscopic hysterectomy would be unsafe. So this phase is concluded, and I think that was very successful. At least we're looking to validate our data. So we're having collaborations, we're having collaborations in the United States and outside the United States to validate these data. And the next phase is obviously to identify predictive factors, to identify predictors of response. Because as you can imagine, there is no point treating patients with a levonorgestrel intrauterine joint device where we know in advance that she's not going to respond. So this is a very, very fascinating story and we got our first set of data already, but now we just really need to validate this data. And then once the validation is done, my unit is keen to do a prospective validation trial. And that also needs to involve international collaborators. Dr. Ebony Hoskins: Very good. Moving on to ovarian cancer, we see patients with ovarian cancer with, say, at least stage 3C or higher who started neoadjuvant chemotherapy. Now, some of these patients are hearing different things from their medical oncologist versus their gynecologic oncologist regarding the number of cycles of neoadjuvant chemotherapy after getting diagnosed with ovarian cancer. I know that this can be confusing for our patients coming from a medical oncologist versus a gynecologic oncologist. What do you say to a patient who is asking about the ideal number of chemotherapy cycles prior to surgery? Dr. Andreas Obermair: So this is obviously a very, very important topic to talk about. We won't be able to provide a simple off the shelf answer for that, but I think data are emerging.  The ASCO guidelines should also be worthwhile considering because there are actually new ASCO Guidelines [on neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer] that just came out a few weeks ago and they would suggest that we should be aiming for R0 in surgery. If we can maybe take that as the pivot point and then go back and say, okay, so what do need to do to get the patient to zero?  I'm not an ovarian cancer researcher; I'm obviously a practicing gynecologic oncologist. I think about things a lot and things like that. In my practice, I would want a patient to develop a response after neoadjuvant chemotherapy. So, if a patient doesn't have a response after two or three cycles, then I don't see the point for me to offer her an operation. In my circle with the medical oncologists that I work with, I have a very, very good understanding. So, they send the patient to me, I take them to the theater. I take a good chunk of tissue from the peritoneum. We have a histopathologic diagnosis, we have a genomic diagnosis, they go home the same day. So obviously there is no hospital stay involved with that. They can start the chemotherapy after a few days. There is no hold up because the chances of surgical complication in a setting like this is very, very low. So I use laparoscopy to determine whether the patient responds or not. And for many of my patients, it seems to work. It's obviously a bit of an effort and it takes operating time. But I think I'm increasing my chances to make the right decision. So, coming back to your question about whether we should give three or six cycles, I think the current recommendations are three cycles pending the patient's response to neoadjuvant chemotherapy because my aim is to get a patient to R0 or at least minimal residual disease. Surgery is really, in this case, I think surgery is the adjunct to systemic treatment. Dr. Ebony Hoskins: Definitely. I think you make a great point, and I think the guideline just came out, like you mentioned, regarding neoadjuvant. And I think the biggest thing that we need to come across is the involvement of a gynecologic oncologist in patients with ovarian cancer. And we know that that survival increases with that involvement. And I think the involvement is the surgery, right? So, maybe we've gotten away from the primary tumor debulking and now using more neoadjuvant, but surgery is still needed. And so, I definitely want to have a take home that GYN oncology is involved in the care of these patients upfront. Dr. Andreas Obermair: I totally support that. This is a very important statement. So when I'm saying surgery is the adjunct to medical treatment, I don't mean that surgery is not important. Surgery is very important. And the timing is important. And that means that the surgeons and the med oncs need to be pulling on the same string. The med oncs just want to get the cytotoxic into the patients, but that's not the point, right? We want to get the cytotoxic into the patients at the right time because if we are working under this precision surgery, precision treatment mantra, it's not only important what we do, but also doing it at the right time. And ideally, I I would like to give surgery after three cycles of neoadjuvant chemotherapy, if that makes sense. But sometimes for me as a surgeon, I talk to my med onc colleagues and I say, “Look, she doesn't have a good enough response to her treatment and I want her to receive six cycles and then we re-evaluate or change medical treatment,” because that's an alternative that we can swap out drugs and treat upfront with a different drug and then sometimes they do respond. Dr. Ebony Hoskins:  I have maybe one more topic. In the area I'm in, in the Washington D.C. area, we see lots of endometrial cancer and they're not grade 1, right? They're high-risk endometrial cancer and advanced. So a number of patients with stage 3 disease, some just kind of based off staging and then some who come in with disease based off of the CT scan, sometimes omental caking, ascites. And the real question is we have extrapolated the use of neoadjuvant chemotherapy to endometrial cancer. It's similar, but not the same. So my question is in an advanced endometrial cancer, do you think there's still a role, when I say advanced, I mean, maybe stage 4, a role for surgery? Dr. Andreas Obermair: Most definitely. But the question is when do you want to give this surgery? Similar to ovarian cancer, in my experience, I want to get to R0. What am I trying to achieve here? So, I reckon we should do a trial on this. And I reckon we have, as you say, the number of patients in this setting is increasing, we could do a trial. I think if we collaborate, we would have enough patients to do a proper trial. Obviously, we would start maybe with a feasibility trial and things like that. But I reckon a trial would be needed in this setting because I find that the incidence that you described, that other people would come across, they're becoming more and more common. I totally agree with you, and we have very little data on that. Dr. Ebony Hoskins: Very little and we're doing what we can. Dr. Obermair, thank you for sharing your fantastic insights with us today on the ASCO Daily News Podcast and for all the work you do to advance care for patients with gynecologic cancer. Dr. Andreas Obermair: Thank you, Dr. Hoskins, for hosting this and it's been an absolute pleasure speaking with you today. Dr. Ebony Hoskins: Definitely a pleasure and thank you to our listeners for your time today. Again, Dr. Obermair's article is titled, “Controversies in the Surgical Management of Gynecologic Cancer: Balancing the Decision to Operate or Hesitate,” and was published in the 2024 ASCO Educational Book. And you'll find a link to the article in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement. Find out more about today's speakers: Dr. Ebony Hoskins @drebonyhoskins Dr. Andreas Obermair @andreasobermair Follow ASCO on social media:       @ASCO on Twitter       ASCO on Bluesky   ASCO on Facebook       ASCO on LinkedIn       Disclosures:   Dr. Ebony Hoskins: No relationships to disclose. Dr. Andreas Obermair: Leadership: SurgicalPerformance Pty Ltd. Stock and Ownership Interests: SurgicalPerformance Pty Ltd. Honoraria: Baxter Healthcare Consulting or Advisory Role: Stryker/Novadaq Patents, Royalties, and Other Intellectual Property: Shares in SurgicalPerformance Pty Ltd. Travel, Accommodation, Expenses: Stryker    

Vanessa Spina is a Sport Nutrition Specialist (SNS) and the Best Selling author of Keto Essentials. She is a researcher who studied biomedical science at the University of Toronto, an international speaker and host of the wildly popular Optimal Protein Podcast, ranked in the Top 20 podcasts in the Nutrition category in the USA and globally #1-20. It has been nominated twice as a top 3 Best Podcast at the Metabolic Health Summit.  Vanessa founded Ketogenic Girl in 2015 with online audience of over half a million. Vanessa has created three innovative wellness products. The Tone device, a breath ketone analyzer which measures acetone, the ketone detected on the breath. The second is a new red light therapy line called the Tone LUX Collection. The third is a supplement line called Tone that includes Tone Protein, a protein powder that is scientifically formulated to initiate Muscle Protein Synthesis in every serving with the addition of leucine, and the new Tone Collagen which has clinical studies (RCTs) proving its effectiveness.  She has been featured as a nutrition expert in articles published in the Orlando Sentinel, Eat This, Parade, Reader's Digest and more. Instagram: @ketogenicgirl @optimalproteinpodcast @tonedevice @thetonelux Twitter: @ketogenicgirl Website: Www.ketogenicgirl.com Timestamps: 00:00 Trailer 01:12 Introduction 04:09 Children's innate eating wisdom 07:44 Rising awareness of food quality 10:29 European dietary habits and trends 15:02 Carnivore diet ended my food obsession 17:49 Revamped keto focus on ketones 19:03 Asymptomatic progress and protein satiety 22:26 MCT and ketone supplements for focus 27:36 Ketones: alternative brain fuel 31:53 High-fat foods and nutrition 33:23 Balanced diet preference over carnivore 38:02 Drunken attempt to avoid onions 41:05 New book on high-protein diets 44:28 Whey protein and insulin response 46:23 Whey protein isolate benefits 51:02 Red meat misconceptions persist 52:55 Where to find Vanessa Join Revero now to regain your health: https://revero.com/YT Revero.com is an online medical clinic for treating chronic diseases with this root-cause approach of nutrition therapy. You can get access to medical providers, personalized nutrition therapy, biomarker tracking, lab testing, ongoing clinical care, and daily coaching. You will also learn everything you need with educational videos, hundreds of recipes, and articles to make this easy for you. Join the Revero team (medical providers, etc): https://revero.com/jobs ‪#Revero #ReveroHealth #shawnbaker  #Carnivorediet #MeatHeals #AnimalBased #ZeroCarb #DietCoach  #FatAdapted #Carnivore #sugarfree Disclaimer: The content on this channel is not medical advice. Please consult your healthcare provider.

Dr. Jonathan Howard and Wendy Orent discuss the growing public health disasters under RFK Jr.'s leadership at HHS. They cover the first measles death of a child in over 30 years, the cancellation of a crucial flu vaccine advisory meeting, and the termination of funding for a promising oral COVID vaccine trial.    Meanwhile, RFK Jr. moves to eliminate public commentary on HHS decisions, and scientific institutions continue to suffer massive cuts. They highlight the Orwellian doublespeak of Vinay Prasad and others who once demanded more RCTs—only to stay silent as Kennedy cancels them.    Finally, they introduce the Bill Cassidy Profile in Cowardice Award, recognizing the senator who had the power to stop this but chose not to. Connect with us further on https://sciencebasedmedicine.org/author/jonathanhoward/  The Fine Print The content presented in the "We Want Them Infected" Podcast and associated book is intended for informational and educational purposes only.    The views and opinions expressed by the speakers, hosts, and guests on the podcast do not necessarily reflect the views of the creators, producers, or distributors. The information provided in this podcast should not be considered as a substitute for professional medical, scientific, or legal advice. Listeners and readers are encouraged to consult with relevant experts and authorities for specific guidance and information.   The creators of the podcast and book have made reasonable efforts to ensure that the information provided is accurate and up to date. However, as the field of medical science and the understanding of the COVID-19 pandemic continue to evolve, there may be new developments and insights that are not covered in this content.   The creators are not responsible for any errors or omissions in the content or for any actions taken based on the information provided. They disclaim any liability for any loss, injury, or damage incurred by individuals who rely on the content.   Listeners and readers are urged to use their judgment and conduct their own research when interpreting the information presented in the "We Want Them Infected" podcast and book. It is essential to stay informed about the latest updates, guidelines, and recommendations related to COVID-19 and vaccination from reputable sources, such as government health agencies and medical professionals. By accessing and using the content, you acknowledge and accept the terms of this disclaimer.   Please consult with appropriate experts and authorities for specific guidance on matters related to health, science, and the COVID-19 pandemic.  

India has a lot of call centers. Who are they calling? Mostly clients in other countries. But what if the efficiency, professionalism, and empathy practiced in those centers were onshored to those closest to the Indian people, perhaps those at most at risk for depression…instead of impatient customers on the other side of the planet? Kaya Guides is a digital mental health startup and one of Ambitious Impact's newest high-impact charity ventures. In our chat, Rachel lays out how a service like Kaya Guides can provide a new chapter in mental health for *hundreds of millions*. Rachel's team is looking to replicate the kind of jaw-dropping results observed in RCTs that have convinced the Lebanese government to adopt Smart Start. Rachel has been in the social impact space for over eight years, and is now clearly thriving as a founder. I was honoured to sit with her after EAG Boston and learn not only the story of Kaya Guides, but also the vibrant human who is walking her values. How to reach Rachel or Kaya Guides: hello@kayaguides.com Best ways to Reach Elliot: Linkedin or the EA Anywhere Slack Kaya Guides https://www.kayaguides.com/ For more on Effective Altruism Global conferences: https://www.effectivealtruism.org/ea-global For more about from Rachel and my other guests, check out the EOA YouTube channel: https://www.youtube.com/@-effectingouraltruism Listen to the full audio podcast: https://pod.link/1754081644 For more on Elliot's coaching: www.elliotbillingsley.com  

The treatment of asymptomatic aortic stenosis, the move to composite endpoints in trials, IFR vs FFR and high-frequency low tidal volume ventilation for AF ablation are the topics John Mandrola, MD, discusses in today's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Aortic valve intervention for Asymptomatic AS Lindman editorial https://jamanetwork.com/journals/jamacardiology/fullarticle/2829881 Trends https://pmc.ncbi.nlm.nih.gov/articles/PMC11308430/ Podcast EARLY TAVR Nov 8, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001865 Faith Healing and Subtraction Anxiety https://www.ahajournals.org/doi/10.1161/circoutcomes.118.004665 Early TAVR trial https://www.nejm.org/doi/10.1056/NEJMoa2405880 EVOLVED https://jamanetwork.com/journals/jama/fullarticle/2825540 AVATAR https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639 II Trial Endpoints Shepshelovich https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2830023 Brown meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785560 III IFR vs FFR—a debate b/w RCTs and observational data 5-year DEFINE https://jamanetwork.com/journals/jamacardiology/fullarticle/2824470 5-year SwedeHeart IFR https://doi.org/10.1016/j.jacc.2021.12.030 Eftekhari meta-analysis https://doi.org/10.1093/eurheartj/ehad582 Gotberg SWEDEHEART Registry https://doi.org/10.1016/j.jcin.2024.12.003 Editorial of SWEDEHEART-Registry https://doi.org/10.1016/j.jcin.2024.12.014 IV High-frequency low-tidal-volume ventilation for AF ablation Osorio et al https://doi.org/10.1016/j.hrthm.2024.07.094 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Send us a textWhat if nonprofits could measure their impact without breaking the bank or succumbing to funder demands for costly trials? Join us on "The Nonprofit Fix" as we unravel the complexities of impact measurement, challenging the dominance of randomized control trials (RCTs) and exploring more accessible alternatives. With three decades of experience in program evaluation, we dissect the limitations of RCTs and the pitfalls of non-experimental studies, which often inflate success rates without truly reflecting causality. Our conversation doesn't stop there—we navigate the promising terrain of AI and machine learning, which holds the potential to revolutionize evaluation methods by leveraging existing data for more accurate and cost-effective assessments.We then examine the paradigm shift in nonprofit data management, advocating for a transition from compliance-driven collection to harnessing data for real-time insights and program enhancement. Imagine reducing evaluation lag time while simultaneously fostering a dynamic, responsive service delivery—technology makes this possible. By repurposing administrative data and adopting machine learning, nonprofits can create feedback loops that enhance decision-making and program effectiveness. This approach not only transforms service delivery but also generates a culture of continuous improvement that benefits both practitioners and beneficiaries.Finally, we delve into the nuances of differentiating raw data from genuine impact within the nonprofit sector. With a critical eye, we address the challenges of using simplistic surveys and the role of sophisticated program administrative data systems. The conversation extends to the potential of machine learning to build comprehensive models that reflect true program efficacy. We explore key resources like Project Evident and training opportunities that open new horizons for nonprofits seeking to refine their impact measurement. As we wrap up, we offer a glimpse into our podcast's evolution and tease future discussions on the effects of changes in federal administration on nonprofits.

Another negative AF ablation trial, predicting AF after stroke, the value of RCTs, troponin testing in the ED and surgical aortic valve choice are the topics John Mandrola, MD, discusses this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I AF ablation Coronary Sinus Isolation for High-Burden Atrial Fibrillation: A Randomized Clinical Trial https://doi.org/10.1016/j.jacep.2024.09.017 Approaches to Catheter Ablation for Persistent Atrial Fibrillation (STAR AFII) https://www.nejm.org/doi/full/10.1056/NEJMoa1408288 Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation: The VENUS Randomized Clinical Trial https://doi.org/10.1001/jama.2020.16195 Hybrid Convergent Procedure for the Treatment of Persistent and Long-Standing Persistent Atrial Fibrillation: Results of CONVERGE Clinical Trial https://www.ahajournals.org/doi/10.1161/CIRCEP.120.009288 II Post-Stroke AF monitoring Prediction of atrial fibrillation after a stroke event: a systematic review with meta-analysisMeta-analysis 10.1016/j.hrthm.2025.01.026 Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source https://www.nejm.org/doi/full/10.1056/NEJMoa1813959 Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source (Navigate ESUS https://www.nejm.org/doi/full/10.1056/NEJMoa1802686 Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy (ARCADIA) https://jamanetwork.com/journals/jama/fullarticle/2814933 III RCTs Large simple randomized controlled trials—from drugs to medical devices: lessons from recent experience https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-025-08724-x Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction (TASTE) https://www.nejm.org/doi/full/10.1056/NEJMoa1405707 IV Troponin Testing in the ED Cardiac Biomarker Testing in US Emergency Departments https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2829344 Updating Our Thinking on Troponin Use and Interpretation https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2777967 V Choice of AVR Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients 40-75 Years https://doi.org/10.1016/j.jacc.2025.01.013 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

In this episode, mechanisms and research are discussed. The question, ‘if we have a randomized control trial (RCT), can we do without knowledge of a mechanism?' is answered. It is held that mechanisms do make a substantive difference to the optimization of a RCT. This is defended through two cases — the failed Duchenne Muscular Dystrophy Phase 3 trials in 2024 ran by Sarepta Therapeutics and Pfizer and the daptomycin 2005 trial to test its efficacy in patients Gram-positive community acquired pneumonia. Nancy Cartwright's INUS contributors are put forth as a potential objection. However, an as-complete-as-possible concept of mechanistic understanding and reasoning is advocated for ultimately.

Many development economists would argue that the most important innovation of the last two decades has been a commitment to use only rigorous evidence for policy, and usually what they mean is evidence generated by RCTs. But are systematic reviews of the results a useful guide to policy? And should development economics continue to be focusing so much on the programmes that flow from RCT- driven research? Lant Pritchett of LSE talks to Tim Phillips about the nature of “rigorous” evidence in development economics, and the future of the discipline itself. Read the full show notes on VoxDev: https://voxdev.org/topic/macroeconomics-growth/rethinking-evidence-and-refocusing-growth-development-economics

Date: December 2o, 2024 Reference: Kotani et al. Positive single-center randomized trials and subsequent multicenter randomized trials in critically ill patients: a systematic review. Crit Care. 2023  Guest Skeptic: Dr. Scott Weingart is an ED Intensivist from New York. He did fellowships in Trauma, Surgical Critical Care, and ECMO. He is a physician coach concentrating […] The post SGEM#465: Not A Second Time – Single Center RCTs Fail To Replicate In Multi-Center RCTs first appeared on The Skeptics Guide to Emergency Medicine.

Send us a textHappy Holidays Rounds Table Listeners! For our penultimate episode of 2024, we are back with a special treat! This week, Drs. Mike and John Fralick chat about the top five RCTs published over the past year:Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (0:00 – 3:40).Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity (3:40 – 9:00).Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes (9:00 – 13:55).Tirzepatide for Metabolic-Dysfunction Associated Steatohepatitis with Liver Fibrosis (13:55 – 20:00).Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections (the Balance Trial) (20:00 – 23:30).And for the Good Stuff:Toronto Star Santa Claus Fund, Calgary Food Bank, Epilepsy Canada (23:30 – 24:51).Questions? Comments? Feedback? We'd love to hear from you! @roundstable @InternAtWork @MedicinePodsSupport the show

In this episode, we discussed the top abstracts in lymphoma and CLL presented at the ASH 2024 annual meeting in San Diego with Dr. David A Russler-Germain from Washington University. Here are the key abstracts we discussed: 1. 3 RCTs in Mantle Cell Lymphoma: a) Update on TRIANGLE: https://ash.confex.com/ash/2024/webprogram/Paper200735.htmlb) ENRICT Trial (Continuous Ibrutinib-Rituximab vs CIT [R-CHOP or BR]): https://ash.confex.com/ash/2024/webprogram/Paper199710.htmlc) ECOG-ACRIN EA4151 Trial (Auto-HCT vs Rituximab maintenance alone in patients with undetectable MRD after induction): https://ash.confex.com/ash/2024/webprogram/Paper212973.html2. DLBCL: a) Update on POLARIX Trial: https://ash.confex.com/ash/2024/webprogram/Paper197938.htmlb) Predictive Value of Cell-of-Origin Subtype By Hans Algorithm in DLBCL Patients Receiving Polatuzumab Vedotin: https://ash.confex.com/ash/2024/webprogram/Paper202153.htmlc) COALITION trial: https://ash.confex.com/ash/2024/webprogram/Paper204930.html3. Follicular Lymphoma: a) Phase 3 inMIND trial (Tafasitamab + R2 vs Placebo + R2): https://ash.confex.com/ash/2024/webprogram/Paper212970.htmlb) Loncastuximab tesirine with rituximab in patients with R/R FL: https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(24)00345-4/abstract4. CLL: a) AMPLIFY Trial (Fixed-Duration Acalabrutinib Plus Venetoclax with or without Obinutuzumab Versus Chemoimmunotherapy in 1st line CLL): https://ash.confex.com/ash/2024/webprogram/Paper200701.html5. Hodgkin Lymphoma: a) Pembrolizumab Maintenance Instead of Auto-HCT for R/R HL: https://ash.confex.com/ash/2024/webprogram/Paper202537.html

Happy Holidays Rounds Table Listeners! For our penultimate episode of 2024, we are back with a special treat! This week, Drs. Mike and John Fralick chat about the top five RCTs published over the past year:Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (0:00 – 3:40).Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity (3:40 – 9:00).Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes (9:00 – 13:55).Tirzepatide for Metabolic-Dysfunction Associated Steatohepatitis with Liver Fibrosis (13:55 – 20:00).Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections (the Balance Trial) (20:00 – 23:30).And for the Good Stuff:Toronto Star Santa Claus Fund, Calgary Food Bank, Epilepsy Canada (23:30 – 24:51).Questions? Comments? Feedback? We'd love to hear from you! @roundstable @InternAtWork @MedicinePods

Clinical research is undergoing a revolution in light of new demands for speed and opportunities from a technological standpoint. These trends have given rise to a debate about the quality and clinical meaning of traditional methods of investigations versus modern types of clinical studies to collect real world evidence. This debate at the 3rd annual Medical Affairs Innovation Olympics #MAIO2024 in a unique and exciting format with a live poll at the conclusion, features an animated discussion from three speakers: Rashad Massoud, MD, MPH, CEO of Rashad Massoud Associates, LLC., globally recognized healthcare quality expert, physician, formerly visiting faculty at the T.H. Chan School of Public Health; Suzanne Pavon (moderator), Doctor of Pharmacy, Board Member at Iethico, former Vice President of Pharmacovigilance and Quality at Argenx; and Sana Syed, Senior Medical Director - Clinical Lead at Sanofi and public health expert formerly at T.H. Chang School of Public Health. Debate Objectives: ● To discuss the utility of RCTs in research and learning ● To discuss the challenges in translating RCT findings into the real-world environment ● To review the utility of the RCT approach to facilitate real world implementation ● To review the impact of the RCT approach for impact and limitations ● To discuss alternative research methods for research and learning ● To conclude with the research approaches that fit best for clinical trials and the real world; indicating a need for an adaptive, dual approach. 0:00 Alloutcoach Intro Music 0:09 Episode Highlight 3:09 Innovation Olympics Introduction 4:44 Debate Rules & Introduction 6:30 RCTs are the Gold Standard for Research and Learning - For the Motion - Sana Syed 8:12 The Scientific Method - Standard RCT Design 9:46 Rare Disease Case Study 11:38 Translating Biology vs Translating Real World Factors 14:34 Diversity of patients critical for data to represent populations 18:50 RCTs are NOT the Gold Standard for Research: Against the Motion - Rashad Massoud 20:27 Properties of an RCT 21:19 Other Research Questions to Eliminate Other Factors that may influence the results 24:13 Access Questions and Outcomes of Interest - Discovery and Delivery 24:48 Agency for Healthcare Research and Quality (AHRQ) - ~17 yrs to translate data into real world 26:33 Efficacy vs. Effectiveness Research 31:02 Concluding Remarks - case study in which RCT designs are not beneficial 35:30 Question: Health Avatar and AI to create real and virtual control arm Using virtual control arm using real world databases using Bayesian statistical methods 39:23 Case study to emphasize Harnessing Tacit knowledge 42:02 Comment: Weaknesses in generating data we can translate into populations 43:44 Question: Are we creating RCTs from virtual patients or classical RCT design? 47:34 Final Comments - For the Motion, Sana Syed Clinical Studies and Scientific Method - adjustments in diverse patient recruitment tactics 49:31 Final Comments - Against the Motion, Rashad Massoud 53:14 Live Voting Results

US doc's pay, the ticagrelor controversy and new RCTs, clopidogrel beats ASA, holding antiplatelets for non-cardiac surgery, and Prof Cleland and ASA dogma are the topics John Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. US Healthcare Mandrola's Top 10 Stories in 2024 https://www.medscape.com/viewarticle/mandrolas-top-10-stories-2024-2024a1000mxe?_gl=1*dcvmkh*_gcl_au*MTgzOTY2ODQ0Ni4xNzI5MjU4NjUz CMS Proposal II. Ticagrelor Controversy New Investigation Casts Doubt on Landmark Ticagrelor Trial https://www.medscape.com/viewarticle/new-investigation-casts-doubt-landmark-ticagrelor-trial-2024a1000n1d Doshi Review https://www.bmj.com/content/387/bmj.q2550 PLATO https://www.nejm.org/doi/full/10.1056/NEJMoa0904327 ISAR REACT 5 https://www.nejm.org/doi/full/10.1056/NEJMoa1908973 Bates Review https://www.ahajournals.org/doi/epub/10.1161/JAHA.123.031606 Victor Serebuany and Dan Atar Editorial https://doi.org/10.1093/eurheartj/ehp545 III. New Ticagrelor vs Clopdiogrel trial Preprint: https://www.medrxiv.org/content/10.1101/2024.11.06.24316875v1.full-text IV. Clopidogrel Better Than ASA Even in HBR Substudy Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity HOST-EXAM 10.1016/S0140-6736(21)01063-1 HOST-EXAM-Extended https://doi.org/10.1161/CIRCULATIONAHA.122.062770 V. ASA During Non-Cardiac Surgery ASSURE DES https://doi.org/10.1016/j.jacc.2024.08.024 VII. Professor Cleland on ASA for Secondary Prevention Cleland Editorial https//jamanetwork.com/journals/jamacardiology/article-abstract/2827201 ASA Meta-analysis 10.1016/S0140-6736(09)60503-1 AMIS https://jamanetwork.com/journals/jama/fullarticle/368745 SAPAT 10.1016/0140-6736(92)92619-Q You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Read the full transcript here. What have we learned about UBI from recent, large-scale studies? What factors contribute to differential attrition in (especially long-term) studies? How much does it cost to run large UBI studies? Where else in the world have major UBI studies been run? What's the difference between "guaranteed income" and UBI? How do people in cash transfer studies tend to spend their money? Should restrictions be placed on what people can spend their study money on? How long does it take to see various effects of UBI or guaranteed income on a large scale? How does guaranteed income affect the nature of work in recipients' lives? How does guaranteed income affect a person's net worth in the long run? What are the effects on well-being? How does topical knowledge affect prediction accuracy in a given area? How good are subject-matter experts at making predictions about the outcome or utility of a study? How can such predictions in aggregate be used to shape future research? To what extent should reseachers express uncertainty when making proposals to policy-makers? How much of an effect does the publishing of academic papers have on the world? What kind of person should try to build a career in academia? How can non-experts assess the rigor and significance of academic papers?Eva Vivalt is an Assistant Professor in the Department of Economics at the University of Toronto. Dr. Vivalt's main research interests are in investigating stumbling blocks to evidence-based policy decisions, including methodological issues, how evidence is interpreted, and the use of forecasting. Dr. Vivalt is also a principal investigator on three guaranteed income RCTs and a co-founder of the Social Science Prediction Platform, a platform to coordinate the collection of forecasts of research results. Find out more about her on her website, evavivalt.com.Further reading:"The Impact of Unconditional Cash Transfers on Consumption and Household Balance Sheets: Experimental Evidence from Two US States", by Alexander W. Bartik, Elizabeth Rhodes, David E. Broockman, Patrick K. Krause, Sarah Miller, and Eva Vivalt StaffSpencer Greenberg — Host / DirectorJosh Castle — ProducerRyan Kessler — Audio EngineerUri Bram — FactotumWeAmplify — TranscriptionistsMusicBroke for FreeJosh WoodwardLee RosevereQuiet Music for Tiny Robotswowamusiczapsplat.comAffiliatesClearer ThinkingGuidedTrackMind EasePositlyUpLift[Read more]

The JournalFeed podcast for the week of Nov 25-29, 2024.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:This secondary analysis of 2 RCTs found no significant difference between rocuronium or succinylcholine on first attempt success or severe complications in critically ill patients undergoing endotracheal intubation. Wednesday Spoon Feed:Acute pericarditis is a common cause of nonischemic chest pain. In North America, it is typically idiopathic, develops after a viral infection, or follows a cardiac procedure. In areas with higher prevalence, tuberculosis can be an underlying cause of pericarditis. For the majority of patients, treatment with NSAIDs and colchicine leads to a favorable prognosis.

This post summarizes the main findings of a new meta-analysis from the Humane and Sustainable Food Lab. We analyze the most rigorous randomized controlled trials (RCTs) that aim to reduce consumption of meat and animal products (MAP). We conclude that no theoretical approach, delivery mechanism, or persuasive message should be considered a well-validated means of reducing MAP consumption. By contrast, reducing consumption of red and processed meat (RPM) appears to be an easier target. However, if RPM reductions lead to more consumption of other MAP like chicken and fish, this is likely bad for animal welfare and doesn't ameliorate zoonotic outbreak or land and water pollution. We also find that many promising approaches await rigorous evaluation. This post updates a post from a year ago. We first summarize the current paper, and then describe how the project and its findings have evolved. What is a rigorous RCT? There is [...] ---Outline:(01:09) What is a rigorous RCT?(02:15) The main theoretical approaches:(04:45) Results: consistently small effects(07:22) Where do we go from here?(09:00) How has this project changed over time?The original text contained 2 images which were described by AI. --- First published: November 25th, 2024 Source: https://forum.effectivealtruism.org/posts/i5wnzz4uAgeF3ZRc5/research-report-meaningfully-reducing-consumption-of-meat --- Narrated by TYPE III AUDIO. ---Images from the article:Apple Podcasts and Spotify do not show images in the episode description. Try Pocket Casts, or another podcast app.

We've reviewed several papers in the past that suggest there might be an advantage to using IV access compared to IO access for medications in cardiac arrest. Is that really a thing? Wouldn't it be great if we had some randomized controlled trials to help answer the questions?  Funny you should mention RCTs. Dr Jarvis reviews three (THREE!) new RCTs that compare IV to IO access in out of hospital cardiac arrest to try to shed some of that bright light of science on this question!Citations:1. Vallentin MF, Granfeldt A, Klitgaard TL, Mikkelsen S, Folke F, Christensen HC, Povlsen AL, Petersen AH, Winther S, Frilund LW, et al.: Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest. N Engl J Med.2. Smida T, Crowe R, Jarvis J, Ratcliff T, Goebel M: A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehospital Emergency Care. 2024;28(6):1–23.3. Nielsen N: The Way to a Patient's Heart — Vascular Access in Cardiac Arrest. N Engl J Med. doi: 10.1056/NEJMe2412901 (Epub ahead of print).4. Ko Y-C, Lin H-Y, Huang EP-C, Lee A-F, Hsieh M-J, Yang C-W, Lee B-C, Wang Y-C, Yang W-S, Chien Y-C, et al.: Intraosseous versus intravenous vascular access in upper extremity among adults with out-of-hospital cardiac arrest: cluster randomised clinical trial (VICTOR trial). BMJ. doi: 10.1136/bmj-2024-079878 (Epub ahead of print).5. Kudenchuk PJ, Brown SP, Daya M, Rea T, Nichol G, Morrison LJ, Leroux B, Vaillancourt C, Wittwer L, Callaway CW, et al.: Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2016;May 5;374(18):1711–22.6.Daya MR, Leroux BG, Dorian P, Rea TD, Newgard CD, Morrison LJ, Lupton JR, Menegazzi JJ, Ornato JP, Sopko G, et al.: Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Circulation. 2020;January 21;141(3):188–98.7. Nolan JP, Deakin CD, Ji C, Gates S, Rosser A, Lall R, Perkins GD: Intraosseous versus intravenous administration of adrenaline in patients with out-of-hospital cardiac arrest: a secondary analysis of the PARAMEDIC2 placebo-controlled trial. Intensive Care Medicine. doi: 10.1007/s00134-019-05920-7 (Epub ahead of print).

Send us a textIn this episode, Dr. Bobby tackles the often perplexing world of health headlines. From bold claims about intermittent fasting to the benefits of wearing socks to bed, he breaks down how to evaluate these headlines critically. With nine key questions to ask about a headline, insights into the hierarchy of evidence, and two practical examples, Dr. Bobby provides listeners with tools to discern fact from fiction in health journalism.And, your Health Type influences how you might use information.  Take the Health QuizJoin the Mastermind Workshop Waitlist here:  the Live Long and Well JumpstartKey Topics Covered:Understanding Health Headlines:Should you believe a health headline?  How do you decide whether it is likely to be true, or not adequately based upon evidence?Common examples of sensational headlines and their flaws.Nine Essential Questions to Evaluate Headlines:Is the article published in a reputable outlet by a science writer?Was the headline based on actual scientific studies or just an expert's opinion?Is the study published in a peer-reviewed journal, or was it just presented at a meeting?What journal was it published in, and what is its impact factor?Who conducted the study, and where?How large was the study population?What type of study was it? (Randomized controlled trial vs. observational vs. model-based.)Was there an editorial discussing the study's limitations?Does the headline sound "too good to be true"?Hierarchy of Evidence:From most likely credible to least likelycredible:Meta-analyses.Randomized controlled trials (RCTs).Observational studies.Case series.Expert guidelines.Individual expert opinions.Explanation of each and when to trust them.Examples of Health Studies:Intermittent Fasting and Heart Risk: Why the headline about a 91% increased risk of death was flawed.Meal Replacement Shakes: Insights from a Chinese randomized trial and its limitations.The Problem of Data Manipulation (P-Hacking):How over-analysis of databases can lead to misleading conclusions.The importance of recognizing correlation vs. causation in studies.Takeaways for Listeners:Use the 9 Questions Framework to critically evaluate health headlines and articles.Understand that the type of study (e.g., RCT vs. observational) significantly impacts its credibility.Remember that sensational headlines often oversimplify or distort study findings.Stay skeptical of small studies or ones with vague methodologies.Engage with Dr. Bobby:Have a confusing health headline you'd like Dr. Bobby to analyze? Send it in!Take the health type quiz at DrBobbyLiveLongAndWell.com to better understand how your approach to wellness influences your perception of health information.Don't forget to leave a review on Apple Podcasts, Spotify, or wherever you listen!

Is Robert F. Kennedy, Jr., just a big crank? Well, yes. But is he nevertheless correct in his specific claims about the harms of water fluoridation? It's long been argued that it's no longer necessary, and that it might have the scary adverse effect of lowering children's IQs. In this episode of The Studies Show, Tom and Stuart look at the evidence.While they're at it, Tom and Stuart ask whether there's evidence for several other dentistry-related claims. Regular check-ups; flossing; fillings; fluoride toothpaste—is your dentist just b**********g you about any or all of these?[This podcast was recorded just before Donald Trump selected RFK Jr. as his candidate for US Health Secretary, but that makes the episode even more relevant].The Studies Show is brought to you by Works in Progress magazine. If you're an optimist who enjoys reading about how things have gotten better in the past, and how we might make them better in the future—then it's the magazine for you. Find it at worksinprogress.co. Show notes* RFK Jr.'s tweet about how the new Trump administration will remove fluoride from the US water supply* US National Research Council's 2006 report on fluoridation* 2023 meta-analysis on water fluoridation and IQ* Letter co-authored by Stuart, criticising a bad study on fluoride and IQ in pregnant women and their babies* The original study* Review of fluoridation and cancer risk* 2000 UK NHS review of fluoridation and cancer risk* 2022 UK Government report on the link of water fluoridation to various different medical conditions* 2024 Cochrane Review on fluoridation and preventing tooth decay* Review of guidelines from the Journal of the American Dental Association* 2020 randomised controlled trial on fillings in children's teeth* The Cochrane Library on the evidence for specific intervals between dental appointments (e.g. 6 months)* The American Dental Association guidelines on flossing, and the NHS ones* 2019 Cochrane review of RCTs of flossing* The ADA and NHS guidelines on brushing with fluoride toothpaste* 2019 Cochrane review on brushing and fluoride* Claims about cardiac health being related to dental health* Study of 1m people in Korea on cardiac health and tooth loss* 2020 meta-analysis of cardiac and dental health* The study included in the meta-analysis by Chen, Chen, Lin, and Chen* Claims about dental health and cancer* 2020 review of the literature* 2024 Ars Technica story on dentists over-selling their services* 2019 Atlantic piece: “Is Dentistry a Science?”* 2013 piece in the Washington State Dental News magazine on “creative diagnosis”* Articles in the British Dental Journal and JAMA Internal Medicine both arguing that evidence-based medicine has left dentistry behindCredits The Studies Show 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 www.thestudiesshowpod.com/subscribe

In this episode of NEJM AI Grand Rounds, hosts Raj Manrai and Andy Beam interview Dr. David Ouyang, a cardiologist and AI researcher at Cedars-Sinai Medical Center. The conversation explores Ouyang's journey from medical training to AI research and entrepreneurship, his groundbreaking work in applying AI to cardiology imaging, and the challenges of bringing AI innovations from academia to clinical practice. Ouyang discusses his experience conducting randomized controlled trials (RCTs) for AI algorithms in echocardiography, the process of commercializing research through Y Combinator, and the hurdles in reimbursement for AI-based medical devices. The episode also delves into the future of AI in cardiology, the importance of clinician involvement in AI development, and the potential impact of large language models (LLMs) on medical practice. Ouyang shares insights on balancing clinical value with business considerations in health care AI and offers advice for researchers looking to conduct clinical trials for AI technologies. Transcript.

2024-10-10 Hosts Craig Lipset, Dr. Amir Kalali, and Jane Myles were joined by Matt Veatch and Aaron Kamauu, hosts of the Real World Wednesday's Club on Clubhouse. We joined forces for a TGIF-DTRA + RWW Crossover Episode! With the release of the FDA Draft Guidance on Integrating Randomized Controlled Trials for Drug and Biological Products Into Routine Clinical Practice, it was the perfect topic to bring together the DCT and RWE community for a conversation around this guidance. We discussed why this guidance was aligned to RWE, the distinctions between decentralized, pragmatic, point-of-care trials, and real-world evidence, and how RCTs and DCTs can drive access for all patients.Read the guidance here --> https://www.fda.gov/media/181871/downloadYou can join TGIF-DTRA Sessions live on LinkedIn Live Audio on Friday's at 12:00 PM ET by checking out our LinkedIn. Follow the Decentralized Trials & Research Alliance (DTRA) on LinkedIn and X. Learn more about Membership options and our work at www.dtra.org.

Omega-3 fatty acids are often viewed as beneficial or, at worst, neutral supplements when it comes to supporting cardiovascular health, lowering triglycerides, and offering anti-inflammatory effects. Much of the focus in recent years has centered on understanding how significant these benefits are, particularly for heart health, with many studies highlighting the potential for omega-3s to play a positive role in reducing cardiovascular risk. However, an emerging concern has complicated the conversation around omega-3 supplementation. Several large trials, including the REDUCE-IT and STRENGTH trials, have suggested that omega-3 supplementation might be linked to an increased risk of atrial fibrillation (AF), a common cardiac arrhythmia characterized by an irregular and often rapid heart rate. These findings have sparked debate over whether omega-3s could contribute to this potentially serious heart condition, leaving clinicians and health-conscious individuals uncertain about the safety of these supplements. However, not all the research supports this elevated risk. This discrepancy raises important questions about how we interpret the data from various studies, the design of those trials, and whether other factors might be influencing these results. Understanding this issue in depth is crucial for making informed decisions about omega-3 supplementation and its potential risks and benefits. In this episode we walk through the studies and the key points to consider. Timestamps: 00:30 Updates on Alan's upcoming study 05:06 Atrial Fibrillation and Omega-3 14:52 RCTs and AFib: Key Studies 29:14 Meta-Analyses and Dose-Response 46:46 Practical Implications and Recommendations 53:53 Key Ideas Segment (Premium-only) Links: Join the Sigma email newsletter for free Subscribe to Sigma Nutrition Premium Go to episode page

TONE COLLAGEN is NOW OUT! Check it out HERE & get 15% OFF for the LAUNCH with the code KG15!  Hi friends! This episode is about a new study on Collagen supplementation for the joints, tendons and connective tissue! We also discuss the RCTs on collagen for beauty + skin health from the boosting collagen and reducing wrinkles in the face and cellulite, as well as strengthening hair and nails! We cover the launch of Tone Collagen and the clinical studies on it! Dr. Luc Van Loon study on Collagen here. Get 20% off the Tone LUX Crystal Red Light Therapy Face Mask with the code VANESSA Everyone is loving Tone Protein! Scientifically formulated based on the science to support Muscle Protein Synthesis.  Click Here to Check it out! Join the Community! Follow Vanessa on instagram to see her meals, recipes, informative posts and much more! Click here @ketogenicgirl Follow @optimalproteinpodcast on Instagram to see visuals and posts mentioned on this podcast. Link to join the facebook group for the podcast: https://www.facebook.com/groups/2017506024952802/   - This podcast content does not constitute an attempt to practice medicine and does not establish a doctor-patient relationship. Please consult a qualified healthcare provider for medical advice and personal health questions. Prior to beginning a new diet you should undergo a health screening with your physician to confirm that a new diet is suitable for you and to out any conditions and contraindications that may pose risks or are incompatible with a new diet, including by way of example: conditions affecting the kidneys, liver or pancreas; muscular dystrophy; pregnancy; breast-feeding; being underweight; eating disorders; any health condition that requires a special diet [other conditions or contraindications]; hypoglycemia; or type 1 diabetes. A new diet may or may not be appropriate if you have type 2 diabetes, so you must consult with your physician if you have this condition. Anyone under the age of 18 should consult with their physician and their parents or legal guardian before beginning such a diet. Use of Ketogenic Girl podcasts & videos are subject to the Ketogenicgirl.com Terms of Use and Medical Disclaimer. All rights reserved. If you do not agree with these terms, do not listen to, or view any Ketogenic Girl podcasts or videos.

Featuring articles on long-term oxygen therapy in severe hypoxemia, reducing opioid overdose deaths, blocking CSF1R in chronic GVHD, and pomalidomide in hereditary hemorrhagic telangiectasia; a review article on central nervous system vasculitis; a case report of a man with confusion and kidney failure; a Medicine and Society on house staff unionization revisited; and Perspectives on ethical challenges in pragmatic and cluster RCTs, on the sense and sensibility of sensitivity analyses, and on there being no one in charge.

Charles Weijer is a professor in the Departments of Medicine and Philosophy at Western University. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. C. Weijer and M. Taljaard. Ethical Challenges Associated with Pragmatic and Cluster RCTs. N Engl J Med 2024;391:969-971.

In episode 585, Mike and James invite Émélie Braschi back to the podcast to talk about the tricky issue of how to deal with a potential penicillin allergy. Believe it or not there are a couple of RCTs looking at this issue. These two trials compared oral challenge alone to skin testing followed (if negative) […]

What if I told you there was something you can drink each morning that will help you lose serious weight? All you need to do is make 1 cup of this and drink it daily. You'll notice body fat begin to melt off after just a few days. I'll be sharing with you the key ingredients to make this fat burning concoction, but before I do I want you to understand how this will help you lose weight. The ingredients I will share have tremendous benefits for your liver. Your liver is the soccer mom organ because it does so many things for us. The liver helps you burn fat, detoxify, and also use fat soluble vitamins as an energy source which is key for fat burning.  The liver produces a substance called bile, which is green, an acts like a detergent to break down fat. Most people think the gallbladder produces bile, but that's not the case. The gallbladder is a storage house for the bile, but the liver produces it. Most people who have trouble losing weight, have a congested liver! When the liver is congested it slows your metabolism and thyroid function. RESOURCES MENTIONED:   ☕️ My personal favorite brands include Purity Coffee head to http://www.ketokampcoffee.com and use the coupon code ketokamp for 15% off. STUDY. Bile acids can activate specific signaling pathways that improve metabolic processes and reduce inflammation, potentially leading to better overall metabolic health. https://hms.harvard.edu/news/diet-gut-microbes-immunity  A study conducted at Tampere University Hospital in Finland found that people with decreased bile flow are seven times more likely to experience hypothyroidism. This connection is believed to be due to the role of bile in the conversion of thyroid hormones. Specifically, bile helps trigger the release of an enzyme that converts the inactive thyroid hormone T4 into its active form, T3. This process is crucial for maintaining proper thyroid function. Additionally, gut bacteria involved in bile metabolism also play a role in this hormonal conversion, further linking bile health to thyroid functiom. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459253/  Studies suggest CGA reduces abdominal fat in overweight adults, including this randomized, double blind, controlled trial. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683100/  A systematic review and meta-analysis of 12 randomized controlled trials (RCTs) suggested that cinnamon supplementation can reduce fasting blood glucose (FPG) and improve lipid profiles in people with diabetes. However, the studies showed mixed results regarding weight loss specifically.  https://www.nccih.nih.gov/health/cinnamon  Another meta-analysis highlighted the potential of cinnamon in reducing FPG and improving other metabolic parameters, but it noted that more research is needed to confirm its effects on weight loss.  https://nutritionj.biomedcentral.com/articles/10.1186/s12937-015-0098-9  Study. Anti-inflammatory effects of cinnamon:  https://pubmed.ncbi.nlm.nih.gov/30379176/ The Journal of Nutrition published a study showing that CLA supplementation led to a reduction in body fat mass in overweight and obese individuals. Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7401241/ , Additional studies on CLA for fat loss: https://www.sciencedirect.com/science/article/abs/pii/S0899900700005840 , https://pubmed.ncbi.nlm.nih.gov/12656216/ MCT Oil studies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1573354/,  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481320/,  https://academic.oup.com/cdn/article/1/4/e000257/4555134 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878196/

The short answer is yes. The long answer here in this episode is how. Using a weighted vest with osteoporosis comes up frequently as a question. Whether or not you have osteoporosis, stay with me, as I will talk about the overall benefits and science that's been out since at least 2000, perhaps as long as I've been using my weighted vest. Questions I'll Answer in this Episode: Can you use a weighted vest with osteoporosis? [00:06:20] If so, how do you get started safely? [00:09:30] What weight should you be using? [00:39:00] What if you have already fractured? [00:06:30] What if you have chronic upper back and neck pain? [00:40:20] Within this episode I'll show some images of my weighted vest and what you want to look for. They're so much better now than they used to be! It was an injury weighting (see what I did there?) to just put one on two decades ago. And they definitely were  not made for women. I've been lecturing about osteoporosis and osteopenia since 1995. That first adult education class I taught was the first time I left my house without my infant son, I think! Back then I had to draw pictures on the chalkboard of modeling and remodeling of bone, explain these then, new terms, and what was happening. And… we had a list of contraindications that are no longer the best science we have. While much of the decade-by-decade steps to build bone and then prevent or slow loss still are true, the veil of doom has been lifted. We no longer have to pop someone into bubble wrap. But you might think so because a search online will bring up ALL the content over decades. You'll think you are a delicate flower and that oh, my you shouldn't do rotation ever. And this fear mongering has to end - not that you shouldn't be informed about how to exercise correctly and what starting and progression looks like. Breaking Barriers Using Weighted Vest with Osteoporosis Back in 1996 I started working with one client, and then another would be diagnosed with osteoporosis. If you're listening, Mary, you were the first to break some barriers and overcome the fear. You had a good doctor who understood the whole person, and the real way healed. If I were concerned about osteoporosis, what I would do: Resistance training - progressive overload to as heavy as safely possible. My preferred is 5 x 5 reps Employ power in those workouts High Impact - at least 4 sets of 10-20 impacts a day most days of the week Moving during the day, breaking up sedentary periods of time, on non-exercise or recovery days (from strength training and HIIT with impact) the addition of weighted vest during walks or movement around house Whole Body Vibration use most days of the week (in conjunction with strength training and for balance or core exercise. (I use the Move: https://www.flippingfifty.com/powerplate and you can get 20% off with code Flipping50) Yoga consistently for the anti-gravity benefit of unique positions (and maintenance of mobility crucial to stability) Though wearing a weighted vest did not have a significant positive impact on the lumbar spine, Whole Body Vibration does. “lumbar spine BMD (MD: - 0.01; 95% CI [- 0.02, - 0.01]) reduced significantly when aerobic exercise training was used as intervention compared with RCTs that utilized resistance training, combined training, and WBV. By contrast, these analyses did not have significant effect on change in femoral neck BMD. WBV is an effective method to improve lumbar spine BMD in older PMW.” References: Mohammad Rahimi GR, Smart NA, Liang MTC, Bijeh N, Albanaqi AL, Fathi M, Niyazi A, Mohammad Rahimi N. The Impact of Different Modes of Exercise Training on Bone Mineral Density in Older Postmenopausal Women: A Systematic Review and Meta-analysis Research. Calcif Tissue Int. 2020 Jun;106(6):577-590. doi: 10.1007/s00223-020-00671-w. Epub 2020 Feb 13. PMID: 32055889. Snow CM, Shaw JM, Winters KM, Witzke KA. Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. J Gerontol A Biol Sci Med Sci. 2000 Sep;55(9):M489-91. doi: 10.1093/gerona/55.9.m489. PMID: 10995045. Shaw JM, Snow CM. Weighted vest exercise improves indices of fall risk in older women. J Gerontol A Biol Sci Med Sci. 1998 Jan;53(1):M53-8. doi: 10.1093/gerona/53a.1.m53. PMID: 9467434. Other Episodes You Might Like: Build Bone After Osteoporosis: https://www.flippingfifty.com/build-bone-after-osteoporosis/ Bone Health, Osteoporosis, Osteopenia Tips You've Never Heard: https://www.flippingfifty.com/bone-coach/ Exercise for Bone Density Then and Now: https://www.flippingfifty.com/exercise-for-bone-density/ Resources: Synergee Weighted Vest Infinity Vest Workout Equipment - Body Cardio Walking or Running Vest - 20lbs: https://www.amazon.com/dp/B07VQLDGPS?linkCode=ssc&tag=onamzvoicefor-20&creativeASIN=B07VQLDGPS&asc_item-id=amzn1.ideas.78VF9ZN2VWI0&ref_=aip_sf_list_spv_ofs_mixed_d_asin Short Weighted Vest 12lbs - 50lbs: https://www.amazon.com/dp/B001VE9RY4?linkCode=ssc&tag=onamzvoicefor-20&creativeASIN=B001VE9RY4&asc_item-id=amzn1.ideas.78VF9ZN2VWI0&ref_=aip_sf_list_spv_ons_d_asin&th=1

A claim: in the world of business analytics, the default/primary source of data is real world data collected through some form of observation or tracking. Occasionally, when the stakes are sufficiently high and we need stronger evidence, we'll run some form of controlled experiment, like an A/B test. Contrast that with the world of healthcare, where the default source of data for determining a treatment's safety and efficacy is a randomized controlled trial (RCT), and it's only been relatively recently that real world data (RWD) -- data available outside of a rigorously controlled experiment -- has begun to be seen as a useful complement. On this episode, medical statistician Lewis Carpenter, Director of Real World Evidence (there's an acronym for that, too: RWE!) at Arcturis, joined Tim, Julie, and Val for a fascinating compare and contrast and caveating of RWD vs. RCTs in a medical setting and, consequently, what horizons that could broaden for the analyst working in more of a business analytics role. For complete show notes, including links to items mentioned in this episode and a transcript of the show, visit the show page.

David Callahan is a prolific creator and thinker within Democratic politics. He helped start the progressive think tank Demos in the late 90s, founded the media outlet Inside Philanthropy as a Consumer Reports of sorts into the world of charitable giving, and more recently created Blue Tent - an advisory group to help progressive donors get the most bang for their buck. In this conversation, David talks his early days in politics focused on foreign policy, his next stint as a think-tanker trying to pull the Democratic Party left, and why he's more recently been focused on the world of political giving. David is one of the most informed people on the planet on all facets of the political donor world and provides a tour de force on both the current state of play and future trends to better understand how our politics are funded.IN THIS EPISODEGrowing up in New York as the child of academics...An early experience that showed David he was not cut out to be an activist...A formative year spent at the liberal magazine, The American Prospect...David talks getting his PhD and his recommendations for those considering academia...David helps found the progressive think tank Demos and talks the role of think tanks in American politics...What led David to start Inside Philanthropy, a media outlet dedicated to understanding political fundraising...The disturbing trend in political giving that led David to start Blue Tent, a resource for progressive donors...How David and Blue Tent determine where donors will get the most bang for their buck...Why David is an advocate of giving to organizations instead of candidates...David on the phenomenon of "rage giving"...Are donors pulling Democratic candidates to the left?Has Democratic giving fallen off this cycle?David's concern about too many advocacy groups and donor fragmentation on the left compared to more unanimity on the right...David de-mystifies the world of big "donor advisors"...David on the Soros factor on the left...The rough balance of spending from the right vs. spending from the left...The types of operatives who succeed in the donor advising space...The political novel David wrote in the late 90s that eerily predicted elements of both the 9/11 attacks and the rise of a Donald Trump-like politician...AND AOC, Stacey Abrams, Miriam Adelson, The American Enterprise Institute, The American Liberties Project, The American Prospect Magazine, Arabella Advisors, Joe Biden, bioethics, Michael Bloomberg, bureaucratic machinations, the Cato Institute, the Center for Voter Information, Bill Clinton, The Committee on States, credential firepower, the DLC, The Democracy Alliance, Michael Dukakis, The Economic Policy Institute, effective altruism, Federalist Society, Marcus Flowers, Focus for Democracy, Fredrick Forsyth, Forward Montana, Give Well, giving circles, Al Gore, Lindsey Graham, Stanley Greenberg, Jamie Harrison, Hastings-on-Hudson, the Heritage Foundation, Hezbollah, Indian Point Power Plant, Indivisible, the Koch Brothers, LUCHA, Mitch McConnell, Amy McGrath, Michigan United, Mind the Gap, Dustin Moskovitz, Movement Voter Project, neoliberal mindsets, The New America Foundation, Paul Nitze, NYPIRG, Beto O'Rourke, Open Markets, RCTs, Ronald Reagan, The Roosevelt Institute, Run for Something, saber-rattling, Sandinistas, Adam Schiff, Star Wars, the States Project, Swing Left, Marjorie Taylor Greene, transactional donors, Way to Win, Working America & more!

Dr. Christina Prevett // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult division leader Christina Prevett discusses reframing the conversation around post-operative guidelines for physical therapy treatment. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTIONHello everyone and welcome to the PT on Ice daily show. My name is Christina Prevett. I am one of our lead faculty in our geriatric division. I'm coming to you from the University of Ottawa, so if there's a little bit of background noise, that is exactly why. But today, what I wanted to talk to you about, and the reason why I'm on here a little bit early is because I feel like this is gonna take me a little bit of time to get through, is to start reconceptualizing our post-operative guidelines when we're thinking about not just musculoskeletal injury, but many of our post-operative protocols when we're thinking about early healing and early recovery. in the post-operative window. And so I just posted a reel on our ICE Instagram account that's talking about hip precautions and how we have research going back from as like synthesis of research systematic reviews of research going back as far as 2015 to show that these precautions that were intended to reduce risk of early hip dislocation actually don't do that and what they actually do is they exacerbate post-operative deconditioning and they increase fear of movement. And we see this all the time in clinical practice, right? Individuals go for surgery. They're given these restrictions. These restrictions are not evidence informed. They're never discharged. And what it does is it causes people to disengage with activities of daily living, with sports, with activities that they enjoy. They become more sedentary. And then downstream, we see that the amount of postoperative deconditioning is greater and their capacity to engage back into the things that they enjoy before surgery is less. You know, I've had clients that have said to me, I'm so much worse. Like, my pain is better, but I feel worse than when I went in for surgery. Like, why did I even get this done if I could have dealt with this surgery? And so over the last couple of months, I have really been thinking and noodling on this. I did a podcast on the pelvic section on our Mondays around how our pelvic restrictive guidelines around lifting are not evidence informed at all either. And that when we remove those guidelines, and we have now multiple RCTs that have said, you know, other than don't have penetrative intercourse for six weeks, when we say here are your buoys, and here's how you can progress based on how you feel. not only do you not see an increased risk of postoperative complications in those individuals with liberal restrictions, but they actually have a reduced pelvic floor burden in that postoperative window. And so that early recovery is actually enhanced. And so we have to kind of understand where some of these guidelines come from and how are we as a profession in allied health going to start pushing the narrative and where is our role in that because I think we have a really massive role. So the first thing that needs to be acknowledged that is really front of center when it comes to post-operative guidelines is that when we do research and we take surgeons and we have done cross-sectional surveys, not we other researchers, and asked, you know, where did these lifting restrictions come from? Like, where is your evidence? Or do you believe that your restrictions are evidence-informed? In our pelvic literature, we saw that 75% of urogyne surgeons recognized that the reason for their restrictions is because this is what they have always done. And only 23% of the surgeons surveyed believed that the restrictions that they were giving were evidence-informed. Now that is a massive problem, right? We so often in medicine come through the lens of let's avoid bad outcomes that we don't acknowledge that the lack of doing something by restricting a person's movement can actually lead to adverse outcomes down the road, right? Because yes, they're not saying we did X activity and caused X outcome, but the removal of activity, now what we know in all of our accumulated literature on the effect of deconditioning on trajectory of aging, clinical geriatric syndromes, and post-operative deconditioning that can lead to changes in independence, that deconditioning also needs to be acknowledged in our algorithm of what we are thinking when it comes to our post-operative guidelines. And so what we are acknowledging first is that one, we have evidence that does not support restrictive guidelines in many different examples, right, our arthritis literature, not sitting in bed post cardiac surgery, our lifting restrictions post pelvic surgery, we now have a variety of different areas across different organ systems, musculoskeletal surgery, cardiovascular surgery, urogyne surgeries where we are acknowledging that our restrictions are overly restrictive and that that restriction does not create better outcomes. The step forward that I want to make is that not only are they not leading to better outcomes, but that subsequent deconditioning by overly restricting a person is an adverse outcome in itself in the opposite direction. And what this is highlighting is that we have a big knowledge translation gap problem. We acknowledge in many areas of medicine that this exists, but this is front of center for our allied health clinicians around what we are allowing in our practice or what we are acknowledging in our practice. And so you're gonna say Christina, okay, where are these restrictions coming from and why as a clinician am I hesitant to push back on these guidelines despite the fact that I know that these are not evidence-informed, right? So because there's a hesitancy on the side of the clinician and We want to acknowledge those. Those are the elephants in the room, right? So the first thing is around the fear of an adverse outcome, right? When we don't do anything, we don't have that same feeling of responsibility if something was to go wrong, right? Because I didn't push them. So it wasn't me that caused that adverse outcome, right? And we can't always avoid adverse outcomes, but what we do a lot at MMOA is we try and flip the script of, you know, we think about the harm of loading people, but what's the harm if we don't load them? And that's a slower churn, a slower burn, but it's important to acknowledge that that's relevant too, right? So that fear. But the fear also comes from going against the surgeon and liability and referrals. And so I want to acknowledge that piece and I want to acknowledge it on a couple of different stances. Number one is that our messaging is never to, you know, speak negatively to the surgeon and speak about the person. We speak about the concept. And so the way that if I'm trying to remove restrictions that have been placed on somebody or deviate from a protocol, which I tend to do a lot, when the surgeon has outlined this, I will say where your surgeon was looking at was this is their scope. They're looking for lumps, bumps, infection, early complications. Where my lens is here. based on their assessment of you two weeks ago, they may have felt X from where I am assessing you today. Here's where I think our steps are going forward. So it is not bashing the surgeon. It is not going against the surgeon. It is using my scope as a doctorate level clinician to be able to make further recommendations going forward. And as a newbie clinician, the thought of going against the protocol set out by the surgeon used to terrify me, right? I'm a rule follower and our medical system has placed medicine at the top, which, you know, they have the brunt of the liability. I understand where that is coming from. But as I get into my research degree or when I get into my research career and I acknowledge the level of the evidence when I see the outcomes that are so much better when I ditch these protocols and load people more aggressively earlier and I recognize that a surgeon has never never actually rehabbed a person after their surgeries, it changes my mind, right? I would never go up to the surgeon and say, you know, you are going to go with that anterolateral approach for that hip replacement. I really think you should take a posterior approach. It would be better. Because that's not my scope of practice, right? That's not what I do. That is not where my skill set is. So why are we so shackled by a surgeon telling us what our job is, who has never, never rehabbed a person after their surgery, has not actually seen them for more than 15 minutes in an appointment after their surgery. And so I I would never take continuing education from a PT who has never treated the condition that they are teaching about, right? Like you would never go to see me and teach in geriatrics if I have never rehabbed a person who is over the age of 65. So why is our system created in a way where we are taking rehab advice from someone who has never done rehab, whose medical degree does not actually have an exercise prescription component in a lot of cases. And so that acknowledgement has really shifted my perspective on this is maybe foundational work that they are giving and they are catering also to the lowest common denominator, right? Like when I am working with a person and they are trying to give a blanket statement guideline that has exercises on it, they have to cater to the person with the most amount of deconditioning in order to believe that this protocol is safe for everyone. And we acknowledge as clinicians that that blanket statement never ever works, including blanket protocols, because our people come in with a variety of different chronic diseases, comorbidities, positions, supports, biopsychosocial considerations, motivations and drives, and musculoskeletal reserve around that postoperative joint. And so what we have to acknowledge is the flaws in the system, but I'm not saying that as a bad thing, I'm saying that as this is where I come in. High five me in, this is my job, and I need to advocate for my profession in making an opinion on this, right? And this is where we need to lock shields with medicine and surgery, not blast each other with swords and acknowledge where our scope is and where their scope is. The final thing is around liability, right? And I think the post-operative guidelines around joint replacement are a really good example of where the liability, we have to be acknowledging liability, but we also want to make sure that we are thinking on the other side of the equation, where when we are working with individuals post-operatively, we are worried about post-operative dislocations. And what we see is that those with low musculoskeletal reserve going into surgery and have a fall in the early postoperative window are the ones who are more likely to dislocate or those that have a size fit issue or get a deep infection in the early postoperative window. So what we are doing by deconditioning is we are impacting one of those risk factors in a positive way. If we are creating more deconditioning, if we are lacking reserve around that joint and we are not supervising them, potentially in the early post-operative window, that is where we can have liability on creating an adverse outcome. But we don't have any evidence around pushing individuals too far from an exercise perspective early on, creating adverse outcomes. Now, if that was to change, sure, we're gonna change our strategy, but we want to really be thinking about this from a clinical and critical lens, because it's really important that we acknowledge these things. So, What do I think we actually need to think about with our post-operative guidelines? Or what do I think we are missing with our post-operative guidelines? I feel like we are missing our confounding variables that are going to dictate how quickly we're going to be able to progress individuals. So what do I mean by that? We acknowledge as clinicians, because we do this all the time in our assessments, that there is going to be different things in a person's background that is going to allow us to be more aggressive in rehab or is going to cause us to take a slower approach. Those are not acknowledged in our postoperative guidelines right now. So what are some of those things? One is our level of frailty, burden of clinical geriatric syndromes or complex comorbidities. Secondary is musculoskeletal reserve going into surgery or the amount of deconditioning we are able to stave off with early postoperative mobility. And so what we are acknowledging or what we want to acknowledge is that some individuals, we obviously have that early protective phase around a graft. I'm not saying that we're just going to blast that out of the water, but we know that after two weeks, most of our collagen synthesis is there and now it's remodeling in order to get stronger. And that remodeling requires load. But then we create a brace around an individual for six weeks where we're actually not creating a lot of loading through that joint or we're not actually having pulsing forces from our muscles that are acting and contracting to start creating tensile forces in order for our collagen fibers that are coming down or our healing fibers that are needing that load in order to get stronger. And there's a huge amount of variability in our in vivo studies around the strength of collagen resynthesis and that range is probably related to musculoskeletal reserve. And so, one, we need to acknowledge that yes, we have that early protective phase, but their amount of reserve going into their surgery is going to be a predictive factor of how aggressive we can potentially be post-operatively. Their complexities with respect to comorbidity are going to incur a higher or lower inflammatory load that is going to dictate how fast we're gonna be able to progress exercises, right? When we really step back from all of our comorbidities, a lot of them are related to inflammatory cascades, depending on the organ system that is impacted by the disease. And so when we have individuals with a high comorbidity burden, they are gonna have a higher inflammatory load, and that higher inflammatory load is going to impact how fast we're gonna be able to get individuals working, but on the flip side of that, exercise is anti-inflammatory. but it's going to slow down our progressions. So all of this to say is that one, we need to be confident in our assessment skills that includes early postoperative management. We need to acknowledge that our role is one of critical thinking that allows us to take information medically from the surgeon and some of their early protective phase issues, and then be able to progress them as we see fit, because we're the ones who are seeing individuals that are progressing and we are responsible as well for their wellbeing and their capacity to return to activities of daily living. And that baseline musculoskeletal reserve going into surgery is going to be a big confounding variable or a big protective variable in order to think about their postoperative reserve. And so where I see our postoperative guidelines hopefully going in the next several years is one, blanket statements are gonna go out the window, right? We are going to remove these lifting restrictions. We are gonna give individuals buoys, okay? We're gonna say, hey, you just had surgery on X joint. This is what I want you to think about. I want you to be thinking about gradually returning to movement within your comfort zone, and I want you to look for X, Y, Z. And if you are experiencing X, Y, Z, that is your body telling you that you've probably pushed it a little bit too far today, okay? You're not hurt. sore is safe, but it's your body telling you that you just had surgery and we need to stay within these buoys and those buoys are going to change. And as you get further from surgery, you're going to be able to experience more and more of life and you're going to be able to come back to more and more things and that is going to be okay. And we're going to be able to guide you along that process. In rehab, what we tend to do is think about things very linearly, where we say, okay, we're going to do range of motion passively, range of motion actively, maybe in combination with some isometrics, and then we're going to load through range. I think that's a huge mistake. And you guys can give me your thoughts on this. I feel like, you know, Ice talks a lot about and not or, that we need to be strengthening through the range that individuals have in that moment. And then as they gain more range, we're gonna continue giving them strength in the upper ranges that they are now gaining, right? I think waiting to exercise through range or strengthen through range actually deconditions the joint more, and it ends up being a huge issue. We see this all the time in rotator cuff post-op management, right? There's a protective phase that now, thankfully, a lot of the surgeons in my area are not prescribing to, thankfully. And then we go range of motion first, and then we go strengthening through range, and then getting that strength in those upper ranges, especially over 90 degrees, is a bear in rehab. And where I have seen a shift in my practice, and I've seen better outcomes anecdotally from it, is that I am strengthening through range and with weight bearing earlier, and they're gaining their strength back a lot faster. And so I think this and not or approach to orthopedic post-operative rehab is going to be important. Now, I acknowledge that I'm in an outpatient setting and I'm going to be seeing people who probably have a little bit more musculoskeletal reserve going into surgery than others who are in skilled nursing facilities, et cetera. But that means that your deconditioning effect is going to be that much more detrimental, right? When I have a person who doesn't have a lot of reserve going into surgery and then I see that dip postoperatively, that is going to be very, very impactful for them versus my person who has more reserve going in. And so it makes me not change my stance, but actually be more diligent about my loading principles in that early postoperative period because that deconditioned individual cannot handle more deconditioning. And we see this all the time, right? It's why our hip fracture research is so poor. You know, we have those statistics that if you break your hip and you need a, or if that your 50%, 50% of people who have that surgery end up in a nursing home or don't end up making it over a year or whatever that may be. And that's likely because they have a period of deconditioning on a deconditioned person that creates a lack of reserve around that joint. And then they aren't able to come back from it. So our role in rehab becomes even more urgent where we need to prevent that from happening, right? We, we can't wait. on a lot of those things. Obviously weight-bearing status is going to be one of the things we have to be mindful of, but being able to strengthen a joint around non-weight-bearing status in order to try and reserve as much capacity around the hip and pelvic musculature as we can is going to be really, really important. So I hope all of that made sense, right? We have this gap and I want us to have so much strength in our convictions around how important it is for us to push back against these guidelines. Yes, it's scary, right? We don't like pushing back against medicine because sometimes I think we are not as confident as we should be in our doctoral level education and our evidence is on our side. And so we don't have to be jerks about it, but we have to acknowledge that our outcomes could be so much better. And I want to let you center in on the fact that you are the expert here. The surgeon is the expert in the actual surgery. You are the expert in managing them after. That handoff should be seamless. And it is important for us to advocate. And until we advocate and have respectful conversations that, yes, are scary, yes, your heart rate is going to be up, yes, you're going to feel like you have that adrenaline going through your system, but have the evidence in your back pocket Acknowledge your scope of practice and your skill set and make sure you are there to best serve your older adults. All right, that is my rant for today. If you were trying to see us live in person over the summer, Julie is in Virginia Beach, July 13th, 14th, so this upcoming weekend. Jeff Musgrave is up in Victor, New York, July 20th and 21st. And the entire crew is up for MMA Summit in Littleton, Colorado, July 27th and 28th. So if you were looking to see us on the road in the month of July, you have a couple of opportunities. If you're hoping to get into our online courses, our next MMOA level one starts August 14th. We are just finishing up our last cohort and we have a bit of a break for the summer. And then our advanced concepts level two course is starting October 17th. So I hope you all, I want to know your thoughts around this. Am I going crazy? Am I on the same boat or same page as you all? And what can we do collectively to make this a little bit better? All right, have a wonderful week everyone and we will talk to you all soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. 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Dr. April Dominick // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick shares how YOU can make a huge impact on the quality of life of a client with an upcoming prostatectomy simply through education on pelvic floor muscle retraining, lifestyle changes and physical activity AND learn the ESSENTIAL clinical pearls to include in a pre-operative physical therapy session when working with this population. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION APRIL DOMINICK This is Dr. April Dominick. I am on faculty with the ICE Pelvic Division. Today we are chatting about prehab for a prostatectomy surgery. Why is prehab important and what should be included in your PT session with that pre prostatectomy client? This topic, it is so near and dear to my heart. it's because these humans just don't have the treatment or education that they deserve prior to going into these surgeries and afterwards when they come out. And if I can convince you why it is so important to be able to connect with these humans and to even just educate them on, hey, there is Help for you. There's pelvic floor muscle training that can be done education about behaviors whether that is you actually doing the PT session or you referring them to someone else it can have incredible outcomes for them post-op just because they are aware of pelvic floor physical therapy for their surgery the prostatectomy so Let's dive into what a prostatectomy surgery actually is. It is something to treat prostate cancer, and that's going to be by removing part or the full gland of the prostate. They're also going to remove surrounding tissues and seminal vesicles. The gold standard for surgery is a radical prostatectomy where they remove the entire prostate gland. I didn't have a walnut, so here's what we're working with. This fig represents the prostate. So let's run through some real estate of where everything is situated in someone with a prostate in terms of the pelvic floor and the organs. So we have our bladder here and then we have the bladder neck with the urethra that goes through our prostate. and this is going to be representative of the urethra itself. So the urethra goes from the bladder neck through this fig or the prostate and then down into the penis and that is how everything is set up. With a prostatectomy, after the prostate is removed, that extra support around the urethra is now lost, and the remaining bit of that urethra now needs to be reconnected back to the bladder. This reconnection, we can think about it like a bridge, or a fancy term is the anastomosis, and that anastomosis needs time to heal. So a Foley catheter is placed in for about five to ten days. That means that the bladder is or the urine is emptying passively. The bladder is not doing its job. It's off on vacation. And then once the catheter is removed, the bladder acts like it forgot how to start or how to store urine. It doesn't know what to do with it. And so we have a lot of urinary leakage. So among other things, this is why urinary incontinence or urinary leakage is a major side effect with these prostatectomy surgeries. post-op, the external urethral sphincter is relied on for maintaining continence. So good news for us, the pelvic floor muscles help to close that sphincter and keep pee in until it's appropriate to release it. And that's why pelvic floor muscle training with physical therapy can be so important pre-op and post-op, at least from the bladder side of things. So who does the prostatectomy surgery affect? Well, obviously those diagnosed with prostate cancer. It is the second leading cause of death from cancer in males. It's going to affect our individuals who are older than 50 years old and who are African-American. So if you think about who you are treating currently, if you're treating individuals who have prostates who are older than 50, one in eight of them are probably gonna have some run-in with prostate cancer, whether that's treated with a surgery or not. That's where you come in. You could have such a profound effect with these individuals just by educating them that pelvic floor muscle training exists And whether you're again, whether you're doing the treatment or you're referring out to someone else, you can have such an incredible impact on their post-op outcomes potentially. So, We talked about with a post-prostatectomy, we talked about that surgery can result in urinary incontinence or leakage. It can also affect sexual function. There can be reduced physical function. Think about it. If you're leaking all the time, is that really going to convince or motivate you to go work out? For some, no. And then it'll also affect the overall health-related quality of life. Take 65 year old Phil. You've got a Phil in your clinic. You're already treating him for low back pain, um, with his hikes and his weightlifting, say. And he went in for his annual physical, and then he walked out with a date for a surgery for radical prostatectomy. Besides being in shock that he now has this potentially life threatening diagnosis, Phil comes in and is like, this happened. He's like, am I, am I ever going to be able to hike with my hiking group and not be the person that smells like pee? Am I going to be able to be cool with being in the changing room in the, in the locker room after my weightlifting session, like removing this soggy pair of underwear, or am I going to be able to enjoy sexy times with his partner? Well, since you're here and you intently are listening to this podcast, You, your first line of question is, hey, Phil, did they recommend any sort of physical therapy for you? Um, whether it's pre-op or post-op. And of course, Phil's like, no. So you teach him that pelvic floor muscle training can be so effective and helpful, um, and play a huge role in those side effects that he's worried about. Y'all, what if we could have an incredibly bigger impact, building the foundation, setting the stage for what to expect post-surgery, just with PT sessions? Clinically, I've been treating this population, hopefully you can hear my passion behind it, for about seven years. I've interacted with so many fills that come in, if they even get to me, right? and they are just slapped with that surgery date, and the side effects are kind of breezed through during their appointment, it seems like. And their concerns aren't really heard, their well-being and their questions, they're just kind of like not given a lot of attention. I didn't always do pre-op sessions, but once I started, hoo-wee, I was just blown away by how different the clinical outcomes were in terms of improving, whether that was decreasing the volume of urinary leakage for some or having them return back to their ADLs exercise a little bit sooner. The biggest thing, which was so powerful for me, is these people came in extremely uncertain, having no idea even why, if their doctor did send them to PT, why they were there. And they were just uncertain about these really scary side effects, about how maybe for the first time they were going to experience some sort of losing control of their bodies, from peeing unexpectedly to changes in their erections. And they walked out of that first session feeling a little more confident, a little more certain. And that is the power, I believe, of these pre-op sessions. And then from a research side of things, what's shaking out in the few RCTs that we have for these pre-op sessions and their effects on prostatectomy, some may be helpful in improving quality of life. they may affect a shorter hospital stay. They may reduce post-op urinary leakage in the short term. So some studies find around month one, three, or six, that the individual is leaking less, meaning they're drier faster. Now, when you compare someone who had some pre-op PT to someone who did not around 12 months, they are about the same with their rate. But I would argue that I bet folks are going to be a lot more satisfied if they did that prehab and they are drier sooner, right? So let's go into what a prostatectomy PT session entails before that surgery. We've got these sessions already in place. for folks who are going in for surgery for their ACL repair, for their hip replacement. But just like we're fighting with our pregnant and postpartum population, we are somehow having to fight for someone to have a pre-obsession for something like a prostatectomy, and that impacts so many daily functions. Let's outline what is involved in that pre-op PT session. Again, you can educate someone on what to expect if you're referring them to someone to do this. So we'll go over subjective, objective, and the treatment. From an assessment side of things, from that subjective piece, what you can be talking to your patient about is what are their current bladder and sexual habits? How many voids do they have during the day? How many times do they go pee? Do they have an urge? Do they have urinary leakage or hesitancy? And there are some outcome measures that go over these things. The International Prostate Symptom Score goes over those things. Plus they ask about nocturia or nighttime urination. And then the NIH Chronic Prostatitis Symptom Index is another outcome measure. And I love it because it asks about the impact of these symptoms. How is it affecting your quality of life? Then you want to also ask about their sexual function. How would they rate their erection strength or their satisfaction with their sexual life? From an outcome measure standpoint, you can give them the International Index of Erectile Function. This is something that asks them to rate qualities of their erection from the past four weeks. Then you want to also get a good idea of their current physical activity regimen. What a wonderful time to, if they're already a little physically inactive, hey, let's like plug in for, here's why it would be really great if you could up that physical activity. Not just for that immediate post-op surgical outcome, but also, hey, we can lower all cause mortality. And then from an objective side of things, so we went over the subjective, objectively speaking, we want to get a pelvic assessment. Whether that is over the clothes, external, near that midline, or it is a visual or tactile palpation, or an internal rectal assessment, if that's what you're trained in. So we're looking for, what's their awareness? Do they even know that they have this group of muscles that they can control? called the pelvic floor. We want to be looking at their coordination, timing of the pelvic floor, and then also getting an idea of what is their breathing and bracing strategies for things that increase interabdominal pressure, like fitness activities or functional lifting of the groceries, coughing, running, weightlifting. Typically, this population tends to be a breath holder. So we're gonna spend some time, there's just so much that we can do to help them in this area, to help them have improvements in their methods with that. And then we also wanna be doing some sort of general orthoscreen because what if their hips are cranky? Obviously that's gonna affect pelvic floor, low back, and all those surgical outcomes. From a treatment side of things, so we went over subjective, objective, highlights from the treatment side of things. where we'll talk about education, what to expect post-op, and some homework for them to work on. Education. I cannot stress this enough. The education piece here is vital for affecting their outcomes and well-being. Let's educate them on the pelvic floor. Here's what it is. Here's the anatomy and physiology. Here's how it affects your penis. whether that's for sexual health or for the urethra for urination. Here is what happens during the surgery. Get to know the surgeons in your area and which methods they use. What are their outcomes, right? And then you want to be explaining the risk factors for these side effects like urinary leakage and sexual function. dysfunction. Non-modifiable factors. If you're older, it's not going to help you as much. And if you already have some reductions in urinary function, like you're already leaking, that is not going to help you on the backside. Modifiable factors, tons. So things like smoking, poor nutrition, That is gonna delay healing post-op. Can we identify some current bladder irritants and reduce those immediately post-op? What about poor mental health? Things like low self-efficacy or if they're experiencing anxiety or depression, helping them ID these things and finding them some psychosocial support to have upcoming for the surgery and post-op, so key. and then reduced physical activity. Hard health is heart health. What do I mean by that? Erections, ejaculation, is related to vascular health. Hard health is heart health. So what affects our vascular system? Aerobic and resistance training exercise. If we can have them and talk to them about how it's important and how increasing that physical activity is going to improve their physiologic resilience to the surgery itself and any complications that come up, that is gonna be having such a huge impact on their quality of life. Regarding physical activity, in a 2014 RCT by Mina et al, they found that men who were meeting physical activity guidelines prior to surgery had greater health-related quality of life at six and 26 weeks post-op compared to men who were not meeting those physical activity guidelines. So, from a post-op perspective, we want to tell them what to expect. Urinary incontinence and sexual dysfunction. From the urinary incontinence side of things, they will have a Foley catheter in for five to 10 days. Remember, the bladder doesn't work during this time. Once that catheter is removed, we gotta retrain that neural pathway to help control the bladder so that they know, oh, my bladder is filling, or this is how I'm gonna stop that leakage from coming out, and how to fully empty the bladder. Another huge tip, have them bring a hygiene product, whether that's a pad or a diaper or something, with them to the hospital so that when they are discharged, they have something to help protect them on their way home or on their way to the store to grab their meds. And then urinary incontinence could be present from a couple of months to a year post-op. We see a significant improvement in that three to six month range, but it could be affected by things like, hey, it gets worse at the end of the day because the pelvic floor muscles are tired, or with transitional movements like sitting to stand. So working on these movements with them is gonna be super helpful pre-op. And then maybe talking to them about how, if you're not going to see them for 10 days or so post-op, we may be using the pad weight or the number of pads in a 24-hour period as a marker for our progress. So just having that in the back of their mind. When it comes to what to expect from a sexual function standpoint post-op, it can take up to two years to recover to baseline function from an erection standpoint. We want to set these expectations from an ejaculation standpoint. Dry ejaculate is going to happen now because those seminal vesicles were removed, and that's what helps produce that ejaculate. There may be some changes in their orgasm sensation. Erections, it could be dependent on surgery outcomes. How much nerve sparing was there in that procedure? They have the potential to get better with this, especially with pelvic floor muscle training or things like pumps. And then loss of penile length. This is something that we want to let them know can happen so they don't get a little surprise. Homework wise, we want to address any of those pelvic floor deficits we found from that objective piece, especially that breathing and bracing strategy. We can do that with biofeedback, whether that's with a mirror, with a palpation from the therapist or from them, and just to really improve their awareness and coordination there. And then giving them cues that connect them to the pelvic floor. Evidence supports, hey, pelvic floor contractions with the following cues, like shortening the penis, though I've been told nobody wants to have that. So something like nuts to guts or stopping the flow of urine is great for that. One side of the range of motion, the contraction side of the range of motion of the pelvic floor, and then something for the relaxation side, like let the testicles or base of penis hang loose. I did an Instagram post recently, so you can check that out on the ICE or Revitalize Pelvic Physio page. And then we wanna be, for homework, modifying their poor lifestyle habits. Can we reduce those bladder irritants, process sugar? Can we increase your physical activity and mental health? And then finally, we want to be scheduling their followup visits on the calendar. So whether that's for pre-op, a couple more sessions, or as early as 10 days, once that catheter is removed, they can pop back in to your office. SUMMARY So, I hope you found that information helpful. We reviewed how prevalent prostate cancer is, especially for those who are 50 plus. We know that radical prostatectomy is the gold standard for treatment. Two major things that are affected post-op are urinary incontinence and erectile dysfunction. Pre-op PT sessions are fairly new, but we have some evidence that says, hey, those who partake in pre-op sessions are drier sooner than their counterparts. And then from a PT session standpoint, thinking about asking what their current bladder and sexual function is, asking them about physical activity, mental health, objectively getting a measurement of the pelvic area, and helping them connect with that area a little bit more. Treatment-wise, we want to really harp on that education. about what the pelvic floor is, how it can help with their function, and also what to expect, possible side effects, modifiable risk factors, and then giving them homework to work on those deficits, and then finally scheduling that additional follow-up before surgery and then getting their post-op session on the calendar. My next podcast, I'm going to go into detail on what a post-op session post prostatectomy looks like. So tune in for that. And then if you want to learn more about pelvic floor examination, join us live. We have our next two courses. One is July 20th, 21st in Cincinnati, Ohio. And then July 27th and 28th, we are gonna be in Laramie, Wyoming. If you're wanting more of a virtual option, we have our two different courses that are eight weeks, L1 and L2. And in L2, we go over the male pelvic health conditions as well. Thank y'all so much for tuning in from my prostate slash walnut. Happy Monday, and I'll see you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Featuring articles on treatments for eosinophilic esophagitis, reteplase versus alteplase for acute ischemic stroke, dupilumab for COPD with type 2 inflammation, and brigatinib in NF2-related schwannomatosis; a review article on amyloidosis; a case report of a man with recurrent fever and liver lesions; and Perspectives on Alzheimer's disease, biomarkers, and mAbs; on climate litigation for protecting public health; on carbon-footprint analyses in RCTs; and on the phantom of the organ.

Dr. Christina Prevett // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Christina Prevett discusses Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION INTRODUCTIONHey everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PT on ICE Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app.com. And if you decide to make the switch, don't forget to use the code icePT1MO at signup to receive a one-month free grace period on your new Jane account. CHRISTINA PREVETT Hello everybody and welcome to the PT on ICE Daily Show. My name is Christina Prevett. I am one of our lead faculty within our pelvic health division. Sorry for coming on here a little bit early. We are in the throes of young kids finishing school and trying to work around new schedules. So apologies for being a little bit early. But today what I wanted to talk to you all about was what do we really know about resistance training in pregnancy. And as many of you who have kind of followed the podcast in the past know, I'm a postdoctoral research fellow at the University of Alberta looking specifically at resistance training in pregnancy, which means that a big part of my job in my postdoctoral fellowship is to be very aware of the state of the literature and then where my role is as a person trying to build a program of research to be able to add to the existing body of literature. And I'm going to start this episode talking a little bit about my story getting into this because I think that it's relevant. So my PhD research was in high load resistance training in a geriatric population. I love my older adults. You know that I'm part of the older adult division. And I had two children while I was going through my doctoral studies. I was going part time. And then I was also a national level weightlifter before I got pregnant with my daughter. So I was doing a lot of heavy resistance training during my pregnancy. And I had a committee meeting during my pregnancy talking about, you know, obviously that I was going to go off on that leave, et cetera. And one of my committee members, whose name is Stu Phillips, many of you know him from the protein metabolism and resistance training literature. He said, you know, Christina, if you think that there isn't any research in loading the older adult appropriately, wolf when it comes to what we know in pregnancy. And I thought that was super fascinating and of course being the nerdy researcher that I am, I looked into the research and I recognized that he was right. And So I kind of want to talk today about what we truly do know, what the state of the literature is, a little bit about me trying to change that, I'm going to talk a little bit about some of my research studies, and then where we can go going forward. So we know in a general population that resistance training is one of the best things that we can do for our overall health. I don't tend to try and put people into specific buckets that you have to exercise in a specific way because the best exercise is the one that you do. But in terms of longevity and maintaining independence into older age, supporting whatever exercise you like to do with resistance training is definitely a recommendation that I'm gonna make with a lot of passion. Whether you choose to prescribe to that exercise program or not, Resistance training is one of these exercise modalities that is going to allow us to have independence. It's going to stave off a lot of chronic disease and musculoskeletal injury. And we know that, you know, the best exercise program is the one that we start as early in our life as possible and go into older adulthood. I'm going to try and put on as much muscle mass as I can before the age of 40 and then hold onto it for dear life into hopefully 100. And so we have a lot of really positive evidence for resistance training in a general, like reproductive age population, but then also into older adulthood. We've talked a lot about it in the Jerry segment. But when we don't have evidence, right, around exercise, or we don't have any evidence in any type of intervention in pregnancy, we freeze, right? And I say this all the time. If we don't know, the answer is no. and when we aren't sure we freeze, which is where bed rest and pelvic rest recommendations have come in when complications can creep up in pregnancy because we don't really know what we can do, right? We're not really sure what we can do. So we want to give a recommendation that we're doing something. And so we pull people back from activities of daily living, sport, exercise and we say like, let's not do anything because you know, there's this complication happening. And where evidence is starting to show now is that many of our complications have pro-inflammatory cascades and therefore exercise might be a really important mitigating factor or modifiable influence on a person's experience of complications during pregnancy. But the baseline is that if we don't know that the answer is no. And so that knee jerk reaction has trickled into a lot of our recommendations around exercise in pregnancy and specifically around resistance training. So when we look at public perception of resistance training or exercise in pregnancy in general, it's really interesting because aerobic training is generally seen as more positive as something that you're doing to benefit the health of mom and baby. But there's a lot of fear-focused messages that are put into the resistance training space. And gosh, we've seen this all the time, right? Like we see when a person lifts a heavy deadlift and they're pregnant, like go into the comment sections and you just are gonna heave because you see everybody telling you that your baby's gonna die and that you're being reckless and all this type of thing. And so if we're going to combat these messages, and we know that the perception is generally more negative because of a lot of fear and thoughts of danger around resistance training and pregnancy, we have to one, know where the state of the research is. And then two, we have to build levels of evidence that are going to gradually gain us more confidence and being able to remove some of those fears around resistance training. I've done podcast episodes before where I talk about risk tolerance of providers to allow individuals to flex their own decision making during pregnancy and how in low to moderate intensity exercise, we tend to feel very good in that risk tolerance zone, but where we get a little squeamish is in these higher intensity zones. Part of the reason for that is the state of the literature currently. So right now I can't speak specifically to my results because I haven't published this yet, but I am working on a systematic review on resistance training during pregnancy. And we have pulled about 50 studies on resistance training during pregnancy, which sounds like a lot, which it is. And it's been a lot of work to get the systematic review under control. But what we have noticed and what I have seen over and over and over again is a couple of things about the resistance training literature. Number one is that we have very few studies that look at resistance training in isolation. And you may not think that's necessarily a bad thing, because a lot of people are exercising in multiple modalities. Think about functional fitness, they're doing aerobic training and resistance training. But when we know that there's a lot of incurred benefit of aerobic training, especially when it's dosed appropriately, there's an interference effect that we see in the literature. So what I mean by that is that we know that there is benefits of aerobic training on rates of gestational hypertension and preeclampsia. We know that individuals who respond and continue to do aerobic training have less rates of gestational diabetes. We know all of these things already. So when we put in a known benefit and then kind of add in resistance training, we can't say with confidence that resistance training reduces our risk of gestational diabetes because we know that aerobic training does and aerobic training is in that multi-component program. So it's a big issue right now that we don't have a ton of research that's on resistance training in isolation, because then we can't isolate and say resistance training benefits X, Y, Z outcome, and aerobic training, there may be overlap, and they also do X, Y, and A, B, C, but without studies done in isolation, interventional studies done in isolation, we can't really say that this is incurring some sort of benefit. The second thing about our current state of the literature is that the resistance training research is unbelievably underdosed. So I'm gonna make a comparison for you. So the evidence that we have right now around resistance training in those with congestive heart failure in their 70s and 80s is higher dosed than a lot of the resistance training literature in pregnancy. Let me say that again. A lot of our dosing for resistance training is higher in our older adults with frailty, multi-morbidity, and complexity than it is for our uncomplicated pregnancies. When I am looking at that research, that makes me sad, and it just shows how much we need to do. When there is a randomized control trial that comes out in 2024, and the aerobic dosing is 70 to 80% of heart rate reserve, which is a great intensity for the aerobic training, and the resistance training part of the exercise program is using a yellow Theraband, I see red and I start to rage. And so the dosing here is unbelievably poor, especially for somebody, right, who we are not thinking has low musculoskeletal reserve going into their pregnancy, right? In general, individuals are not having trouble with activities of daily living as soon as they find out they're pregnant. And so we are going in almost with this assumption that individuals who are pregnant cannot have higher loading on their skeleton. And we're worried about strain, but a strain is not happening on the body with a yellow TheraBand for a person who's of reproductive age who is pregnant. Like that is not an appropriate dose. And so it's concerning that there is not an appropriate dosage for our resistance training interventions, especially when it is dosed appropriately. the aerobic side. So this brings me to our next problem. is if resistance training isn't dosed appropriately, if I am getting an individual who is pregnant with no complications to do a 16-week exercise program where the max amount that they are allowed to lift is two kilos or 4.4 pounds, and I wish I was lying about that prescription, can I realistically, as a provider and as a researcher in that space, say resistance training was the part of that exercise program that incurred the positive benefit? Right, going back to my first point about how when we have multi-component programs and there's a known benefit for aerobic training, it's hard to see the additive effect of resistance training. In combination with the fact that the resistance training prescription is not sufficient, what I would deem sufficient, to drive musculoskeletal adaptation or maintenance to prevent deconditioning in a pregnant individual. That creates a problem. It creates a problem and it creates all the downstream issues that we're seeing where pregnant individuals are restricted, right? Like when our max is a yellow fare ban on a 2024 randomized control trial, that don't lift more than 20, don't lift more than 30 pounds. that's gonna hold, you know, that's not gonna get better because we don't have any evidence to back us up, right? And so this is like a call to action around how we need to change some of our thought processes around the way that we are prescribing exercise for pregnant individuals, but we also need to push back on academia and be like, hey, like, this is not okay for this to be the state of our literature because I hate that I have to say this and my postdoctoral supervisor and I were having this conversation. Do we even have enough evidence in resistance training in pregnancy to truly be able to include it in our guidelines? And the answer is we don't. Not really. We're extrapolating from our general population literature and we're saying, well, based on some of the preliminary literature we have right now, light toning exercises seem to be okay. Literally the term in a big conglomerate of our RCTs was saying that they did aerobic training and light toning for our resistance training interventions. That drives me. It drives me with just unbelievable amounts of passion about why it is so important for this clinician science bridge to happen. It is why I will not step away from literature and doing research because we just need to demand so much better. And so what does that mean going forward? we need more research in this area. And so that is where my postdoctoral work has really taken off. So when we are thinking about our literature base, when the state of the literature is a two pound dumbbell, and I'm saying, I want to do an RCT where women are deadlifting over a hundred pounds, you can imagine that that amount of gap can create issues with an IRB board or an ethics board saying, whoa, whoa, whoa, whoa, whoa. We don't want to put mom and baby at risk. here's what we need to do. And so because of that, we need to build layers of evidence. So if you guys remember from your schooling, right, we have our levels of evidence from level five, which kind of our clinical commentaries, our professionals who are doing this in practice, that when the evidence isn't there to back us up, and then we go retrospective, prospective, RCT, and then systematic reviews and meta-analyses are kind of at the top of this evidence pyramid. And so when we are trying to build an area that does not have a ton of research to back us up, we need to start building levels of evidence. And that's what I'm trying to do. And so this started with our cross-sectional survey. You've heard us talk about this on our podcast, this podcast in the past, where the first thing that we have to do is show that there are individuals who are heavy lifting during their pregnancy. And so the cross-sectional survey that was published last year was the first step in that process. say, hey, look, we put out a survey for a couple of weeks online. We got almost 700 women who had lifted heavy during their pregnancies to tell us about their experiences. Great. Look, there's this need. They are very confused about what they're allowed to do and what they're not allowed to do. Like they're getting advice, like don't lift more than 20 pounds. Two, if you were doing it before, you can continue doing it now. Just don't strain your body. And even the strain on the body is a little bit question marks because, you know, there's so much that goes into it, et cetera. Right? It creates a situation where we recognize that there is a need because there is an absence of literature and there are people who need the answers to that. The next part is that we're going to start doing retrospective data taking and so right now I have two research studies that are open for enrollment and I am going to beg all the clinicians who are listening to this if you have a person who fits these bills if you could please please please send them our studies because I hope that the first part of this podcast tells you that there is just so much we need to do. There is so much that we need to do in this area, and I need your help in order to do it. So our retrospective study is taking individuals who have given birth within the last year and tracked their exercise through a training app. So if that was Wattify, if that was an Excel spreadsheet, if that was, you know, pen and paper, whatever it may be. If you tracked your exercise during pregnancy, specifically your resistance training, and you gave birth in the last year, we want you in our research study. So what we're going to do is we're going to ask you a whole bunch of questions about your pregnancy, your labor and delivery, how you felt about it, all those types of things, and then we're going to ask you to upload your training logs. And so what we're gonna try and do is descriptively see how did people modify? Are there any issues with resistance training that are popping up as patterns that clinicians or providers or obstetricians need to be aware of? And then how can we use that information to start help counseling individuals on strength training during pregnancy? And so that's a retrospective study. We also have a prospective study that is open for analysis. This is gonna take me about three and a half years to get out, but that is okay. So we are taking individuals who are less than 20 weeks pregnant, so in that first trimester, first half of their pregnancy, and we are following them forward over time. So every trimester, we are asking individuals questions about exercise during pregnancy, and we are asking you to upload your training logs. And so what that's going to do is it's going to build on our level of evidence, right? So now we have cross-sectional snapshots in time. There are recall biases that happen with that. We have our retrospective study that because we were using the training log, that recall bias is worked around because we have evidence of what they did over time. And then the prospective study, we are getting their thoughts in real time going forward. And so now we've gone from a level five of evidence and we're going to be pushing up to level With that evidence, my next goal is something interventional. Right now, we're going to have this building of evidence that we're seeing that is going to allow me to apply for funding for a randomized control trial that looks at different dosing schemas for individuals who are deciding that they want a resistance train during their pregnancy. SUMMARY And so if you have any individuals or if you are listening and you are in one of these two camps, I would love for you to join our army to try and build the level of evidence on resistance training in pregnancy. It is so necessary. It is so needed. And we are going to be leading the way in our pelvic division. We are very actively involved in research. Obviously, I'm a postdoctoral research fellow, so I'm there in the weeds of it, but also our other faculty are involved in the trenches as well. And it's just so, so, so important that we do this the right way and that we gradually build a level of evidence. And I am not okay with where we are right now. We need to do better. I will be part of the trying to make this better. And I'm recruiting you all to my cause to try and help me out. So I will post these research links in the captions, or you can head over to my Instagram at drchristina underscore private, and you can hopefully sign up for some of our studies. All right, if you are wanting to hear me get all fired up about other stuff or you wanna hear some of our faculty on the road, we have two courses in July that are still open for participation if individuals wanna sign up. I am in Cincinnati, Ohio. That is a smaller course. So if you are interested, July 2021, I'm in Cincinnati, Ohio. If you are interested and you are closer to Wyoming, we have a course July 27th, 28th in Wyoming. If you cannot get on the road because of kiddos like me who is coming early because kiddos are home for the summer, we have our next online cohort starting July 6th. So we are past 90% sold out for that course. So if you are looking to get in, please don't wait because there may not be the opportunity and then you'll have to wait until the fall. All right, that's all I got. 19 minutes. I'm sorry, I just get so passionate talking about resistance training in pregnancy. I hope you all have a wonderful week, and we'll talk to you all soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

**NEW Timestamps below!** The BRAND NEW 2nd Generation Tone Devices are NOW SHIPPING!! Order HERE Hi friends! This episode is about a NEW Study that has completely shook the protein and muscle building scientific community - about how eating 100 g of protein's effect on muscle building! We also talk about why this study is so exciting, the novel insights from it, why I love eating huge protein meals & do TRE/IF daily to get into ketosis for my cognition, and finally a brand new collagen that I am launching with scientific research behind it! The study discussed in today's episode. Timestamps: 1:50 start of episode and intro to the new study findings  3:26 RCTs for skin health and cellulite on Collagen - Tone launch & discount info  6:00 what I've been doing with my skin care to improve it, hair skin and nails  7:58 cellulite and treatments to improve it, red light therapy and collagen 9:06 start of new study breakdown  10:24 study methods  13:30 background on what muscle protein synthesis is  14:20 previous studies on this topic  16:18 limitations of past studies  16:30 new study breakdown  20:00 why this specific study yielded novel insights from the data  21:00 how Amino acids are distributed in the body after ingestion 24:00 some amino acids fuel our intestinal tract 26:40 results of muscle amino acid concentrations and muscle protein synthesis rates on 100 g vs 25 g  28:35 study results  29:15 I eat huge protein meals! Why this study is a game changer for intermittent fasting/ omad fans 30:59 why I'm doing more IF and omad for my brain and cognition  31:40 I love to feast!  32:42 why I am getting into ketosis daily  33:00 why I love doing omad bc of this study  35:00 I can eat 100 G + protein at one meal easily 35:42 so many novel findings, your thoughts?  36:00 tone collagen VIP launch discount and extro  36:50 how I use the tone device to measure my ketosis and fat burning when doing intermittent fasting  Get on the LIST for Tone Collagen HERE! Get 20% OFF Energybits Spirulina and Chlorella with the code KETOGIRL Energybits.com Get $50 OFF The Tone LUX Red Light Therapy Panels when combined with a pre-order for the new Tone LUX Crystal Mask - use the code TONELUXSAVE50 - Click HERE To Shop! Everyone is loving Tone Protein- Click Here to Check it out! - Follow @optimalproteinpodcast on Instagram to see visuals and posts mentioned on this podcast. Follow Vanessa on instagram to see her meals, recipes, informative posts and much more! Click here @ketogenicgirl Link to join the facebook group for the podcast: https://www.facebook.com/groups/2017506024952802/ - This podcast content does not constitute an attempt to practice medicine and does not establish a doctor-patient relationship. Please consult a qualified healthcare provider for medical advice and personal health questions. Prior to beginning a new diet you should undergo a health screening with your physician to confirm that a new diet is suitable for you and to out any conditions and contraindications that may pose risks or are incompatible with a new diet, including by way of example: conditions affecting the kidneys, liver or pancreas; muscular dystrophy; pregnancy; breast-feeding; being underweight; eating disorders; any health condition that requires a special diet [other conditions or contraindications]; hypoglycemia; or type 1 diabetes. A new diet may or may not be appropriate if you have type 2 diabetes, so you must consult with your physician if you have this condition. Anyone under the age of 18 should consult with their physician and their parents or legal guardian before beginning such a diet. Use of Ketogenic Girl videos are subject to the Ketogenicgirl.com Terms of Use and Medical Disclaimer. All rights reserved. If you do not agree with these terms, do not listen to, or view any Ketogenic Girl podcasts or videos.