Podcasts about Rhode Island Hospital

What happens when the doctor becomes the patient?

Send us a textWelcome to part one of a special two-part conversation featuring distinguished neonatologist and physician-scientist, Dr. Phyllis A. Dennery. In this “At the Bench” episode, hosts Drs. David McCulley and Misty Good, along with guest co-host Ben Courchia, delve into Dr. Dennery's remarkable journey—spanning from her early fascination with molecular biology to her influential roles as Chair of Pediatrics at Brown University and Pediatrician-in-Chief at Rhode Island Hospital. Throughout the discussion, she reflects on the challenges of investigating bilirubin as a possible antioxidant, pioneering new insights into newborn lung injury, and unraveling the complexities of oxidative stress.Dr. Dennery also opens up about building vibrant research programs at leading institutions, underscoring the value of mentorship, collaboration, and taking bold risks in pursuit of groundbreaking discoveries. She offers candid perspectives on balancing clinical demands with scientific innovation, and how she has navigated multiple leadership positions to foster deeper community engagement in pediatric health. This episode highlights not only her scientific achievements, but her passion for cultivating new talent and forging interdisciplinary partnerships. Don't miss this engaging opening segment of our two-part series. Be sure to tune into The Incubator's Sunday Interview for part two, where Dr. Dennery's inspiring story continues!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!

When Luke Messac began his emergency medicine residency at Rhode Island Hospital in 2018, he noticed his patients often came to him concerned about costs. Some worried about his recommendations for them to stay in the hospital overnight. Others questioned his motives when he asked them to undergo a test, like an X-ray or MRI. A few came in way too late in the course of their illnesses out of fear of the cost. He'd heard about aggressive debt collection practices at hospitals around the country that put people at risk of profound financial and legal consequences. It made him wonder: Was his hospital doing that, too? After a quick trip to the country courthouse to examine the case files, what he found troubled him. “I was inundated with what I thought were pretty horrific cases,” said Messac, author of the 2023 book, Your Money or Your Life: A History of Medical Debt Collection in the United States. “Low-income single moms, people living on disability, recent immigrants, were facing thousands of dollars of bills and court fees and interest fees. And if they did not pay and if they did not settle their suits quickly, then they could have their wages garnished. They would be charged double-digit interest rates.”In Berkeley Talks episode 219, Messac, now an attending physician at Brigham and Women's Hospital and an instructor in emergency medicine at Harvard Medical School, discusses how the changing role of hospitals, and the passage of Medicare and Medicaid in the 1960s, transformed how medical debts are collected in the U.S.This talk took place on Sept. 17, 2024, and was sponsored by the Berkeley Center for Social Medicine at the Institute for the Study of Societal Issues (ISSI) and cosponsored by Berkeley Public Health. Listen to the episode and read the transcript on UC Berkeley News (news.berkeley.edu/podcasts) or on YouTube @Berkeley News (youtube.com/@BerkeleyNews/podcasts).Music by Blue Dot Sessions.Photo by Ahmed for Unsplash+. Hosted on Acast. See acast.com/privacy for more information.

S5 E4 Understanding Disordered Eating with Dr. Aubrey CarpenterIn this episode, we welcome our friend and colleague, Dr. Aubrey Carpenter, a licensed clinical psychologist who has spent over a decade working as a pediatric psychologist, educator and researcher in Child Mental Health and parenting support. Dr. Carpenter has extensive training and experience from the likes of Boston University, Massachusetts General Hospital, Boston Children's Hospital, Hasbro Children's Hospital and Rhode Island Hospital. In this nuanced discussion, we dive deep into a comprehensive understanding of people's relationship with food, the signs of disordered eating, self- and body-image, treatment for eating disorders, and resources for individuals and families affected by disordered eating. Be curious. Be Open. Be well.The ReidConnect-Ed Podcast is hosted by Alexis Reid and Dr. Gerald Reid, produced by Cyber Sound Studios, and original music is written and recorded by Gerald Reid.*Please note that different practitioners may have different opinions- this is our perspective and is intended to educate you on what may be possible.Follow us on Instagram @ReidConnectEdPodcast and Twitter @ReidConnectEdShow notes & Transcripts: https://reidconnect.com/reid-connect-ed-podcast

Ping! Another episode of Brains On just dropped! And it's all about phones: how they help us, why they're so hard to put down – and how to have a balanced relationship with them.In this episode, Molly and co-host Linden do a deep dive on phone use. They'll chat with an expert about whether screens are bad for us and hear from some teenagers about how they really feel about their phones! Meanwhile, Marc takes his camels Humpty and Dumpty to a phone-free picnic, and Dwayne the Brain demonstrates the powerful connection between phones and dopamine. All that, plus a stumper of a mystery sound!We've been thinking about our phones a lot here at Brains On – so we started this new thing called Analog August, a month-long campaign to unplug our phones and get out in the world. If this episode inspires, we hope you and your family will join in the fun, and do your best to use your phones less! Parents can attend our virtual event about kids and phones on Thursday, August 15th from 12pm PT / 2pm CT / 3pm ET and sign up for our newsletter of ideas for phone-free adventures and tips on finding a healthy screen-life balance. Read more here.Featured experts:Julia Storm is a digital wellness specialist, educator, and advocate. She helps families work through issues around tech.Jacqueline Nesi is an Assistant Professor of Psychiatry and Human Behavior at Brown University and a Clinical Psychologist at Rhode Island Hospital. She specializes in issues affecting kids and teens. Subscribe to Smarty Pass for ad-free feeds, bonus episodes, and ticket discounts!Today's episode is sponsored by:- Indeed.com/brainson - Receive a $75 sponsored job credit with code brainson

Dr Ankur Kalra's guest this week is Dr Saraschandra Vallabhajosyula, Interventional and Critical Care Cardiologist, Assistant Professor of Medicine at the Warren Alpert Medical School of Brown University and the Director of the Cardiac Intensive Care Unit at Rhode Island Hospital, the Miriam Hospital and Lifespan Cardiovascular Institute. In this episode of Parallax, they delve into the latest insights from ACC.24 through the lens of five pivotal late-breaking trials. Dr Vallabhajosyula offers a deep dive into the nuances of each study. Together, Dr Kalra and Dr Vallabhajosyula distil the complexities of these trials into key messages for practice, grounded in their own clinical experiences. In the spotlight are five key trials: 1. DanGer Shock: Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock 2. RELIEVE-HF: Safety and effectiveness of the V-Wave® Ventura® Interatrial Shunt for the treatment of heart failure (HF) 3. PREVENT: Preventive PCI or medical therapy alone for vulnerable atherosclerotic coronary plaque 4. REDUCE AMI: Decreased usage of beta-blockers after acute myocardial infarction 5. ORBITA-COSMIC: Coronary sinus reducer for the treatment of refractory angina Dr Kalra and Dr Vallabhajosyula dissect the practical implications of these trials, answering pressing questions and addressing emerging dilemmas. What are the key takeaways from ACC.24? How do these findings shape contemporary clinical practice?

This episode discusses four MMWR reports. First, there was a rapid increase in the number of reported measles cases during the first quarter of 2024. Almost all cases occurred in people who were unvaccinated or with unknown vaccination status. Second, backyard poultry might increase the risk of Salmonella in infants and newborns, even in the absence of direct exposure. Third, new data show COVID-19 vaccines did not cause cardiac death in teens and young adults in Oregon. Finally, a cluster of central nervous infections at the Rhode Island Hospital was associated with a medical device commonly used in neurosurgery.

Rollin Wright, MD, is an Associate Professor of Medicine at Penn State Health – Hershey Medical Center. She holds a medical degree from Albany Medical College and completed her fellowship in Geriatric Medicine at Rhode Island Hospital. In addition to her clinical experience, Dr. Wright has developed curricula in areas such as dementia care, interprofessional education, and post-acute and long-term care. Mentioned in the show: Medicare vs. Medicaid HMO vs. PPO HSA vs. FSA Atul Gawande The Price We Pay by Marty Makary

Dr. Colleen Jackson discusses cognitive testing in a way that makes it easily understandable, alleviating any apprehension associated with the assessment. She starts by distinguishing between neuropsychological testing and cognitive assessments. Colleen shares insights into her approach and describes the valuable information that can be obtained from the testing process. Emphasizing a holistic perspective, she looks at an individual's overall health and well-being when giving her recommendations. Listeners will learn about cognitive assessments and neuropsychological testing to determine whether they might benefit a loved one.   IN THIS EPISODE:   [2:11] Colleen begins by describing the difference between neuropsychological testing and cognitive assessments [4:17] Colleen explains what the tests look like from a client perspective and what is involved [7:36] Colleen talks about how a family member can encourage a loved one to seek a provider and what is learned through the testing [12:06] Colleen discusses older adults, specifically  [16:06] Colleen refers to different treatment protocols based on test results [20:25] Colleen ends by discussing other illnesses that can impact mental health or cognitive impairment   KEY TAKEAWAYS:   [2:01] There is a difference between neuropsychological testing and cognitive assessment [7:27] There are some tips that family members can use to encourage a person to seek a provider [11:44] You can identify different conditions or illnesses through testing.   RESOURCES:   Beyond the Balance Sheet Website Dr. Colleen Jackson - LinkedIn   BIOGRAPHY:  Dr. Colleen Jackson received her doctorate in clinical psychology from the University of Connecticut. She pursued a clinical internship in clinical neuropsychology and dementia clinical research at Rhode Island Hospital through the Warren Alpert Medical School of Brown University, followed by research postdoctoral fellowships in the National Center for PTSD and the Translational Research Center for TBI and Stress Disorders at the VA Boston Healthcare System. After completing postdoctoral training, Colleen assumed a staff neuropsychologist position at the VA Boston Healthcare System, where she was involved in direct clinical care, clinical supervision/mentorship, and research. Colleen served as the Chief of the Neuropsychology Clinic in the Department of Neurology at Boston Medical Center prior to establishing her private practice in 2022. Colleen conducts clinical neuropsychological evaluations with adults presenting with cognitive concerns associated with neurodevelopmental disorders, neurodegenerative conditions, acquired brain injuries, substance use, and psychiatric conditions. Colleen approaches clinical care with a tailored focus on the client's cognitive and psychological needs, individual strengths, and personal values.  

In this best of 2023 episode, I revisit my conversation with Dr. Maslow - easily one of my favorite attendings from Rhode Island Hospital. Listening back, I'm reminded by how smart he is, right from the beginning of the episode. He's inspiring and accomplished in his career. This is a must listen (or relisten if you're a true fan).

Bill Bartholomew welcomes Dr. Elizabeth Benz, the head of Samuels Sinclair at Rhode Island Hospital – and Michelle Muscatello, Vice President of Communications and External Affair for Delta Dental to discuss a new oral surgery partnership Delta Dental and the Samuels Sinclair Dental Center at Rhode Island Hospital.Support the show

Rebecca Karb, MD, PhD, Co-Director, Comprehensive Stroke Center, Rhode Island Hospital, Attending Physician, Emergency Medicine, Rhode Island Hospital and House of Hope's Director of Outreach Sara Melucci join the show to discuss Lifespan's Street Outreach Program which seeks to provide direct care to vulnerable Rhode Islanders. Support the show

BUFFALO, NY- September 27, 2023 – A new editorial paper was published in Oncotarget's Volume 14 on September 22, 2023, entitled, “Reassessing the risks and benefits of COVID-19 precautions in 2023.” The COVID-19 pandemic has killed over one million Americans with many dying during the Omicron wave. By now most Americans have either had COVID-19 and/or been vaccinated against it. Despite the availability of updated immunizations, only 16.7% of Americans are now up-to-date on bivalent boosters. In their new editorial, researchers Thomas A. Ollila, Rashida Taher and Prashanth Moku from the Alpert Medical School of Brown University and Rhode Island Hospital discuss the current state of COVID-19 treatment. “At our cancer center, we treat many patients with hematologic malignancies, most of whom are older adults.” Patients with hematologic malignancies, especially lymphoma, are at increased risk of poor response to vaccination and worse outcomes from COVID-19 infection. The researchers state that most of their patients have been abundantly cautious since the onset of the pandemic and some have avoided ever becoming infected. Patients in their clinic frequently inquire about the safety of being outdoors, spending time with their families during large gatherings (Christmas, Thanksgiving, etc.), and methods to prevent the contraction of COVID-19. “Despite these precautions, too many patients reached remission from cancer only to then perish from COVID-19 in the first years of the pandemic.” The concerns behind their questions are very real, but understanding how to best answer them is not always easy and their abundance of caution is not without cost. Grandchildren's birthdays went uncelebrated, weddings were forgone, and memorable moments with loved ones were lost. With both aging and malignancy, an acute awareness of the limited days means that there may not be years ahead to make up for all that was missed. “Although COVID-19 continues to pose a serious threat, medical advancements have now allowed for a more in-depth risk-benefit discussion to weigh the risk of infection versus the challenges of social isolation.” DOI - https://doi.org/10.18632/oncotarget.28468 Correspondence to - Thomas A. Ollila - thomas_ollila@brown.edu Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28468 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords - cancer, COVID, immunosuppression, coronavirus, vaccination, lymphoma About Oncotarget Oncotarget (a primarily oncology-focused, peer-reviewed, open access journal) aims to maximize research impact through insightful peer-review; eliminate borders between specialties by linking different fields of oncology, cancer research and biomedical sciences; and foster application of basic and clinical science. To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: SoundCloud - https://soundcloud.com/oncotarget Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Media Contact MEDIA@IMPACTJOURNALS.COM 18009220957

The Assessment of Implementation of Methods in Sepsis and Respiratory Failure (AIMS) Study seeks to determine the safest and most effective approach to sepsis intervention using the evidence-based Surviving Sepsis Campaign guidelines. Marylin N. Bulloch, PharmD, BCPS, FCCM, was joined by Mitchell M. Levy, MD, MCCM, at the 2023 Critical Care Congress to discuss the goal of the AIMS Study and the elements of both the Hour-1 and 3-Hour bundles. Dr. Levy is chief of the Division of Critical Care, Pulmonary, and Sleep Medicine and professor of medicine at the Warren Alpert Medical School of Brown University. He is also the medical director of the medical ICU at Rhode Island Hospital in Providence, Rhode Island, USA.

In this podcast, Editor-in-Chief Dr Jeanette Hasse interviews Dr Marion Winkler and Dr Kelly Tappenden, authors of the paper, “Epidemiology, survival, costs, and quality of life in adults with short bowel syndrome” published in the June 2023 Nutrition in Clinical Practice Supplement on short bowel syndrome. Dr Winkler is a Professor of Surgery, at the Alpert Medical School of Brown University and a Surgical Nutrition Specialist at Rhode Island Hospital in Providence RI. Dr Tappenden is currently Professor and Head of the Department of Kinesiology and Nutrition at the University of Illinois at Chicago and as of July 1, will be the Dean of the College of Health at the University of Utah. Business Corporate by Alex Menco | alexmenco.net Music promoted by www.free-stock-music.com Creative Commons Attribution 3.0 Unported License creativecommons.org/licenses/by/3.0/deed.en_US June 2023 SUPPLEMENT

Welcome back to Behind the Drapes. In this episode, we talk to Dr. Caramez - one of our recent graduates from Brown Anesthesia Residency who stayed on as staff here at Rhode Island Hospital. Paula is vibrant with energy and her story of how she found a career in Anesthesiology is a unique one! Stay tuned to hear more about her life in Brazil, moving to America, experiencing a second residency, and how she's adopting to her new role as the Anesthesiologist in the OR. Here's what you have to look forward to: 00:09 Introduction 01:40 Medical Career in Brazil 09:10 Coming to the USA 11:30 Path to Citizenship + Residency 18:50 Residency Take Two 26:00 How is life as an attending? 30:30 Becoming a Medical Educator

Key takeaways: The changing role of the Oncologist - Starting as the Sherpa, transitioning to a mentor, and then breaking up! Awareness of barriers the LGBTQ community faces in accessing healthcare The distinction between addressing reproductive health and sexual health in cancer care About Dr. Don Dizon: Don S. Dizon, MD, FACP, FASCO, is an oncologist who specializes in women's cancers. He is the director of women's cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital. He is also a professor of medicine at The Warren Alpert Medical School of Brown University. His research interests are in novel treatments of women's cancers and issues related to survivorship, particularly as they relate to sexual health after cancer for both men and women. He is a prolific researcher and writer, and he has authored hundreds of publications, including peer-reviewed articles, books and book chapters. He is an active member of the American Society of Clinical Oncology, SWOG cancer research network, and the National Consortium of Breast Cancers, of which he has served as both vice president and president. Key moments: 12 minutes 27 seconds That person may be more interested in symptom control, in which case they would find more affinity in a metastatic brain tumor group. But they also may want to see people that look like them, that are like them who are going through this experience because of the threats metastatic brain cancer has on people's sexual health. 14 minutes 35 seconds It's what makes cancer care so multifaceted today. There's no one person who can really manage all the aspects of cancer care. By that, I mean whole-person cancer care. It really brings in the importance of having a team approach. 21 minutes 8 seconds There's a relationship between medical oncologists and their patients that is very difficult to walk away from for a lot of people. It almost feels like severing a relationship and it's quite an unsettling thing. Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions. --- Support this podcast: https://podcasters.spotify.com/pod/show/manta-cares/support

Season 2 | Episode 43 | October 26, 2022Rheumatologist Matthew Stanishewski, DO, practices with SVMC Rheumatology, part of Southwestern Vermont Medical Center, in Bennington. Stanishewski earned his medical degree from Philadelphia College of Osteopathic Medicine and most recently served as a fellow in Rheumatology at Roger Williams Medical Center, Rhode Island Hospital, and the VA Medical Center in Providence. He is the chair of Internal Medicine at SVMC and the vice president of the medical staff. In addition, he is a fellow of the American College of Rheumatology. Stanishewski will see patients in suite 307 of the Medical Office Building, which is located at 140 Hospital Drive in Bennington.Underwriter: Mack MoldingMedical Matters Weekly features the innovative personalities who drive positive change within health care and related professions. The show addresses all aspects of creating and maintaining a healthy lifestyle for all, including food and nutrition, housing, diversity and inclusion, groundbreaking medical care, exercise, mental health, the environment, research, and government. The show is produced with cooperation from Catamount Access Television (CAT-TV). Viewers can see Medical Matte...

On Episode 21 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the October 2022 issue of Stroke: “Oral Contraceptives, Hormone Replacement Therapy, and Stroke Risk” and “Effectiveness and Safety of Antithrombotic Medication in Patients With Atrial Fibrillation and Intracranial Hemorrhage.” She also interviews Dr. Shadi Yaghi about his article “Direct Oral Anticoagulants Versus Vitamin K Antagonists in Cerebral Venous Thrombosis.” Dr. Negar Asdaghi:         Let's start with some questions. 1) Do hormone replacement therapies or oral contraceptives increase the risk of stroke? And if yes, does the age of the individual or the duration of therapy modify this risk? 2) Should survivors of intracranial hemorrhage who have atrial fibrillation be treated with antithrombotic therapies for secondary prevention of stroke? 3) And finally, what is the anticoagulant of choice for treatment of cerebral venous sinus thrombosis? We have the answers and much more in today's podcast as we continue to bring you the latest in cerebrovascular disorders. You're listening to the Stroke Alert Podcast, and this is the best in Stroke. Stay with us. Welcome back to another amazing issue of the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine, and your host for the monthly Stroke Alert Podcast. The October issue of Stroke covers a number of timely topics. As part of our October Literature Synopsis, we have a nice paper by Dr. Farida Sohrabji and colleague, which summarizes three recently published animal studies to evaluate the association between small vessel ischemic injury and either development of Parkinsonism or the future risk of Parkinson's disease. These studies looked at how ischemia, specifically involving the lenticulostriate arteries, can modulate the nigrostriatal dopaminergic pathway and ultimately lead to Parkinsonism. As part of our Original Contributions, we have the results of a small randomized trial out of Korea, which was led by Dr. Yun-Hee Kim from Sungkyunkwan University School of Medicine in Seoul, where we learned that doing 20 sessions of transcranial direct current stimulation for about 30 minutes for each session at home can improve post-stroke cognition. This was found to be specifically effective in patients with post-stroke moderate cognitive decline. Now, transcranial current stimulation can be given using a handheld device at home, and if truly proven safe and efficacious in larger studies, can dramatically change the landscape of stroke recovery in cognitive rehabilitation. I encourage you to review these articles in addition to listening to our podcast today. Later in the podcast, I have the great pleasure of interviewing Dr. Shadi Yaghi from Brown University. Shadi will walk us through a systematic review and meta-analysis of published studies to compare the safety and efficacy of direct oral anticoagulants to that of vitamin K antagonists in patients with cerebral venous sinus thrombosis. Our devoted Stroke Alert Podcast listeners recall that we did cover this topic in our March podcast when we reviewed the results of ACTION-CVT, a multicenter international study that was led by none other than Shadi himself. I'm delighted to have him as a guest on my podcast today to talk more about the seminal study and all things cerebral venous sinus thrombosis. But first, with these two articles. Millions of women worldwide use exogenous hormones, most commonly in the form of oral contraceptives and hormone replacement therapies. Despite the many different formulations of these drugs that are now available on the market, the two therapies are similar in that both combined oral contraceptives and hormone replacement therapies, or HRTs, contain various dosage of estrogen and progestin. Now, the principal difference between them being that the hormone contents of oral contraceptives are at high enough dosage to prevent ovulation, whereas hormone replacement therapies are considered more physiological as their aim is to return post-menopausal hormone levels to what they were before menopause. Well, by now, you must wonder how is any of this even relevant to vascular neurology? Well, the answer lies in the close relationship between hormonal therapies and stroke. But before we get to that, we have to review a few things. First of all, it's long been known that the endogenous estrogen has strong and protective effects on the arteries. It promotes vasodilation and cell survival of the endothelial layer. It increases the endothelial mitochondrial efficiency and stimulates angiogenesis. In other words, endogenous estrogen is good for vascular health. And in fact, that's why we think that premenopausal women, in general, are at a lower risk of stroke as compared to their age and vascular risk factors–matched male counterparts. And to make things even better for estrogen, there's enough evidence to suggest that exogenous estrogen also does all of these good things for the endothelium. So, why are we even talking about an increased risk of stroke associated with use of hormonal therapies? The problem is, we have to remember that exogenous estrogen also does other things. It can increase the blood concentration of procoagulants, which, in turn, can increase the risk of thromboembolism, especially venous thrombosis. But there's still a lot of unknown on this topic. For instance, the majority of the prior research on the topic involves postmenopausal women using hormonal therapies. Some of that research has actually suggested that HRTs may be protective against vascular events, while others showed the opposite. Well, we know that a majority of oral contraceptive users are actually much younger and use these medications premenopausal. So, there seems to be a lot of gaps in our current knowledge on the simple question of whether or not oral contraceptives and hormonal replacement therapies do, in fact, increase the risk of stroke or not. In the current issue of the journal, a group of researchers led by Drs. Therese Johansson, Torgny Karlsson, and Åsa Johansson from the Department of Immunology, Genetics and Pathology at Uppsala University in Sweden set out to fill some of these gaps with their study titled, "Oral Contraceptives, Hormone Replacement Therapy, and Risk of Stroke," as part of a large UK Biobank population-based cohort. Just a bit about the UK Biobank. This was a large population-based cohort from 2006 to 2010 that included over 500,000 residents of the United Kingdom between the ages of 37 and 73. Participants at the time of enrollment would have extensive information collected from them through questionnaires, interviews, health records, physical measures, as well as some imaging and biological samples. Data on each participant was collected from the time of their birth all the way to the day of assessment, which is interesting, because the day of assessment would then count as the end of the follow-up for each participant. Now, for the current study, they included over 250,000 women of White race in whom information required for the study on whether or not they use hormonal therapies, duration of treatment, age at the time of exposure was available. And just a quick comment about their methodology. They analyzed their cohort once for oral contraceptive use and once for HRT use and compared each group to a reference group of either women who never used their set therapy or the number of years they contributed to the study prior to initiating that set treatment. So, for instance, if a person started using oral contraceptives at the age of 21, all of the years that she contributed to the study before that age would count as non-exposed user years and were included in the control cohort. So now, on to their findings. A total of 3007 stroke diagnosis of any type were identified prior to the initial visit to the assessment center, which, as we mentioned, was the end of the follow-up in the study. Of these, 578 were ischemic strokes, 177 intracerebral hemorrhage, and 478 were subarachnoid hemorrhages. But as expected for any large cohort, over half of total strokes were self-reported as stroke of any type and could not be classified into any of the above subtypes. Now, let's look at the effects of oral contraceptives on the outcome of stroke. Overall of the women included in the study, 81% were classified as oral contraceptive users, while 19% reported never having used oral contraceptives at any point during the study. On the association between oral contraceptive use and the risk of stroke, at first glance, things looked OK. The hazard rates of any stroke for any stroke subtypes were not different between women who had used oral contraceptives as compared to those in the reference group. That's great news. But when they looked deeper, they realized that the odds of development of any stroke was actually quite high during the first year after the initiation of oral contraceptives with hazard rate of 2.49 for any stroke, while there was no difference in hazard rates found during the remaining years of use and after discontinuation of oral contraceptive use. So, meaning that there was no lingering effects of oral contraceptives on increased risk of stroke after the first year or after discontinuing the medication. Now, on to HRTs. In total, 37% of women in the study had initiated HRTs at some point during the study, while 63% had never used this therapy. Here's the bad news. Overall, HRTs did increase the risk of stroke. An approximately 20% increase event rate of any stroke was noted among women who had initiated HRTs as compared to those who had not. When analyzing stroke subtypes, the use of HRTs was associated with increased risk of only the subarachnoid hemorrhage subtypes. We don't know why. Diving deeper, in considering timing of HRT initiation, very similar to what was observed for the oral contraceptives, during the first year after starting the HRTs, the treatment group was twice more likely to suffer from any type of stroke, and the hazard rate was also increased for all three stroke subtypes that were available in the study. But, unlike oral contraceptives, the hazard rate of any stroke remains significantly high even after the first year of use, not just for those who continued HRTs, but sadly, even for those who discontinued the therapy. Though the risk remained high, the hazard ratio declined over time as we went further away from the first year when treatment was initiated. So, bottom line, if women had initiated HRTs at some point in their life, the hazard risk of any stroke increased significantly in the first year. That hazard risk did decline over time, but it always remained significantly higher than non–HRT users. Now, what about timing of treatment in relation to the onset of menopause? Is the risk of stroke any different if women start on HRTs prior to or after their menopause? The answer is no. Initiation of HRTs was associated with an increased hazard rate of any stroke if it was started pre- or postmenopausal, but the risks were higher if the treatment was started prior to menopause. So, in summary, this large population-based cohort has truly given us some very important practical findings. We learned that both oral contraceptives and hormone replacement therapies do, in fact, increase the risk of stroke, an effect that was most notable in this study in the first year after initiation of both of these therapies, and in the case of oral contraceptives, was just actually limited to that one year alone. Why does this happen? I guess the easy answer is that these drugs, as we noted earlier, have an immediate prothrombotic effect, which gradually weakens over time. That's one plausible explanation, but for instance, why HRTs increase the risk of subarachnoid hemorrhage is something we can't explain based on the prothrombotic effects of HRTs. So, we have to come back to the vessels, the impact of hormone therapies and estrogen specifically on the blood vessels, on the endothelial cells, the potential increase in blood pressure, especially early on in the course of treatment with these medications. And also, we have to think about the role these drugs may play in increasing inflammatory markers, providing a more suitable milieu for accelerated atherosclerosis, as to why these associations were noted in this study. And it's fair to say that we need more research on this topic in the future. One challenging scenario that we commonly face in our daily practice is deciding whether or not we should resume antithrombotics in patients with atrial fibrillation who have survived an intracranial hemorrhage. The majority of intracranial hemorrhage survivors with atrial fibrillation actually have a very high CHA2DS2-VASc score, which means that they are actually at a very high risk of future ischemic stroke and systemic embolic events unless they're treated with anticoagulants. On the other hand, the risk of spontaneous intracranial bleeding is substantially higher in a person who has previously suffered from one, let alone if we treat them with anticoagulants. And to make matters worse, we have little evidence from the literature to guide us. So, in the current issue of the journal, in the study titled "Effectiveness and Safety of Antithrombotic Medication in Patients With Atrial Fibrillation and Intracranial Hemorrhage," a group of researchers from the UK led by Dr. Deirdre Lane, Professor of Medicine at the University of Liverpool, performed a much needed systematic review and meta-analysis of the available evidence on this subject. I have to say that lately, it seems that we've been covering a few of these reviews in our podcasts, and we are just getting started. In fact, my next paper in today's episode is also a systematic review and meta-analysis. These papers are packed with details, a testament to the work needed to complete them, but I have to say that even summarizing these papers for a podcast has been a bit challenging. So, feel free to put me on pause, go get some coffee, and let's power through this one together. For their methods, they used the usual search engines looking for papers that included adults over the age of 18 with atrial fibrillation who had survived a non-traumatic spontaneous intracranial hemorrhage of any size, any type, and any location, be it lobar, brain stem, deep, cerebellar, subdural, epidural, or subarachnoid hemorrhage. And very importantly, they included even those with evidence of microbleeds on neuroimaging. The intervention of interest was either long-term oral anticoagulation or antiplatelet therapy versus no antithrombotic use for the following three outcomes of interest: number one, recurrent thromboembolic events; number two, recurrent intracranial hemorrhage; and number three, all-cause mortality. Just a quick note that for this analysis, they excluded studies that looked at either short-term anticoagulation or non-oral anticoagulation use for any reason that was given to the patient other than for secondary prevention of stroke. For example, if a patient suffered from a pulmonary embolism and was treated with IV heparin or, for a short period of time after that, with oral anticoagulation, those patients or those studies were excluded from this meta-analysis. So, with this criteria, they pulled over 4,000 citations and abstracts, and finally included 20 papers that were published between 2015 and 2021 for a total of over 50,000 participants for this meta-analysis, very nice sample size. Most of the papers included were observational cohorts, but in addition, we had two small randomized trials, and I want to take a moment and review these trials for our listeners. The first one was a small noninferiority pilot trial out of the UK, the SoSTART trial, that looked at any anticoagulant versus either antiplatelet therapy or no antithrombotics in this population, and the other trial was the Phase 2 trial, the APACHE-AF, that studied apixaban versus no anticoagulation after anticoagulant-associated intracerebral hemorrhage. A reminder that both of these trials were published in Lancet Neurology in 2021. And before we move on to the findings of the meta-analysis, it's worth noting that they had included a mix of patients, some were oral anticoagulant–naive, and some had developed their index intracranial hemorrhage while already on treatment with anticoagulants or antiplatelet therapies. OK, now on to their findings, as mentioned, we're going to review three outcomes of recurrent thromboembolism, recurrent intracranial hemorrhage, and all-cause death for the following three groups: group one, oral anticoagulant therapy versus no therapy; group two, oral anticoagulation therapy versus either antiplatelet treatment or no therapy; group three, comparing new oral anticoagulants versus warfarin. So, for the first outcome of recurrent thromboembolic events in group one, when comparing oral anticoagulant therapy to no therapy, the study showed a significant reduction in thromboembolic events in favor of oral anticoagulation compared to no therapy. That's great news. Next, analysis of the studies that compared oral anticoagulation versus either antiplatelets or no therapy didn't show the same difference in prevention of embolic events in favor of either groups. Actually, no difference was noted between the two groups. Number three, now, in terms of comparing NOACs to warfarin, three studies had the information on this comparison, and they reported a significant reduction in the risk of thromboembolic events with NOAC as compared to warfarin. So, great news for oral anticoagulation overall, and especially for NOACs. Now, on the next outcome. Our second outcome was a recurrent intracranial hemorrhage. Keeping in mind that they included some studies where the outcome was defined as any form of intracranial hemorrhage, meaning they included subdurals, epidurals, etc., and some studies only included the outcome of intracerebral hemorrhage. So, on to the first group, comparing oral anticoagulants to no therapy, the pooled estimate revealed no statistically significant difference between oral anticoagulant–treated patients to those who were not treated with any antithrombotics on the risk of recurrent intracranial hemorrhage. That's great news. Next, on our second group, for the same outcome of recurrent intracranial hemorrhage, comparing oral anticoagulants to either antiplatelet therapy or no treatment, they found that oral anticoagulation was associated with a higher risk of recurrent intracranial hemorrhage as compared to antiplatelets or no therapy. And finally, third group comparing new oral anticoagulants to warfarin for the same outcome, the risk of recurrent intracranial hemorrhage was significantly reduced in patients treated with NOACs as compared to warfarin. And now, we're finally on to our last outcome of the study, which is the outcome of all-cause mortality. So, again back to group one, comparing oral anticoagulants to no therapy, this meta-analysis showed a significant reduction in all-cause mortality rate associated with oral anticoagulation. That's, again, great news. Next group, for the same outcome of mortality, comparing oral anticoagulants to either antiplatelet therapy or no treatment, they found no significant difference in the mortality rates between the two groups. And finally, comparing NOACs to warfarin, the pooled estimate showed that NOACs were associated with a significantly reduced risk of all-cause mortality. Amazing news for NOACs. So, in summary, here's what we learned from this big study. Oral anticoagulation use after intracranial hemorrhage in patients with atrial fibrillation did significantly reduce the risk of thromboembolic events and all-cause mortality without significantly increasing the risk of recurrent intracranial hemorrhage. In general, new oral anticoagulants, or NOACs, are preferred to warfarin as they do prevent embolic events with a lower risk of recurrent intracranial hemorrhage. But, of course, we still have a lot more questions. For instance, would any of the outcomes mentioned above be different in patients with lobar intracerebral hemorrhage, a condition typically associated with amyloid angiopathy, which carries a high risk of development of intracerebral hemorrhage? Also, we have to keep in mind that the majority of the studies included in the meta-analysis were observational. So, there remains an urgent need for a larger randomized trial on this subject, and we have to stay tuned for more research. Cerebral venous sinus thrombosis, or CVST, is an uncommon form of stroke resulting in headaches, seizure, or focal neurological symptoms due to either intracranial hemorrhage or venous ischemic infarcts. The rarity of the disease has made it difficult to study as part of randomized trials, so current treatment guidelines for CVST are consensus-based with much of the recommendations extrapolated from data on treatment of patients with systemic deep vein thrombosis. In general, based on the current evidence, the field agrees that a patient with CVST should be anticoagulated. The decision that is difficult and sometimes inappropriately delayed in the setting of acute hemorrhage in the brain. And not surprisingly, there's significant equipoise around the choice of anticoagulant, duration of therapy, and the role of heroic therapies, especially in the acute setting. Currently, there are a number of ongoing trials to address some of these issues. The direct oral anticoagulants present an attractive alternative to vitamin K antagonists for treatment of patients with CVST. This is partly because of their convenience of use. But how do direct anticoagulants compare in safety and efficacy to the vitamin K antagonists in the setting of CVST is less known. In our March podcast, we reviewed the results of ACTION-CVT, which was a multicenter international study that compared the safety and efficacy profile of the direct oral anticoagulants to that of warfarin in routine practice. The study included over a thousand imaging-confirmed CVST patients from multiple centers in the US, Italy, Switzerland, and New Zealand. And if you missed it, no worries at all. We're here to review some of the results again, as in this issue of the journal, many of the ACTION-CVT investigators, led by Dr. Shadi Yaghi, present the results of a systematic review and meta-analysis comparing the safety and efficacy of DOACs, or direct oral anticoagulants, to that of vitamin K antagonists. I'm joined today by Dr. Yaghi himself to discuss ACTION-CVT and the current meta-analysis. Dr. Yaghi is a Director of Vascular Neurology at Lifespan and Co-Director of Comprehensive Stroke Center and a Director of Research at the Neurovascular Center at Rhode Island Hospital. Good afternoon, Shadi, and welcome to our podcast. Dr. Shadi Yaghi:               Good afternoon, Dr. Asdaghi. Thank you so much for having me. Dr. Negar Asdaghi:         Thank you. And please call me Negar. Congrats on the paper. Before we talk about the meta-analysis, can you please remind us of the results of ACTION-CVT and why the systematic review, in your opinion, was an important next step to that effort? Dr. Shadi Yaghi:               Thank you so much for having me and for bringing up ACTION-CVT. So ACTION-CVT is a real-world multicenter international study that used real-world observational data to compare the safety and efficacy of direct oral anticoagulants to vitamin K antagonists in patients with cerebral venous thrombosis. The reason why we did ACTION-CVT was, as you know, cerebral venous thrombosis is a rare disease, and it's hard to have large studies that would be powered enough to compare the safety and efficacy of direct oral anticoagulants to vitamin K antagonists. So, most of the studies that were done are small, retrospective. There's one randomized controlled trial, but most of them are underpowered to detect the difference between the two groups. So, we decided to do a large-scale international multicenter study using real-world data to compare the safety and efficacy of both. Dr. Negar Asdaghi:         OK, so we're glad you did. Let's start with the methodology of the current meta-analysis. Can you please give us an overview of the inclusion criteria for selection of the papers and the intervention and outcomes that you were interested in? Dr. Shadi Yaghi:               Of course. So, this is a systematic review and meta-analysis that included studies comparing direct oral anticoagulants to vitamin K antagonists in patients with cerebral venous thrombosis. The studies needed to have the two groups included, the direct oral anticoagulants and vitamin K antagonists, and they need to include at least one of the outcomes in our study to compare this outcome between the two groups. In addition, we included articles published in English, and we also included papers that had five patients or more in each group. Dr. Negar Asdaghi:         Perfect. So just recap for our listeners, in order to have been included in the meta-analysis, the paper had to have a reasonable number of patients, and you put that reasonable at the number five, and also they had to have at least one of the outcomes of interest reported in their papers. And those outcomes were either recurrent venous thromboembolism or recanalization rates. Right? Dr. Shadi Yaghi:               Correct. Yes. Dr. Negar Asdaghi:         Perfect. So with that, how many papers did you have to go through to come up with the current number of papers included? Dr. Shadi Yaghi:               That's a great question. We had a little over 10,000 papers, and then we went through a screening process. We used this tool that was developed by Brown University. It's called Abstrackr, and what you do is, we did the search and using several databases like PubMed, Cochrane, and then we included all these studies. We uploaded them in Abstrackr, and Abstrackr was utilized to be able to review all these abstracts and select studies that may or will probably qualify and then go through the studies and details that would qualify. So, we had about 10,000 studies with the initial search, and we had two reviewers go through each abstract, and from these 10,665, we excluded 10,411, and that left us with 254 studies. And then we went through these 254 studies in details. And then finally, we had 19 studies included that met our inclusion/exclusion criteria. And these 19 studies included three randomized control trials and 16 observational studies. Dr. Negar Asdaghi:         Incredible effort. So, three randomized trials in this meta-analysis and 16 observational studies. I think we're very ready to hear the primary outcomes. Dr. Shadi Yaghi:               Yeah, so, the primary outcomes were recurrent venous thrombosis, and that included recurrent venous thromboembolism like peripheral DVTs or PEs, for example, and including recurrent cerebral venous thrombosis. And we know that most of the events are recurrent VTEs, not CVTs, like probably about two-thirds to three-quarters were VTEs, and a third to a quarter were CVT. And then the other efficacy outcome is venous recanalization on follow-up imaging. And we found that direct oral anticoagulants and warfarin were not significantly different in the primary efficacy outcomes. Dr. Negar Asdaghi:         Thank you. I just want to repeat this for our listeners. So, you mentioned some important information here. First one was the fact that about three-quarters of recurrent events were actually systemic thromboembolic events rather than cerebral thromboembolism. So, an important outcome to keep in mind for our practicing physicians. And the fact that DOACs did the same as compared to vitamin K antagonist. So, I think you can already guess my next question, and that is, was there any compromise on the safety profile when using DOACs as compared to vitamin K antagonists in this meta-analysis? Dr. Shadi Yaghi:               Thank you. That's a great question. In ACTION-CVT, we found that there was a lower risk of major hemorrhage with direct oral anticoagulants compared to vitamin K antagonists. In this systematic review and meta-analysis, we didn't find a significant difference, but there were fewer events in patients treated with direct oral anticoagulants versus vitamin K antagonists. This did not reach statistical significance, but if you look at the raw data, it's kind of along the same lines as ACTION-CVT, so the risk of major hemorrhage was about 3.5% with warfarin, and that was about 2% with direct oral anticoagulants. Dr. Negar Asdaghi:         So, again, very important finding, and I want to repeat this for our listeners. So, important finding number one was that there was a superiority in favor of DOACs that you found in terms of a reduced risk of intracerebral hemorrhage in ACTION-CVT. You didn't find this superiority in the meta-analysis, but there was sort of a hint to perhaps lower risk of intracerebral hemorrhage in patients that were treated with DOACs. Did I get that right? Dr. Shadi Yaghi:               Yes, that is correct, and in addition, also major hemorrhage in general, and that included also ICH. Dr. Negar Asdaghi:         Oh, OK, so not just intracranial, but systemic hemorrhages as well. All right. Very good. So, I think my next question would be, why do you think that DOACs have a lower chance of causing hemorrhage? Dr. Shadi Yaghi:               Yeah, that's a really good question. This is not unexpected with DOACs as opposed to vitamin K antagonists. We saw these same trends in patients with atrial fibrillation. We saw improved bleeding profiles with direct oral anticoagulants as compared to vitamin K antagonists. And the risks were along the same lines that we found in patients with cerebral venous thrombosis in ACTION-CVT. Also in the VTE trials as well, there was also reduced bleeding complications with direct oral anticoagulants as compared to vitamin K antagonists. So, it was kind of reassuring to see the same results in patients with cerebral venous thrombosis. Dr. Negar Asdaghi:         Perfect, so kind of expected based on what we know from treatment of systemic conditions with DOACs. The next question I have for you is that in routine practice, treatment of cerebral venous sinus thrombosis almost always starts parenterally with either unfractionated heparin or low molecular weight heparin and then we switch to an oral agent. In the observational studies, did you find any differences in terms of timing of this switch or characteristics of the patients in whom vitamin K antagonists were chosen over direct oral anticoagulants? Dr. Shadi Yaghi:               Thank you very much. Most of the studies did not report these details. I think the one study, off the top of my head, that does report the differences in characteristics between the two groups is RESPECT-CVT. That's the randomized controlled trial comparing dabigatran to vitamin K antagonists. In this study, there was a treatment with parenteral anticoagulation for several days, I think seven to 14 days, prior to transitioning to oral anticoagulation. And this is generally my practice. I typically would treat patients with at least seven days or so parenteral anticoagulation, and once they're clinically stable, then I would transition them to oral anticoagulation, either vitamin K antagonists or direct oral anticoagulant. Dr. Negar Asdaghi:         And I think my next question is along the lines of this question as well. We have several direct oral anticoagulants now available on the market. What was the most common DOACs used for treatment of CVST in these studies, and did you note a preference for the use of any particular agent over others? Dr. Shadi Yaghi:               Thank you so much for the question. Anti-Xa inhibitors were much more common than dabigatran, and the anti-Xa inhibitors most commonly used were apixaban and rivaroxaban. It's in line with what we saw in ACTION-CVT as well, although most of the randomized controlled trials or the largest randomized controlled trial, RESPECT-CVT, used dabigatran, but overall people have been using anti-Xa inhibitors, more particularly apixaban, which was also in line with what we saw in ACTION-CVT. Dr. Negar Asdaghi:         But I think it's fair to say that we don't really have data on superiority of one over others. Is that fair? Dr. Shadi Yaghi:               Yes, that is correct. Dr. Negar Asdaghi:         OK, and so now, where are we at in terms of the future of studies on this topic? We have one ongoing randomized trial now? Dr. Shadi Yaghi:               Yes, we have one randomized controlled trial ongoing, and this is the SECRET trial, and it's looking at rivaroxaban versus vitamin K antagonists in patients with cerebral venous thrombosis. There's another study, it's a prospective observational study that's called the DOAC-CVT study. It's an international study also looking at real-world data prospectively to see if there's a difference in outcomes between the two groups. Dr. Negar Asdaghi:         So, we look forward to the results of those studies. Shadi, a follow-up question I have on this topic is, how long should a duration of therapy be in idiopathic cases of cerebral venous sinus thrombosis? Dr. Shadi Yaghi:               Thank you so much for this question. So, it's unknown at this point for how long should we treat. The key things from the treatment are first achieving venous recanalization, and second is preventing another venous thromboembolic event from happening. So, regarding the venous recanalization, studies have shown that there's not a lot of recanalization beyond four months of treatment. So, a lot of the recanalization really happens early, and continuing anticoagulation beyond the six-months interval, for example, in order to achieve further venous recanalization probably has limited utility. And the second important reason why we treat patients with anticoagulation is also to reduce the risk of a recurrent venous thromboembolic event or cerebral venous thrombosis. And for that, if it's a provoked CVT, then I think usually it's three to six months. If it's unprovoked, up to maybe six to 12 months or even longer, depending on the profile. And if there's a persistent provoking factor, such as cancer, antiphospholipid antibody syndrome, then the treatment is lifelong or until this condition subsides. There's a lot of controversy about the duration of treatment. The European guidelines were very helpful in identifying the duration of treatment. Hopefully, also, we have some guidelines or at least a scientific statement by the AHA that also doles details out and provides some guidance to practitioners. Dr. Negar Asdaghi:         Shadi, what should be our top two takeaways from the current meta-analysis and also ACTION-CVT? Dr. Shadi Yaghi:               So, really, the top two from ACTION-CVT and the meta-analysis are, first is direct oral anticoagulants have a comparable efficacy to vitamin K antagonists in terms of recurrent venous thrombosis and achieving venous recanalization on follow-up imaging. And then the second point is direct oral anticoagulants are probably safer than vitamin K antagonists. We have to keep in mind that this data is based mostly on observational studies. And, as we mentioned earlier, we need more randomized controlled trials to support these findings. Dr. Negar Asdaghi:         Dr. Shadi Yaghi, it was a pleasure interviewing you on the podcast. Thank you very much for joining us, and we look forward to having you back on the podcast and reviewing this topic again in the future. Dr. Shadi Yaghi:               Thank you so much. I appreciate you having me. Dr. Negar Asdaghi:         Thank you. And this concludes our podcast for the October 2022 issue of Stroke Please be sure to check out this month's table of contents for the full list of publications, including an important update from the European Stroke Organisation by Prof. Martin Dichgans. I also want to draw your attention to this month's InterSECT paper, which is our International Stroke Early Career and Training section, to discuss the key topic of burnout and mental health amongst physicians, especially amongst neurologists and stroke neurologists. It's alarming to read in this article that neurology is one of the specialties with the highest reported rates of burnout syndrome, and stroke neurologists are at particularly higher risk than other neurological subspecialties. The article tackles some tough subjects, such as the barriers for physicians to seek help and important strategies to mitigate burnout and how to improve mental health in general. I think it's also timely to know that October is the Mental Health Awareness Month, and the theme for October 2022 is "Back to Basics." The basics of recognizing the burden of stress, anxiety, the burden of isolation and depression, not only on those who we take care of, but also on those who give care to us. So, whether you're a stroke physician, a stroke caregiver, or whether you've been touched by this disease in some way or shape, please know that you are part of the stroke community and a part of our Stroke podcast family. Thank you for listening to us, and, as always, stay alert with Stroke Alert. This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.  

In the 100 years since its founding in 1922, the American Society for Clinical Pathology has guided the application and evolution of pathology and laboratory medicine. But how much do you know about the history of ASCP? On this episode of Inside the Lab recorded live at the ASCP Annual Meeting in Chicago, our hosts, Ms. Kelly Swails and Dr. Lotte Mulder, are joined by Team Total Kuality, Dr. Kamran Mirza, MD, PhD, Associate Professor of Pathology at Loyola Medicine, and Dr. Theresa Tellier-Castellone, EdD, MPH, MLS(ASCP)CM, Program Director for the School of Medical Technology at Our Lady of Fatima and Rhode Island Hospital; Team Buffy Coat, Dr. Kim Sanford, MD, MASCP, MT(ASCP), Past President of ASCP, and Dr. Will Finn, MD, MASCP, Medical Director at Warde Medical Lab and Past President of ASCP; and Team Diplococcus, Ms. Christy Nickel, MHA, MLS(ASCP)CM, CPHQ, ASCP CMLA Chair and Director of the Clinical Laboratory at Bryan Health, and Ms. Jeannie Guglielmo, MS, MAT, MLS(ASCP)CM, Chair of the Clinical Laboratory Science Program at Stony Brook University, for an enthusiastic game of ASCP Trivia. Our teams answer questions about the ethical issues that concerned ASCP in its early years and the goals of the organization that have remained consistent since its founding in 1922. They buzz in to share their knowledge of how we made history by electing Dr. Emma Sadler Moss as President in 1955. Listen in as the teams compete for bragging rights (and a glow-in-the-dark Erlenmeyer flask). Topics Covered · Dr. Emma Sadler Moss' roles at Charity Hospital in New Orleans and with ASCP in the 1950s· The ethical issues around the practice of pathology that concerned ASCP in its early years· Other professional organizations founded at ASCP meetings· Why ASCP changed its name to the American Society for Clinical Pathology in 2002· How ASCP's Center for Global Health is responding to disasters and expanding laboratory services all over the world· What goals ASCP established when the organization was founded in 1922 (and how those goals have remained consistent in the years since)· How ASCP made history by electing the first female president of a medical organization in 1955 Connect with ASCPASCPASCP on FacebookASCP on InstagramASCP on Twitter Connect with Team Total KualityDr. Mirza on TwitterDr. Tellier-Castellone on TwitterConnect with Team Buffy CoatDr. Sanford on TwitterDr. Finn on Twitter Connect with Team DiplococcusMs. Nickel on LinkedInMs. Guglielmo on LinkedInConnect with Ms. Swails & Dr. MulderMs. Swails on TwitterDr. Mulder on Twitter Resources ASCP Annual MeetingInside the Lab in the ASCP Store 

New research on Alzheimer's and other related dementias is taking place right here in RI! Check out what Terry Fogarty of the The Alzheimer's Disease & Memory Disorders Center at Rhode Island Hospital has to share! https://rielderinfo.com/

On Episode 17 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the June 2022 issue of Stroke: “Vitamin D Enhances Hematoma Clearance and Neurologic Recovery in Intracerebral Hemorrhage” and “Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns.” She also interviews Dr. Bruce Campbell on his article “Role of Intravenous Thrombolytics Prior to Endovascular Thrombectomy.” Dr. Negar Asdaghi:         Let's start with some questions. 1) Is vitamin D that golden key to recovery from intracerebral hemorrhage? 2) Endovascular therapies seem to have prevailed where thrombolytics have failed. In the era of fast and furious thrombectomy, what is the role of pre-thrombectomy thrombolysis? 3) And finally, 20 years of clinical research has failed to demonstrate the superiority of anticoagulation over antiplatelet therapies for treatment of patients in sinus rhythm with low left ventricular ejection fraction, and yet, our practice patterns have not changed. Why do we remain resolute in prescribing anticoagulation despite the lack of evidence? We're back here to tackle the toughest questions with our Stroke Alert Podcast because this is the latest in Stroke. Stay with us. Dr. Negar Asdaghi:         Welcome back to another extremely motivating Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. The June 2022 issue of Stroke contains a number of interesting articles. As part of our Advances in Stroke, we have two articles, one on the topic of cost-effectiveness of stroke care to inform health policy and the second on the current state and the future of emerging stroke therapies. As part of our Original Contributions category, we have an interesting study by Dr. [Ben] Assayag and colleagues from the Department of Neurology at Tel Aviv Sourasky Medical Center, where we learned that just over 10% of patients with TIA and stroke developed post-traumatic stress disorder, or PTSD. Higher presenting stroke severity, preexisting white matter disease, and having anxious coping styles are risk factors for development of post-stroke PTSD. Dr. Negar Asdaghi:         In another Original Contribution, by Dr. Daehoon Kim and colleagues from Yonsei University College of Medicine in Seoul, South Korea, we read with interest on the topic of whether or not we should be anticoagulating frail patients with atrial fibrillation. In this large population-based cohort, which included patients with atrial fibrillation older than 65 years of age with frailty as defined by a score of equal or greater than five on Hospital Frailty Risk Score, we learned that despite their frailty, patients with atrial fibrillation still significantly benefit from oral anticoagulation therapy. In this study, those treated with anticoagulation had lower net adverse clinical events as compared to those untreated. We also learned that direct oral anticoagulants provided lower incidence of stroke, bleeding, and mortality over Coumadin. This paper really provided practical information on treatment of frail patients with atrial fibrillation. So, I encourage you to review these papers in addition to listening to our podcast today. Later in the podcast, I have the great pleasure of interviewing Dr. Bruce Campbell from University of Melbourne in Australia on an especially timely topic, that is the role of intravenous thrombolytics prior to endovascular therapy. Dr. Campbell is a leading authority on the topic, and his interview does not disappoint. But first, with these two articles. Dr. Negar Asdaghi:         In the setting of intracerebral hemorrhage, or ICH, aside from the primary brain insult that occurs at the time of hemorrhage, secondary brain injuries continue for days and sometimes to months mostly due to the pathological response of the brain to byproducts of hematoma lysis or RBC degradation products. Today, the majority of spontaneous ICH cases are not surgically evacuated, so we rely on the body's own ability to clear blood for hematoma clearance, and obviously the faster the clearance, the better the outcome. Erythrophagocytosis by monocyte-derived macrophages contributes to hematoma clearance and ultimately to the functional recovery from ICH. So, it's conceivable that therapeutic approaches to enhance the endogenous erythrophagocytosis can potentially improve ICH outcomes. Vitamin D has been known to have variety of functions within the central nervous system, and it turns out that it may also be one such therapeutic option to improve the much needed erythrophagocytosis in intracerebral hemorrhage. Dr. Negar Asdaghi:         In the current issue of the journal, in the study titled "Vitamin D Enhances Hematoma Clearance and Neurologic Recovery in Intracerebral Hemorrhage," a group of researchers led by Dr. Jiaxin Liu from the Department of Surgery at Queen Mary Hospital at the University of Hong Kong studied the effects of oral vitamin D administered two hours after the induction of hematoma in a rodent model of ICH using direct collagenase injection into the striatum of the mouse. Eighty-nine young mice and 78 middle-aged mice were included in the study and randomly divided into three groups. Group one were sham-operated mice; group two, ICH mice treated with vehicle, which was corn oil; and group three, vitamin D-treated ICH mice. In the third group, 1000 international unit per kg of vitamin D diluted in corn oil was administered orally using a pipette two hours after the induction of ICH to mice, and then daily afterwards. And here are their top three findings of this study. Dr. Negar Asdaghi:         Number one, vitamin D-treated mice did better than vehicle on two neurobehavioral tests that were completed in the study. On the cylinder test, treatment with vitamin D significantly alleviated the asymmetric usage of four limbs at day seven, and vitamin D elongated the duration that the mice could run on the accelerated rod at day 10 on the rotarod test. Dr. Negar Asdaghi:         Number two, in terms of hematoma resolution and perihematoma edema, it's an issue that we deal with, with ICH, they used MRI imaging for edema measurement on T2-weighted images, and then sacrificed the mice and used digital quantification of hematoma volume with fresh brain specimens. And they found that treatment with vitamin D significantly alleviated both the ICH-associated brain swelling on MR and resulted in significant reduction in hematoma volume on the fresh brain specimens when compared with the vehicle-treated group at day three and day five. Dr. Negar Asdaghi:         And finally, their third main finding is in terms of erythrophagocytosis. So, the pathway that is mediated by the monocyte-derived macrophages is an endogenous pathway, that is, PPAR-γ (which stands for peroxisome proliferator-activated receptor γ) and its downstream scavenger receptor CD36 mediated. This pathway is essential for directing the endogenous erythrophagocytosis. Using flow cytometry, they found that vitamin D-treated mice had more mature macrophages expressing the scavenger receptor CD36, which was not expressed by the undifferentiated monocytes. Dr. Negar Asdaghi:         Western blot analysis confirmed that vitamin D treatment increased the tissue levels of CD36 and the upstream PPAR-γ levels in the brain at day five after collagenase model. Locally, vitamin D-enriched phagocytes that were positive for PPAR-γ and CD36 in the perihematoma regions. So, in summary, vitamin D increased the number of mature macrophages rather than undifferentiated monocytes in the perihematoma region and accelerated the differentiation of reparative macrophages from bone marrow-derived monocytes. So, bottom line is that in vitamin D, we have a simple, accessible, and well-tolerated agent to improve both the ICH outcomes and enhance hematoma resolution, but this we all observed in rodents. So, we stay tuned with interest to find out whether the same success will be seen in humans treated with vitamin D after intracerebral hemorrhage. Dr. Negar Asdaghi:         Patients with depressed left ventricular ejection fraction, or low EF, are at risk of development of ischemic stroke even if they remain in sinus rhythm. The optimal antithrombotic treatment for these patients is still unknown. Over the past two decades, we have a number of randomized trials studying the efficacy of oral anticoagulation, predominantly Coumadin, over aspirin therapy in prevention of all forms of stroke, that is ischemic and hemorrhagic, and death in patients with a low EF in sinus rhythm. Dr. Negar Asdaghi:         The meta-analysis of WASH, HELAS, WATCH, and WARCEF trials showed that treatment of low ejection fraction patients in sinus rhythm with Coumadin does reduce the subsequent risk of stroke, but it comes at the cost of a higher major bleeding risk in this population. The COMMANDER HF clinical trial published in New England Journal of Medicine in October 2018 studied whether low-dose rivaroxaban at 2.5 milligram BID was superior to placebo in patients with recent worsening of chronic heart failure, reduced ejection fraction, coronary artery disease, but no atrial fibrillation, and very similar to its prior counterparts, it did not show that rivaroxaban was associated with a lower rate of combined death, myocardial infarction, or stroke as compared to placebo. But very similar to prior studies, it also showed that rivaroxaban-treated patients had a lower risk of subsequent ischemic stroke. This poses a conundrum for stroke neurologists treating patients with this condition, especially after they present with an embolic-appearing stroke. So, the question is, how often do we encounter this situation, and what do we do in routine practice? We know that when there is equipoise, there's practice variation. Dr. Negar Asdaghi: In the current issue of the journal, in the study titled "Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm," Dr. Richa Sharma from the Department of Neurology at Yale School of Medicine and colleagues examined the prevalence of heart failure with sinus rhythm among hospitalized patients with acute ischemic stroke and the physician's practice patterns with regard to the choice of antithrombotics in this population. Dr. Negar Asdaghi:         So, let's look at their study. The study was comprised of five separate study cohorts of hospitalized acute ischemic stroke patients in the Greater Cincinnati Northern Kentucky Stroke Study for the year 2005, 2010, and 2015, and then four additional academic hospital-based cohorts in the United States during different timeframes. These were the Massachusetts General Hospital from 2002 to 2016, Rhode Island Hospital from 2016 to 2018, Yale-New Haven Hospital 2015 to 2017, and Cornell Acute Stroke Academic Registry from 2011 to 2018. All of these cohorts combined contributed to the 19,155 total number of patients in this study, which included over 14,000 patients that had documented left ventricular ejection fraction. Amongst those, 1,426 had a depressed EF and were included in this study. The investigator obviously excluded those with documented atrial fibrillation and flutter. And so the sample size for this analysis was 805 patients. And here are their main results. Dr. Negar Asdaghi:         The overall prevalence of this condition, that is low ejection fraction and sinus rhythm, among hospitalized acute ischemic stroke patients was 5%. It varied slightly between the different cohorts in this study from 4 to 6%. In terms of the antithrombotic treatment patterns, this information was available in close to 500 patients in the cohort. Overall, 59% of patients were discharged on an antiplatelet treatment alone, and 41% on anticoagulation. But these percentages significantly varied between the different institutions and was as low as 22% in one of the cohorts and as high as 45% in another cohort. Dr. Negar Asdaghi:         So, what were the factors that were associated with the use of anticoagulation at discharge? They found that the absolute percentage of left ventricular ejection fraction and the presenting NIH Stroke Scales were associated with anticoagulation use. That is, the lower the percentage of EF and the higher the presenting NIH Stroke Scale, the more likely physicians were to discharge the patients on an anticoagulation in univariate analysis, but in multivariate analysis, only the study site and presenting NIH Stroke Scale over eight were independently associated with anticoagulation use. Dr. Negar Asdaghi:         Now, interestingly, 2002 to 2018, which was their overall study period, was a time during which some of the largest and neutral randomized trials on the topic of anticoagulation versus antiplatelet were published, including the WATCH and the WARCEF trial. But the authors found no temporal variation in anticoagulation practice patterns before and after the publication of the results of these trials. So, it appears that we didn't change our minds. So, overall, we have some important takeaway messages from this study. We learned that 5% of hospitalized acute ischemic stroke patients have low left ventricular ejection fraction and remain in sinus rhythm without atrial fibrillation. Today, over 40% of patients with this condition are anticoagulated at discharge despite the results of the randomized trials, but the practice is widely variable among different institutions, and a higher presenting NIH Stroke Scale is a significant predictor of anticoagulation use at discharge in this population. Dr. Negar Asdaghi:         Almost 20 years after the approval of intravenous thrombolysis for treatment of patients with acute ischemic stroke, endovascular therapy was approved for treatment of select ischemic stroke patients with a large vessel occlusion. The two treatments are, therefore, entangled, as one was the standard of care while the second one was being tested. Therefore, all endovascularly treated patients enrolled in randomized trials would've received intravenous thrombolysis if eligible. Now, with the overwhelming success of endovascular therapy in achieving reperfusion in areas where IV thrombolysis has drastically failed, there're still critical questions regarding the added value of IV thrombolysis to endovascularly treated patients. The critical question remains as to whether eligible ischemic stroke patients who have immediate access to endovascular thrombectomy should receive prior IV thrombolysis, or should we skip the thrombolysis step altogether and just move to the angio suite as fast as possible. And there are, of course, arguments for and against each approach. Dr. Negar Asdaghi:         In this issue of the journal, in an invited topical review titled "The Role of Intravenous Thrombolytics Prior to Endovascular Thrombectomy," we learn about these arguments as the authors go through a comprehensive review of the current literature on this issue. I'm joined today by the first author of this review, Dr. Bruce Campbell, to discuss this paper. Dr. Campbell absolutely needs no introduction to our Stroke listeners. He's a professor of neurology and head of neurology and stroke at Royal Melbourne Hospital, University of Melbourne, in Australia. He's a pioneer in the field of acute stroke therapies and acute neuroimaging. He has served as the lead investigator of multiple landmark randomized trials, including EXTEND-IA and EXTEND-IA TNK, and holds multiple leadership roles. He's the clinical director of the Stroke Foundation and co-chairs the Australian Stroke Guidelines Working Party and the coordinator of the National Brain School Training Program for Neurologists in Training. And, of course, last but not least, he's my friend. So, I'm delighted to welcome him to our podcast today. Top of the morning to you, Bruce, 6:00 a.m. in Melbourne. That's quite some dedication. Thank you for being here. Dr. Bruce Campbell:       It's great to be with you. Thanks for the invitation. Dr. Negar Asdaghi:         Congrats on the paper, really exciting topic. So, let's just start with this question as part of a case. We have a patient with an M1 occlusion, a large clinical syndrome presenting two hours out from their symptom onset, and we are at a hospital where the angio suite is ready. What are some of the benefits of basically spending time in giving IV thrombolytics first rather than quickly going to the angio suite? Dr. Bruce Campbell:       I think a key element of this case is that the patient has presented directly to a hospital with immediate access to thrombectomy. Thrombolytic used in drip-and-ship transfer patients really isn't controversial, and the recent randomized trials excluded them. So, the debate's all about this context of bridging thrombolytics in patients presenting directly to a comprehensive stroke center. And you mentioned spending time giving lytics, but in fact, if you do things in parallel, that shouldn't be the case. It shouldn't delay thrombectomy if you go and give thrombolysis. Dr. Bruce Campbell:       So, the general principle is that getting the artery open faster by any means is better, and IV thrombolytic certainly has the potential to open the artery before thrombectomy in a proportion of patients, perhaps not that many, but it may also facilitate the thrombectomy. So, in the randomized trials, reperfusion after the thrombectomy was significantly better when patients had had bridging thrombolytic despite a low rate of pre-endovascular reperfusion. Other reasons for giving the lytics are the potential safety net it provides if the thrombectomy procedure is unexpectedly delayed or fails to get the artery open, and there's also this potential for lytics to dissolve distal embolic fragments and perhaps improve microvascular reperfusion. Dr. Negar Asdaghi:         So, great. So, let me summarize for our listeners what you mentioned. First off, so these are arguments in favor of giving lytics. As you mentioned, we're not really wasting time. These processes occur in parallel, so it's not like we're wasting time in giving a therapy that is potentially not as efficacious as thrombectomy is. And number two, we have improved the possibility of early reperfusion, perhaps, with the lytics. And if there are some fragments or distal clots that thrombectomy wouldn't have reached, then the lytics would. And then also there is also the chance that the thrombectomy might have failed in difficult access, and so on and so forth, and at least the patient has some chance of revascularization with the lytics. So, if these are the arguments for giving lytics, what are the arguments against giving lytics in this scenario? Dr. Bruce Campbell:       The main argument is the potential to reduce both the intracerebral and systemic hemorrhagic complications. There's also potential cost saving by skipping thrombolytics. That's probably more relevant in low-resource settings, particularly when relatives may have to pay for the thrombolytic before treatment is initiated, and that can be burdensome and also potentially delay the thrombectomy. There's a theoretical concern about thrombus fragmentation with lytics and potential migration of the clot out of reach of the thrombectomy or to new territories. But final reperfusion, as I mentioned, was, on average, better with the patient having a lytic on board in the randomized trials. Dr. Negar Asdaghi:         Perfect. And I want to highlight this issue of thrombus fragmentation because I think our readers will read more and more about this idea of, as you mentioned, fragmentation will potentially make an accessible clot for thrombectomy inaccessible. But I see that later in our questions, we're going to address that as part of the findings of randomized trials as well. So, these are some of the arguments for and against. And before we go to the randomized trials, I'd like to get an overview of what we knew as part of observational studies and non-randomized studies prior to more recent randomized trials on this topic. Dr. Bruce Campbell:       There've been a couple of nice systematic reviews and meta-analyses of the observational data, and notably in most of these studies, the direct thrombectomy patients had contraindications to lytics, and that introduces confounding factors that are difficult to adjust for. For what that's worth, the functional independence, mortality outcomes were better in the bridging patients. Hemorrhage rates weren't always higher with the lytic, and one study by Jonathan Coutinho in JAMA Neurology for the SWIFT and STAR studies showed the opposite despite them having really careful adjustment for all the confounders they could think of. And the meta-analysis by Eva Mistry in Stroke did not detect a difference in symptomatic ICH between the direct and bridging strategies. One thing that should be less affected by the patient characteristics would be the technical efficacy outcomes, and it was interesting that in the observational data, the patients who'd had bridging lytic had higher mTICI 2b-3 rates and also fewer device passes. Dr. Negar Asdaghi:         Okay. And now we do have further information with all of these new randomized trials. So, why don't we start with some of the earlier studies, the three, SKIP, DEVT, and DIRECT-MT, and start with those studies first before we move to some more recent European trials. Dr. Bruce Campbell:       SKIP was performed in Japan, and it used the lower 0.6 milligram per kilogram dose of alteplase that's standard there, and DEVT and DIRECT-MT were performed in China. All three of them showed numerically similar functional outcomes with slight trends favoring direct thrombectomy. SKIP had a smaller sample size and did not meet its non-inferiority criteria, and the other two trials did meet their specified non-inferiority margin, but it could be argued those margins were overly generous. If you think about non-inferiority trials, we generally try to set a margin for non-inferiority such as lower 95% confidence interval for the trial intervention would sacrifice up to 50% of the reference treatment effect. And it's difficult to estimate the effect of alteplase in this specific population. But if you think of the Emberson meta-analysis of alteplase, overall zero to three hours alteplase versus placebo has a 10% effect size and mRS 0-1, three to four and a half hours of 5% effect size. And we regard that as clinically important. So, half of 5%, 2.5%, is a lot tighter margin than any of the direct randomized trials employed. Dr. Negar Asdaghi:         So, Bruce, let me recap what you just mentioned. Two out of the three earlier trials seem to suggest that perhaps skipping IV therapy is the way to go rather than bridging as these two trials met the non-inferiority criteria if we believe that non-inferiority margins you mentioned. And now we have a couple of more trials, more recent trials. Can you tell us about these trials please? Dr. Bruce Campbell:       MR CLEAN-NO IV in a European population did not demonstrate non-inferiority, and the point estimate slightly favored bridging. Interestingly, in that trial, the symptomatic intracerebral hemorrhage risk, which was one of the main drivers for trying this strategy, was 5.9% in the direct and 5.3 in the bridging group. So, there's no hint of benefit from dropping the lytic on that metric. SWIFT-DIRECT was more selective in only enrolling internal carotid and M1 occlusions, which had a lower chance of early recanalization with lytic. But the protocol also specified giving the full dose of lytic. In the other trials, it seems the alteplase infusion was often stopped once the patient was in the angio suite, so the full dose may not have been delivered. And despite very low pre-endovascular recanalization in that selected group in SWIFT-DIRECT, the end of procedure reperfusion was significantly better in the bridging group, which is a consistent finding across the trials and suggests that the lytic may improve the thrombectomy outcome. Dr. Bruce Campbell:       DIRECT-SAFE, the final of those trials, was interesting in that the patients were enrolled roughly 50:50 from Australia, New Zealand, versus Asia. And in contrast to the original three randomized trials in Asian patients, DIRECT-SAFE found a significant benefit of bridging lytic in Asian patients. So, it'd be very interesting to see the results of the IRIS individual patient data meta-analysis, but we may not find a difference in Asian versus Caucasian patients despite those initial trials and despite substantial differences in the prevalence of intracranial atherosclerosis, which has often been proposed as something that would increase the risk of having bridging thrombolytic on board. Dr. Bruce Campbell:       The original study level estimate of symptomatic hemorrhage had a borderline significant 1.8% absolute reduction in the direct group. Whether those data were not all core lab adjudicated and the final analysis may show a smaller difference than that. Notably, given that trend with symptomatic intracerebral hemorrhage, mortality did not differ significantly, and, in fact, the trend favored bridging patients. So, the symptomatic hemorrhage slight trend into increase did not translate into any hint of increased mortality. Dr. Negar Asdaghi:         So, Bruce, a lot of information, and I need a recap for me. So, let me try to recap some of the things you said, and please jump in. So, so far, the newer data really basically don't show us any convincing evidence that skipping is the way to go, and direct endovascular we really don't have data in favor of going directly to the angio suite. And the jury is still out regarding an increase in the symptomatic intracerebral hemorrhage rate amongst those that actually are pre-treated with IV therapy. Is that correct? Dr. Bruce Campbell:       That's correct. So, none of the three recent trials met their non-inferiority margins. And again, we had this issue of relatively generous non-inferiority margins, and the symptomatic hemorrhage, it would make sense that there's a small difference, but it's not really been borne out in the data to be statistically significant at this stage. And again, this individual patient data meta-analysis is keenly awaited to get the most accurate estimate on that. Dr. Negar Asdaghi:         So, while we wait that, I'm going to digress a little bit and ask you a question that's not addressed in the paper that you have in this issue of the journal, and that's the CHOICE trial. So, by now, we have the results of CHOICE trial. Do you mind first give us a brief overview of what CHOICE was and how you feel that the results of CHOICE would affect this field of direct versus bridging in general? Dr. Bruce Campbell:       CHOICE is a very interesting study in that it tested giving the intra-arterial lytic at the end of a thrombectomy procedure that had achieved an mTICI 2b or better, which is what we traditionally regarded as angiographic success. The idea was to improve microvascular flow, and that may be the case. The trial was terminated early due to logistic reasons and showed a very large effect size that requires replication. The subgroup analyses are interesting in that the benefits seem to mostly accrue in patients who'd not already had intravenous lytic. Dr. Bruce Campbell:       So, perhaps giving the IV lytic before thrombectomy can still benefit patients after the thrombectomy, as well as achieving early recanalization in a proportion of patients and perhaps facilitating the thrombectomy. The other issue to address with the DIRECT trials is that with the exception of a few patients in DIRECT-SAFE, the comparator was alteplase and not tenecteplase. And we have data from EXTEND-IA TNK that tenecteplase bridging is not just non-inferior, but superior to alteplase bridging. There's an ongoing Brazilian trial of exactly that, tenecteplase versus the direct approach, which will be very interesting. Dr. Negar Asdaghi:         So, great, Bruce. I just want to repeat this segment again for our listeners. So, CHOICE is a very interesting study, looked at giving intraarterial alteplase to patients after endovascular therapy was completed and after they'd already achieved the complete and successful revascularization, and the trial was terminated early because of logistic reasons. So, we have to keep in mind, this was a smaller study, early termination, but the effect size was pretty large in favor of giving lytics. Dr. Negar Asdaghi:         So, what you mentioned is interesting, and I think that it's really worth paying attention to, that the majority of the benefits seem to have occurred from intraarterial thrombolytics in patients that have not been given intravenous lytics prior to endovascular therapy. So, in other words, you need some sort of lytics either before or after the endovascular thrombectomy to achieve that ultimate improved outcome. So, moving forward now from the randomized trials that we have on bridging versus direct thrombectomy, you have mentioned in the paper some interesting subgroups that may benefit or not benefit as much from bridging versus direct thrombectomy. Do you want to elaborate a little more about those subgroup analyses? Dr. Bruce Campbell:       The idea of precision selection or individualized treatment is being talked about a lot given there didn't seem to be much overall difference between strategies in the randomized trials, but it's important to note that the randomized trial actually disadvantages the bridging group by delaying lytic until the patient was firstly confirmed eligible for thrombectomy and then consented and randomized. Putting that aside, if we could identify a subgroup who clearly benefit from skipping lytic and, importantly, identify them without delaying lytic for those who likely benefit, that's clearly attractive. Dr. Bruce Campbell:       Currently, I'd say we have not identified that kind of subgroup, and the planned IRIS individual patient data meta-analysis will be critical for that. Patients with a large ischemic core are one potential group where there's a high risk of bleeding hypothesized. To date, there is no definitive data to indicate the risk is lower with the direct approach. Patients who need stents certainly may benefit from not having a lytic on board because they often need adjuvant antithrombotics that could increase the bleeding risk. But the question there is whether we can confidently identify those patients before the procedure, and I think that's unclear at this stage. Patients with really large clot burdens and proximal occlusions have sometimes been said not to benefit from IV lytic based on the low rates of pre-endovascular reperfusion, but the randomized trials really hinted other benefits like this potential facilitative thrombectomy. So, that hypothesis may be insecure as well. Dr. Negar Asdaghi:         And how about age? Have you come across and has there been any signal towards an impact or interaction between age and benefit from pre-endovascular thrombectomy and thrombolytics? Dr. Bruce Campbell:       It's an interesting question because age has not generally been a treatment effect modifier in previous stroke studies with thrombolytics and thrombectomy, and the individual direct thrombectomy trials that have reported subgroups haven't shown any convincing heterogeneity by age. There's certainly no indication that older patients are at risk from bridging in what I've seen so far. Dr. Negar Asdaghi:         So, this question comes up in clinical practice all the time, that a person's older, perhaps more atrophy, more vascular risk factors and white matter disease, and they're more prone, so to speak, of having a symptomatic intracerebral hemorrhage. So, what you're saying is, from the data we have, there's really no signal in favor of withholding pre-thrombectomy lytics in this population. So, it's important to know this. Bruce, what should be our final takeaway message from this study? Dr. Bruce Campbell:       I tend to agree with the recent European Stroke Organization and ESMINT guideline that for now, patients should receive lytic as early as possible and in parallel with the decision to perform thrombectomy such that neither treatment delays the other. I think if we can identify a subgroup that benefits from direct thrombectomy, and that's confirmed in the individual patient data and meta-analysis, and we can identify them without disadvantaging the majority of patients, and also that the ongoing improvements in IV lytic strategies don't render the existing trial data obsolete, then we may, in future, skip lytic for some patients, but we are not there yet. Dr. Negar Asdaghi:         So, that's amazing, Bruce. We look forward to reviewing the paper and individual data meta-analysis and interviewing you, hopefully at a better hour your time, on that. Thank you very much for joining us on the podcast today. Dr. Bruce Campbell:       Thanks again for the invitation. It's been great talking to you. Dr. Negar Asdaghi:         Thank you. Dr. Negar Asdaghi:         And this concludes our podcast for the June 2022 issue of Stroke. Please be sure to check out this month's table of contents for the full list of publications, including three very interesting images that are presented as part of a new article type, Stroke Images, and a special report in Comments and Opinions section on "Bias in Stroke Evaluation: Rethinking the Cookie Theft Picture." June is the month of Pride, and in spirit of equality, we hope to do our part to reduce all biases in stroke processes of care, diagnosis, and outcomes as we continue to stay alert with Stroke Alert. Dr. Negar Asdaghi:         This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.

In this episode we talk to Dr Andrew Green, Chief of Shoulder and Elbow Surgery, University Orthopedics, Rhode Island Hospital and Director, the Brown University Shoulder and Elbow Fellowship. Tune in for insights on the biggest advances in shoulder care in the last 30 years, future innovation in shoulder care, and advice for aspiring leaders.

Lifespan Hospital is being overwhelmed with staffing problems as pediatric emergency room visits rise. It's been a persistent issue that is only growing. Dr. Jay Schuur, Chief of the Emergency Department at RI Hospital talks to Gene about what parents should know ahead of a hot and busy weekend.  See omnystudio.com/listener for privacy information.

In this episode we talk to Dr Andrew Green, Chief of Shoulder and Elbow Surgery, University Orthopedics, Rhode Island Hospital and Director, the Brown University Shoulder and Elbow Fellowship. Tune in for insights on the biggest advances in shoulder care in the last 30 years, future innovation in shoulder care, and advice for aspiring leaders.

On this episode, we have returning guest Dr. Abby McElroy who previously was a guest on the Hypermobility Happy Hour discussing EDS in animals. Today, she returns with her principal investigator Dr. Heather Gray-Edwards to discuss the exciting new research they have been working on. Dr. Gray-Edwards is an assistant professor of Radiology at the University of Massachusetts' Chan Medical School and is a member of the Horae Gene Therapy Center. Much of her research has been focused on evaluating therapeutic interventions in testing novel Adeno-associated viral vectors and delivery routes using both biochemical and molecular biology techniques, as well as in vitro evaluation like neurological examinations, MRIs, and electrodiagnostics of GM1 and GM2 gangliosidosis cats. Dr. McElroy is a doctoral student who previously received her Doctor of Veterinary Medicine degree from Tufts University in 2017. She further obtained a master's degree from Michigan State University in 2018 which focused on the characterization of neurological abnormalities in an equine model of Ehlers-Danlos syndrome. From 2018 to 2021, Dr. McElroy was a Postdoctoral Research Associate in the Department of Neurosurgery at Rhode Island Hospital and the Medical School of Brown University where she studied tethered cord syndrome and myodural bridge dysfunction in patients with Ehlers-Danlos Syndrome. In her current position at the Gray-Edwards laboratory at the University of Massachusetts' Chan Medical School focuses on the development of gene therapy for Ehlers-Danlos syndromes and multisystemic smooth muscle dysfunction syndrome (related to the ACTA2 mutation). Abby also has two cats and two dogs and one of her cats has Ehlers-Danlos syndrome and is a bit of a social media star in his own right (his name is Reed and you can follow him at reed_eds)

According to co-hosts Dr. Jim McDonald and Dr. Philip Chan, this week's episode is long overdue. We're talking to a nurse! This week's guest expert is Erin Abrahamsen. She is a nurse and team lead on the Rhode Island Department of Health's COVID-19 Prevention Field Team. She also works in the emergency department at Rhode Island Hospital and serves as a nurse in the Rhode Island Air National Guard.  Erin shares stories that highlight the versatility and adaptability of nurses working in emergency response scenarios. She talks about her experiences being deployed to Afghanistan as a trauma nurse in 2019, working in an emergency department during the early stages of the COVID-19 pandemic, and working with RIDOH to ensure that nursing homes, corrections facilities, and shelters have access to supports and resources that prevent the spread of COVID-19. What is it like wearing full PPE while treating someone who is positive for COVID-19? How do healthcare workers like Erin who've been a part of the response since the start stay motivated for the long haul? Download this week's episode to find out.  

Arun Singh, M.D., is a preeminent cardiac surgeon, who has personally performed over 20,000 heart surgeries. He has earned numerous awards as a physician including the American Heart Association's Hero at Heart Award and the Milton Hamolsky Outstanding Physician Award. In practice at Rhode Island Hospital since 1975, for 20 years, Dr. Singh was voted "Top Doc" by Rhode Island Monthly Magazine. He was also elected to the Rhode Island Heritage Hall of Fame - only the second person of Indian descent to receive this distinction. His memoir is titled, Your Heart, My Hands: An Immigrant's Remarkable Journey to Become One of America's Preeminent Cardiac Surgeons. Visit https://yourheartmyhands.com. Sister Jenna is a trusted spiritual mentor committed to bridging divides in societies and building relationships between global influencers. She is the founder and director of the Brahma Kumaris Meditation Museums in the metropolitan Washington D.C. area and host of the America Meditating Radio Show. Check out Sister Jenna's new book, Meditation: Intimate Experiences with the Divine through Contemplative Practices. Listen to the Om Shanti album by Sister Jenna on Spotify. Visit www.americameditating.org. If you like this show, please subscribe and leave us a review wherever you get your podcasts, so other people can find us.

This week's guest expert, Dr. Mitchell Levy, is a member of the National Institutes of Health's panel on COVID-19 treatment guidelines. He is also the medical director of the Medical Intensive Care unit at Rhode Island Hospital, and a professor of medicine and chief of the Division of Pulmonary, Critical Care and Sleep Medicine at the Warren Alpert Medical School of Brown University.  Dr. Levy is joined by co-hosts Dr. Philip Chan and, the newly appointed Interim Director of the Rhode Island Department of Health, Dr. Jim McDonald. They ask their guest expert about the increased availability of safe and effective treatments for COVID-19 and address the impact that misinformation on faux treatments like Ivermectin have had on their patients and clinical staff. What kind of treatments are available for people with mild symptoms of COVID-19? What does a local intensive care unit do to treat people experiencing a more severe case of COVID-19? To learn more, download this week's episode and visit covid.ri.gov/treatment.  

Welcome back to the Brown survey podcast. Today we are going to kick things off with the important topic of enteral nutrition delivery in the acute care setting. Nutrition delivery can be a challenge at times on surgical services and there are always a lot of questions by clinicians on how to approach enteral delivery with patients, calculating individual caloric goals, route of nutritional delivery, and choosing the correct supplemental formulas. Joining me to discuss this topic is Our local expert on surgical nutrition, Dr. Marion Winkler, PhD, RD, LDN, CNSC. Dr Winkler is a Professor of Surgery at the Alpert School of Medicine here at Brown and a Surgical Nutrition Specialist in the Department of Surgery and Nutritional Support Service at Rhode Island Hospital. Podcast Chapters: (1:46) What are our goals with enteral nutrition delivery? (3:12) When should we consider supplementing enteral nutrition? (6:08) How do we determine caloric goals for patients (9:05) Protein requirements in patients (11:42) Which formula to choose (16:01) Route of administration: gastric vs post pyloric (17:23) Continuous versus Bolus feeding (19:04) Interruptions in feeding/volume based feeding (21:35) Gastric Residuals (24:15) How good are we at delivering nutrition (25:38) When to consider TPN administration ASPEN Guidelines: https://aspenjournals.onlinelibrary.wiley.com/doi/10.1002/jpen.2267

This episodes discusses the role of social media in patient care with Dr. Don Dizon. Dr. Dizon is the Director of the Pelvic Malignancies Program at Lifespan Cancer Institute, Head of Community Outreach and Engagement at The Cancer Center at Brown University, and Director of Medical Oncology at Rhode Island Hospital. Living with melanoma is emotionally stressful, no matter which side of the challenge you are on. Melanoma has more than a physical impact when living with the disease. It's also a significant source of emotional distress, anxiety, and depression—both during treatment and after. Our new program, “Beyond the Clinic: Living Well With Melanoma,” will feature topics seldom discussed in the exam room but essential to patients and their families during and beyond treatment. Led by the Director of Cancer Survivorship for Kaiser Permanente San Francisco, Raymond Liu, M.D., Beyond the Clinic: Living Well With Melanoma is a monthly live webinar designed to support patients' and families' emotional needs. --- Support this podcast: https://anchor.fm/aimatmelanoma/support

What is the key to Mark Mandell's success as a trial lawyer?  He questions all assumptions and has spent his entire career in search of answers.  And what he has uncovered along the way is required knowledge for anyone who wants to try cases for a living.  Join  Ben ((Ben Gideon | Gideon Asen LLC) )  and Rahul ((Rahul Ravipudi (psblaw.com) for our probing discussion with Mark as he describes his thoughtful approach to trial work that has led to many successful verdicts and settlement and underpins his two widely acclaimed books on trial practice:  Case Framing and Advanced Case Framing.About Mark MandellMark Mandell graduated from Georgetown University Law Center receiving his J.D. in 1974. When Mark graduated from Georgetown he served as a law clerk for the Honorable U.S. District Judge Edward W. Day in the United States Federal District Court in Providence for a year before entering private practice.Mark is certified for his expertise in civil trials by two national organizations. He is a Board Certified Civil Trial Specialist by the National Board of Legal Specialty Certification. Attorney Mandell is also nationally recognized and Board Certified as an expert in medical negligence litigation by the American Board of Professional Liability Attorneys. Double board certification nationally is rare for trial lawyers. Both certifications require trial experience and passing a national certification examination.Mark is actually Triple Board Certified as he is also board certified in Civil Pretrial Practice by the National Board of Legal Specialty Certification.Mark is a member of the prestigious Inner Circle of Advocates. Membership in the Inner Circle is limited to 100 of the best trial lawyers in the country. The Inner Circle has been described as “an invitation only group of the best plaintiffs lawyers in the United States”.Mark is also a Fellow of the American College of Trial Lawyers. Membership in the College is an honor that is given only after a lengthy and rigorous evaluation.Attorney Mark Mandell is a Fellow of the American Academy of Appellate Lawyers and a member of the American Law Institute. He has also attained bar membership in United States Supreme Court, United States Court of Appeals for the First Circuit, United States District Court for the District of Rhode Island and in the States of Rhode Island and Alabama.Mark Mandell has served as President of the Association of Trial Lawyers of America, the Roscoe Pound Institute of Civil Justice, the Rhode Island Bar Association and the Rhode Island Trial Lawyers Association. He has chaired the Board of Bar Examiners for the United States District Court for the District of Rhode Island and is a Past Chair of the National Center for Victims of Crime. He is also a Past President of the National Crime Victims Bar Association. He not only has served these presidential roles but has served many intermediary positions in these prestigious groups.Attorney Mandell is a current member of the Rhode Island Supreme Court Ethics Advisory Panel and has also served on the Governor's Advisory Commission on Judicial Appointments, the Rhode Island Supreme Court Commission on the Future of Rhode Island Judicial System, the Rhode Island Board of Medical Licensure and Discipline, and the Governor's Council on Mental Health.He is currently a member of the Alabama Bar Association, the American Bar Association, the American Association for Justice, the Rhode Island Association for Justice, and the Rhode Island Bar Association. Mark has written 22 articles in well known journals and has lectured many hundreds of times to Trial Lawyers Associations, state and national, in 45 different states and internationally. Attorney Mandell is currently listed in the publication “The Best Lawyers in America“.Mark Mandell focuses his practice on catastrophic personal injury cases, wrongful death cases, liquor liability cases, and medical negligence cases. He has obtained many million dollar trial verdicts and settlements for his clients. Mark has obtained more verdicts of $1,000,000 and also of $10,000,000 or more than any other lawyer in Rhode Island history. Mark was the Chair of the Plaintiff's Settlement committee in the Station Fire litigation, which resulted in a settlement of more than $176,000,000.Attorney Mandell has also lectured on Medical/Academic topics at well respected establishments such as Brown University Medical School, Harvard Medical School, Women and Infants Hospital in Providence, Rhode Island, The Massachusetts Anesthesia Council on Education/Massachusetts, Society of Anesthesiologists, Rhode Island Hospital, The Miriam Hospital, and State of Rhode Island, Department of Health.In 2018, Mark Mandell was honored as the recipient of the Howard Twiggs Award by the American Association for Justice. The Howard Twiggs Award recognizes an AAJ member of at least 10 years standing whose passion, civility, cordiality, and professionalism reflect the high standards set by Howard Twiggs; and whose courtroom advocacy and distinguished service to AAJ have brought honor to the trial bar and the legal profession. Howard Twiggs was selfless and a tireless worker who always put the welfare of his client and AAJ ahead of any personal glory or satisfaction.Mark Mandell has previously been honored with many other awards as well, including:2021- “Best Lawyers” for 2022 and Sept 20212003- “Harry M. Philo Award” in 2003 from the Association of Trial Lawyers of America1999- “Lawyer of the Year Award” from the Melvin Belli National Society1998- “Citizen of the Year Award” from the Rhode Island Trial Lawyers Association1987- “Rhode Island Jewish Citizen of the Year Award” from the Jewish Community Center of Rhode Island1984- “Merrill L. Hassenfeld Leadership in Community Service Award” from the Jewish Federation of Rhode IslandAttorney Mark Mandell is also an active member of the community as he was formerly on the Board of Directors of The Miriam Hospital, Board of Directors of the Jewish Federation of Rhode Island, Board of Directors of the Urban League of Rhode Island, Chair of the Executive Committee of the Holocaust Memorial Committee of Rhode Island, President of the Jewish Community Center of Rhode Island, member of the Executive-Finance Committee of The Wheeler School, Chair of the Education Committee of The Wheeler School, the Board of Trustees of the Wheeler School, the Board of Roger Williams University, and Chair of the Board of Directors of Roger Williams University School of Law.About the Elawvate PodcastThe Elawvate Podcast – Where Trial Lawyers Learn, Share, and Grow is where the practice of trial law meets personal growth. To succeed as a trial lawyer and build a successful law firm requires practice skills, strategic thinking and some amount of business and entrepreneurial savvy. Elawvate is a place to learn and share skills and strategies for success.But it is also a place to dig deeper and achieve personal growth.Those who succeed as trial lawyers at the highest levels cultivate character, principle, integrity, leadership, courage, compassion and perseverance.  We learn and draw inspiration from those who have achieved this success.For more about Elawvate, visit our website at www.elawvate.fm.  You can also  join our Facebook Group at Elawvate | FacebookFor more information or to contact the hosts, see:(Rahul Ravipudi (psblaw.com) (Ben Gideon | Gideon Asen LLC)  

This week, CancerNetwork spoke with Don Dizon, MD, about certain unique challenges LGBTQ+ patients face when navigating through their cancer journey, and how providers can improve these experiences. The director of women's cancers at the Lifespan Cancer Institute, director of medical oncology at Rhode Island Hospital, and professor of medicine at the Warren Alpert Medical School of Brown University in Providence, touched on overcoming barriers in clinical cancer research, creating a gender-affirming environment for patients, and other important topics for treating LGBTQ+ patients with cancer. Don't forget to subscribe to the “Oncology Peer Review On-The-Go” podcast on Apple Podcasts, Spotify, or anywhere podcasts are available.

This week on Public Health Out Loud, we're joined by guest expert Dr. Megan Ranney, an emergency physician at Rhode Island Hospital and Miriam Hospital. She is also the Associate Dean of Strategy and Innovation for the School of Public Health, founding Director of the Brown-Lifespan Center for Digital Health, and co-founder and Senior Strategic Advisor to the American Foundation for Firearm Injury Reduction in Medicine at the Aspen Institute. Her full biography is available on this web page.  In this episode, co-hosts Dr. Jim McDonald and Dr. Philip Chan ask Dr. Ranney about her experience working on the front lines of a local emergency department since the beginning of the COVID-19 pandemic. “It has been a series of ups and downs. I was actually in the emergency department the night that the very first identified COVID-19 patient in our state came in,” Dr. Ranney says. “I remember the feeling that night knowing that it finally hit us here in Rhode Island.” Dr. Ranney also talks about her work with Dr. Ashish Jha on the Long COVID Initiative, which is a coalition of clinicians, researchers, and public health communicators working together to shed light on the long-lasting impacts that a COVID-19 diagnosis has had on some patients' health.  Download this week's episode to learn more.  

In New England, the flu season typically runs from October to May. Last winter, the number of flu-related hospitalizations and deaths was historically low. Community mitigation measures; like physical distancing, frequent hand washing and sanitizing, indoor mask wearing, and staying home while sick; weren't just keeping people safe from COVID-19. They were preventing the spread of other viruses like influenza, too. But as people return to work, school, and social gatherings, will we see a particularly harsh flu season this winter? Our guest expert this week is Dr. Leonard Mermel, an infectious diseases specialist and medical director of the department of epidemiology and infection control at Rhode Island Hospital. Dr. Mermel talks about how the influenza virus spreads and offers his predictions on the severity of the 2021-2022 flu season. Co-hosts Dr. Jim McDonald and Dr. Philip Chan also chat with Dr. Mermel about the importance of getting your flu shot and your COVID-19 vaccine to protect yourself and those around you from getting sick this winter.  Flu shots are important for everyone older than six months. But they are especially important for certain people who are at higher risk, like older adults, younger children, healthcare workers, pregnant women, people with a weakened immune system, and people with chronic medical conditions like diabetes, cancer, heart disease, and asthma. Download this week's episode to learn more.  

This episode is also available as a blog post: http://donnyferguson.com/2021/10/08/nurse-prevails-in-11-year-legal-fight-as-100-rhode-island-hospital-employees-win-refund-of-illegally-seized-union-dues/ --- Send in a voice message: https://anchor.fm/donny-ferguson/message

You're listening to the Westerly Sun's podcast, where we talk about the best local events, new job postings, obituaries, and more. First, a bit of Rhode Island trivia. Today's trivia is brought to you by Perennial. Perennial's new plant-based drink “Daily Gut & Brain” is a blend of easily digestible nutrients crafted for gut and brain health. A convenient mini-meal, Daily Gut & Brain” is available now at the CVS Pharmacy in Wakefield. Now for some trivia. Did you know that Rhode Island native, Al Del Greco is a former football placekicker and a current sports radio personality. Del Greco finished his 17 NFL seasons with 347 of 449 field goals and 551 of 554 extra points, giving him a total of 1,592 points. Now, for our feature story: More than 90 health care facilities have requested a 30-day extension to meet Gov. Dan McKee's requirement to get all workers vaccinated against COVID-19, the Rhode Island Department of Health announced last week. The list includes some of the largest hospitals in the state, including Rhode Island Hospital and the Miriam Hospital, along with dozens of nursing facilities. A total of 92 health care facilities have requested extensions to meet the vaccine requirement, which took effect last Friday. All have plans to meet the mandate by Oct. 31, according to the health department. Another 215 facilities reported that they are in compliance with the requirement, including Kent County Memorial Hospital and Our Lady of Fatima Hospital. McKee announced in August that all healthcare workers would be required to be fully vaccinated against COVID-19 by Oct. 1. On Friday, the health department separately ordered a Cranston dentist to stop practicing after he told The Providence Journal he would defy the mandate. The agency said Dr. Stephen Skoly must stop seeing patients until he meets the requirement. For more information on all things Westerly and Rhode Island, check out this story and more at thewesterlysun.com Are you interested in a new opportunity? You're in luck! Today's Job posting comes from Randall Realtors Compass in Westerly. They're looking for real estate agents. You'll need to obtain a real estate license before you start. Pay can be $100,000 or more per year. If you're interested and think you'd be a good fit for the role you can apply using the link in our episode description. https://www.indeed.com/jobs?l=Westerly%2C%20RI&mna=5&aceid&gclid=Cj0KCQjwpf2IBhDkARIsAGVo0D2S3gEb-328GyRpBuTTeeKPdn3-klOh0KYAsfete6MEZmI5S4qTg-4aAnQkEALw_wcB&vjk=ca280a731c2da875&advn=7652287743140876 Today we're remembering the life of Julia Felicetti, of Granite Street in Westerly who passed away at the age of 98. She was the wife of the late Ernest Felicetti. Born in Westerly, Julia was predeceased by her daughter Linda Felicetti; and her siblings. Julia was known for her volunteer work at The Westerly Hospital and she spent over 29,000 hours crocheting blankets for hospital patients. Thank you for taking a moment with us today to remember and celebrate Julia's life. That's it for today, we'll be back next time with more! Also, remember to check out our sponsor Perennial, Daily Gut & Brain, available at the CVS on Main St. in Wakefield! See omnystudio.com/listener for privacy information.

This week we discuss a short series of wrong-sided brain surgery mishaps at Rhode Island Hospital in 2007. Although wrong-sided operations are quite rare, how did three happen at the same hospital in less than one year? Despite the Universal Protocol created in 2003 to prevent surgical mistakes like these from happening, we learn very quickly that instructions aren't very useful if you don't follow them...For a full list of all episode references and pictures, visit our case files and pictures page! https://www.ethicalsideeffects.com/episode-case-filesEmail: ethicalsideeffectspodcast@gmail.comBuy Merch, Subscribe, & Follow Us!https://linktr.ee/EthicalSideEffects Go to https://partner.canva.com/ESEFFECTS to get started with a one-month free trial of Canva Pro today! Stop scrolling and starting listening now, with Newsly! Use promo code ESEFFECT at newsly.me and receive a 1-month free premium subscriptionSupport the show

“How are they going to make croissants and not have the recipe? A grocery list? Not have the equipment that you need to make something? It's the same concept. How are you going to be a Chief or Chair or the Dean or the Provost or whatever you want to be without having some sort of roadmap?” -Phyllis A. Dennery, MD, FAAP In today’s episode Coach Gabriella Dennery MD sits down with her sister, Dr. Phyllis A. Dennery, Chair of Pediatrics at Brown University, to have a frank and rich conversation. They discuss topics including leadership, women in medicine, race and medicine, medical careers, diversity and changing the culture of medicine, mentorship and so much more!    Dr. Phyllis Dennery attended medical school at Howard University College of Medicine, and completed her residency at George Washington University at Children’s National Medical Center. Her fellowship in Neonatology was completed at Case Western Reserve University - Rainbow Babies and Children’s Hospital, Cleveland OH. Phyllis A. Dennery MD is the Sylvia Kay Hassenfeld Chair of Pediatrics at the Warren Alpert School of Medicine at Brown University, Pediatrician-in-Chief at Rhode Island Hospital, and Medical Director of Hasbro Children’s Hospital. She is also Professor of Molecular Biology, Cell Biology and Biochemistry at Brown University.* Excerpts from the show:   “So tell me a little bit more about how you see your journey in medicine as a leader. What was the easiest thing for you and what was the biggest challenge for you?” -Coach Gabriella Dennery MD  “When I first thought about medicine, as you well know, our family is riddled with physicians throughout the whole family and that was almost a premeditated or predestined choice to go into medicine for many of us in the family. However, at one point I sort of thought, ‘Oh, do I really want to do this?’ I thought about genetics. I wanted to be a geneticist and a scientist. But somewhere along the line I realized when I was an undergraduate that I really did want to go to med school and that was something that was a passion that I wanted to have. So I put my energy into it and said, ‘Ok, I'm going to get there and really make it work.’ So I ended up going to Howard University and enjoying medical school more than I thought. It felt very familiar. It's a lot of stuff I already knew in my mind, or that made sense to me. Then, deciding what to do next, when I was a third-year medical student I walked into the neonatal intensive care unit because we had a pediatric rotation. So now, we would never have a baby out in the open so somebody could reach in because that's not good safe practice and you know, infection control. But there was a tiny baby on a warmer bed and the attending physician reached over and placed her little finger into the space, and the little baby grabbed her little finger just like that, and I said, ‘Wow!’ I said, ‘I want to be a neonatologist because these little creatures that are so fragile will go on to become human beings that participate in this life! This is what I want to do.’ So I pushed for that. That was something that I really thought was my calling. So I realized I had to do a whole lot of things before I got there. I trained in pediatrics and then trained in neonatology and I did all those things, and then I finally ended up with my first position in neonatology at Stanford University.” -Dr. Phyllis A. Dennery, MD, FAAP ‘When I got there (Stanford University), I realized how important research was for me. I wanted to understand why these babies had problems with their lungs. What was causing the problems? Was it the oxygen we were giving in order to support them? And I studied that and I'm still studying that for the last 30+ years. So a strange thing happens in medicine. You're asked to serve as a physician doing clinical work, doing research, doing whatever you're doing in academia, but all of a sudden people say, ‘Well look, this person is doing so well as a researcher, as whatever.’ And they say, ‘Oh she'll be a great leader.’ Well, I don't know how those two connect but that's how people see it. If there is a connection between your skills in the lab or whatever research you're doing and you becoming a leader? So I was approached for many leadership opportunities to become a division director in neonatology. That's what took me to the Children's Hospital of Philadelphia where I spent the next 12 years after spending 14 years at Stanford. Twelve years of my career as a division director in that unit and of course, when you spend time there, you develop programs, and that became more fun for me. To think of strategically engaging people and building programs and making things happen and developing other people. How do you help other junior people learn about what their passion is and how they're going to make that passion happen? So I saw it as a way to pay it forward.  Then, after 12 years of doing that, they said, ‘Oh now you’ve got to do more.’ So I was recruited to be a Chair here at Brown University, the Chair of Pediatrics. So it's an opportunity to really engage others and to take people and help them see their way through this difficult and complicated path of getting a career that is satisfying and fulfilling. So that's kind of been the journey that I've taken and why I’m where I am.” -Dr. Phyllis A. Dennery, MD, FAAP “As far as leadership is concerned, did you feel like you knew what you were doing right off the bat?” -Coach Gabriella Dennery MD “Unfortunately, that's what I say is wrong with that system. They don't prepare you as much as they should for the opportunity that they're saying you're so good at. They don't know that. But there's a lot of on-the-job learning. But there are many opportunities now that are much more clear about ways in which people can train to become what they are excited about. So now my journey continues and it's much more strategic about how I get to know what I am getting myself into in these next steps and these next opportunities. And so I took a lot of leadership development courses through various national organizations and also locally to better understand what are some of the pitfalls of becoming a leader. You want to be a leader that's inclusive. You want to be a leader that has a way of thinking that helps people and isn't reactive, isn't strident, isn't many many things. So there's lessons to learn. Because we all have our personalities. But sometimes we have to also understand how our personality traits might affect others and make their lives either good or bad.”  -Phyllis A. Dennery, MD, FAAP “Phyllis, I asked you before we started recording if you were the only black chair at your medical school.” -Coach Gabriella Dennery MD “My answer can be really simple, yes. But a much more in-depth answer would be to say I really hate the concept of ‘the first’ and ‘the only’. Because the whole point is where it becomes irrelevant. Where it's just as likely that you or your colleagues of color or the woman next to you could be that person versus it just being relegated to men. So right now we're so happy, ‘Oh there's the first this and the first that,’ but the reality is, it needs to become as normal and as accepted and as common as it needs to be for the population.” -Phyllis A. Dennery, MD, FAAP “What does that mean in terms of your work right now though? What is your impact on young doctors of color who are looking at you and saying, ‘Whoa’?” -Coach Gabriella Dennery MD “Well, you know just my face makes a difference in young people who are looking at a website and say, ‘Oh,’ and they reach out and they say, ‘Oh, I'd like to talk to you, work with you, do something with you.’ It's a bit easier for me to recruit someone who is of color. So the higher you are in the hierarchy, the more impact you have on who will be there with you. So it's so much easier for me to recruit someone who is like me. I can have much more credibility as a recruiter of these people into my department by saying, ’It’s safe to come here, it's a good place to be. It's a place where you could grow,’ than someone who doesn't represent what I represent. Sometimes they don't come. But one of which, a really brilliant guy, he's now my mentee. He said, ‘I’d like you to mentor me.’ We meet monthly or every month to talk about his career path and I send opportunities his way. So there are ways in which by just being who we are we can help grow that group so that we are not the only one. That's my passion. My determination and what I do is that I feel like a lot of people talk about, ‘Let's diversify the medical school class, let's diversify this one that one.’ Doesn't matter as much in my opinion. I could get a lot of people all upset. But if you have a leader who represents that diversity, so that now you can keep bringing more residents and students and fellows of color into the mix. So it's not that it doesn't matter to do it from the ground up. A lot of people use that strategy. The question is, that pipeline is awfully long and ‘leaky’ in that you send people elsewhere too. But if you bring people into leadership, you can make a difference in that culture. Because someone gets on their bully pulpit and says, ‘No we're not going to accept these micro aggressions. This very white supremacist educational model where you don't think about these things, and how they affect us, and make us feel like we don't necessarily belong.’ The other day some white man was talking about how just not having bandages of color can influence a child in thinking they are outside of the norm. So why aren't we having bandages that are brown and beige and not just white or light? Similarly, when we show a picture of a disease on a white skin, do we now prevent people from seeing and understanding how that disease would look on a brown skin? There's so many things that, only people who are thinking about that, can help change the medical curriculum and can help broaden people's perspective of disease and what's normal. I can play a role as a leader and not feel that I'm going to get reprimanded for saying things. Saying we don't have enough women in leadership at our university. We have two women chairs in the medical school and one is me as a woman of color but there's just two. If you add the Biomed (Department) there's maybe one or two more, so it's very limited when you think about it. So we have to make a difference there.” -Phyllis A. Dennery, MD, FAAP *“Phyllis A. Dennery,” vivo.brown.edu/display/pdennery Get One-on-One Coaching with Coach Gabriella Dennery MD Get One-on-One Coaching with Master-Certified Coach Jill Farmer   DocWorking believes the time has come to prioritize the health and wellness of physicians. Professional coaching is transformational. Elite athletes, award-winning actors and top-performing executives all know this, which is why they embrace coaching to achieve such extraordinary success. Leading corporations also know this, which is why they encourage coaching for employees at every level. Smart leaders leverage the power of coaching to achieve outcomes that are meaningful, measurable, and attainable. Our Coaches Will Show You How!   We have exciting news! Our live course, STAT: Quick Wins to Get Your Life Back is coming soon! Life is too short to be stretched so thin. Do you want more time to focus on what matters most to you? Our power packed plan fits easily into your busy day! Coaches Gabriella and Jill have taken all their best strategies from coaching hundreds of physicians over multiple years and folded them into one efficient course. You can easily practice these bite-sized strategies on your timeline: anytime, anywhere. Are you ready to invest in yourself, reclaim your time and minimize stress? Click here!    To learn more about DocWorking, visit us here!   Are you a physician who would like to tell your story? Please email Amanda, our producer at Amanda@docworking.com to apply.   And if you like our podcast and would like to subscribe and leave us a 5 star review, we would be extremely grateful!   We’re everywhere you like to get your podcasts! Apple iTunes, Spotify, iHeart Radio, Google, Pandora, PlayerFM, ListenNotes, Amazon, YouTube, Podbean   Some links in our blogs and show notes are affiliate links, and purchases made via those links may result in small payments to DW. These help toward our production costs. Thank you for supporting DocWorking: The Whole Physician Podcast!   Occasionally, we discuss financial and legal topics. We are not financial or legal professionals. Please consult a licensed professional for financial or legal advice regarding your specific situation.   Podcast produced by: Amanda Taran

Jonathan Kurtis, MD, PhD is a professor of pathology and laboratory medicine at the Brown University Medical School, where he also directs the Center for International Health Research at Rhode Island Hospital. Since 1993, Jake has studied malaria, developing a vaccine candidate for this terrible disease through his field research in the Philippines, China, Kenya and Brazil. Twitter: @AstroTerry Instagram: astro_terry

You're listening to the Westerly Sun's podcast, where we talk about the best local events, new job postings, obituaries, and more. First, a bit of Rhode Island trivia. Today's trivia is brought to you by Perennial. Perennial's new plant-based drink “Daily Gut & Brain” is a blend of easily digestible nutrients crafted for gut and brain health. A convenient mini-meal, Daily Gut & Brain” is available now at the CVS Pharmacy in Wakefield. Now for some trivia. Did you know that Gilbert Stuart, famed Rhode Island painter, also painted the Lansdowne portrait of George Washington which currently hangs in the East Room of the White House? The painting was rescued during the burning of Washington in the War of 1812 thanks to First Lady Dolley Madison and Paul Jennings, one of James Madison's slaves.  Now, for our feature story: Stonington High School has earned a rank in the top 10% of public schools in the U.S.  They took the No. 3 spot in the Norwich metropolitan area. U.S. News & World Report released its annual rankings recently, listing Stonington High No. 1,781 out of the 18,000 eligible schools. The rank places the district in a top tier, and by earning a national ranking in the top 40%. Stonington High School also achieved status as a U.S. News Best High School. Dr. Van Riley, superintendent of Stonington Public Schools, said that the faculty and staff are best-in-class teachers, mentors, scholars, and most importantly, role models who work tirelessly to support students in all of their endeavors. SHS Principal Mark Friese said the recognition is a testament to the dedication of the entire school community.  Friese feels that the town and Board of Education supports the schools and programming immensely. He also praised the superintendent that encourages them to continuously move forward with new initiatives that are always focused on what is best for students.  For more information on the school, including a link to rankings check out our fully story at thewesterlysun.com Are you interested in a new opportunity? You're in luck! Today's Job posting comes from the University of Rhode Island in Kingston. They're looking for a full-time fiscal clerk. Bookkeeping experience is preferred. Pay starts at $21.00 per hour. If you're interested and think you'd be a good fit for the role you can apply using the link in our episode description. https://www.indeed.com/l-Westerly,-RI-jobs.html?vjk=c833267992db5c1a Today we're remembering the life of Dr. Henry B. Freye, 90, of Mystic. Henry was born in Koenigsberg (Kaliningrad today), East Prussia. In 1939, he and his family immigrated to Havana, Cuba and to the USA in 1940. During his important formative years in New York, he was very active in the Boy Scouts where he earned the Eagle Scout Award with Palms. In 1948, he enlisted in the Army artillery, 35th regimental combat team and played in the Army Band where he served 5 years in the Reserves in the Rainbow Division. He was awarded an Academic Scholarship to Wagner College, followed by Queens College, where he met his future wife of over 60 years, Virginia Anne Lucas. While in college, he played the tuba in the Lawton Symphony, Staten Island Symphony, Queens College Orchestra, NY Teachers Symphony & All City Orchestra & Band. Additionally, he played soccer, was the captain of the team, and was named All NY City fullback. After graduating in 1954, he began his preclinical medical studies at Basel University Medical School where he became the first American to play in the Stadt Musik Basel, and received a Swiss Music Passport. While in Switzerland, he continued playing soccer and subsequently Semi-Pro for the German American team, Eintracht. His medical studies were completed at Duke University Medical School, followed by his internship at Stanford University, division at San Francisco General Hospital, residency at Duke University Hospital, as well as a Fellowship in Allergy & Immunology, completed at the Childrens Hospital in Boston. After completing his Residency in 1963, he joined the pediatric practice of Neida Q. Ogden in Westerly and subsequently, founded Shoreline Allergy and Asthma Associates, with offices in Mystic, Waterford, and East Lyme. While in private practice, he published and presented numerous medical papers in the USA, Europe, and South America. He was on the clinical faculty of Brown Medical School for 25 years and on the medical staffs of Rhode Island Hospital, Westerly Hospital, Lawrence and Memorial Hospital, and the Childrens Hospital of California until his retirement in 2008. He served on a number of boards and associations and helped develop the health plan for the children of Rhode Island. He enjoyed his studies at the Lyme Academy of Art and the opportunity to sail, play tennis, golf, and fish. He also loved to travel and made yearly adventures to all corners of the world with his wife. His most precious memories are those spent with his beloved wife  and his family. Thank you for taking the time today to remember and celebrate Henry's life. That's it for today, we'll be back next time with more! Also, remember to check out our sponsor Perennial, Daily Gut & Brain, available at the CVS on Main St. in Wakefield! See omnystudio.com/listener for privacy information.

Seventy percent of medical decisions depend on laboratory results. And yet, pathologists and medical laboratory professionals received very little press coverage prior to the pandemic. Now that our work has been recognized, what can we do to keep that ball rolling? How can we expand Medical Laboratory Professionals Week beyond the walls of the lab and inspire our communities to celebrate with us? On this episode of Inside the Lab, our hosts Dr. Lotte Mulder and Ms. Kelly Swails are joined by Ms. Theresa Tellier-Castellone, EdD, MPH, MLS(ASCP)CM, Program Director at Our Lady of Fatima Hospital and Rhode Island Hospital, Dr. Melanie Johncilla, MD, Consultant Pathologist at Port of Spain General Hospital in Trinidad and Tobago and Medical Director at Global Pathology Solutions, and Mr. Aaron K. Odegard, MS, MLS(ASCP)CMSMCM, Medical Laboratory Technologist at Baptist Health in Jacksonville, Florida, and Chair of the ASCP Council of Laboratory Professionals, to discuss their plans for Medical Laboratory Professionals Week and the importance of celebrating the lab. Our panelists share how they recognize Lab Week outside the lab, offering insight how to engage the rest of the hospital staff and even the general public to celebrate with us. They weigh in on the psychological benefit of celebrating the work we do and describe how we might take advantage of the lab’s visibility during COVID to elevate Lab Week this year. Listen in for Ms. Tellier-Castellone, Dr. Johncilla, and Mr. Odegard’s favorite Lab Week memories and get their top ideas for celebrating our role as medical laboratory professionals and pathologists. Topics Covered  · Our panelists’ favorite Medical Laboratory Professionals Week games and activities· The challenges celebrating Lab Week in a resource-restricted setting · What to do to have Lab Week recognized outside the lab · How we might take advantage of the lab’s visibility during COVID to elevate Lab Week this year and invite the rest of the hospital staff to celebrate with us· The psychological benefit of celebrating the work we do as medical laboratory professionalsConnect with ASCP ASCPASCP on FacebookASCP on InstagramASCP on Twitter Connect with Ms. Theresa Tellier-CastelloneMs. Tellier-Castellone on LinkedInConnect with Dr. Johncilla Dr. Johncilla on LinkedInGlobal Pathology Solutions Connect with Mr. Odegard Mr. Odegard on TwitterMr. Odegard on LinkedIn Connect with Ms. Swails & Dr. Mulder Ms. Swails on TwitterDr. Mulder on Twitter Resources ASCP Resources for Celebrating Medical Laboratory Professionals WeekASCLS Resources for Celebrating Medical Laboratory Professionals WeekInside the Lab in the ASCP Store 

Dr. Megan Ranney, an ER physician at Rhode Island Hospital and associate professor at Brown University, is our guest this week on Political Roundtable. Here's a transcript of the conversation, which also includes Ted Nesi from WPRI-TV, Channel 12, and URI emeritus professor of political science Maureen Moakley.. Donnis: Let's start with the issue of […]

This episode features Dr. Gerardo Carino, MD, PhD from Brown University's Warren Alpert Medical School and The Miriam Hospital in Rhode Island. He is the Director of the Intensive Care Unit at The Miriam Hospital and the Assistant Director of Graduate Medical Education at Rhode Island Hospital. The host for this episode is Merih Deniz Toruner. The topic of conversation is ‘ICU and Trauma Response with Patients of Violence during COVID-19'. We discuss the role of trauma response during COVID-19, the impact of obstructive masks on patient-doctor relationships, the rise in gender-based violence, balancing emotions and rational decision-making as a first responder in addition to empathy, permanent changes to ICU care due to COVID-19 and the joys of being a first responder.

Expert trainer and Certified Interpreter Eliana Lobo discusses how to raise the bar for interpretation during the global pandemic. Eliana is a CoreCHI™ Certified Healthcare Interpreter and a Washington state authorized Medical Interpreter. She's also a certified Trainer of Trainers of medical interpreters. Eliana holds two M.A.s from Brown University in Bilingual Education, and Portuguese & Brazilian Studies. She started out as a Spanish/Portuguese medical interpreter at Rhode Island Hospital in 1980.

David Reuben MD is the Director, Multicampus Program in Geriatrics Medicine and Gerontology and Chief, Division of Geriatrics at UCLA. He is the Archstone Foundation Chair and Professor at the David Geffen School of Medicine and Director of the UCLA Alzheimer's and Dementia Care Program. Dr. Reuben completed his medical school at Emory and residency at Rhode Island Hospital. He pursued a fellowship from UCLA. He has served as principal investigator of numerous large studies including the STRIDE study aimed at reducing serious falls related injuries in the elderly. His bibliography includes more than 200 peer reviewed publications in medical journals and over 30 books including the widely distributed Geriatrics at Your Fingertips. Dr. Reuben has received numerous awards including the Henderson Award from the American Geriatrics Society and the 2008 John Eisenberg Patient Safety and Quality Award. He has served in a number of important leadership roles including the Board Chair of the American Board of Internal Medicine, President of the American Geriatrics Society and President of the Association of Directors of Geriatric Academic Programs. What is the hallmark of a great physician? Today, Dr. David Reuben reflects on how we as physicians are very powerful people: people listen to us, return our phone calls. A great physician, according to Dr. Reuben, is one who uses that power to advocate for their patients. Sharing anecdotes from his own life, Dr. Reuben shares how many of our real achievements never make their ways on a CV. Oftentimes, those lie in the small differences we can make for our patients and their families. And that is true success. Pearls of Wisdom: 1. In a patient encounter, building a relationship with a patient should be the first thing on our checklist. 2. The move from a good internist to a great internist is built on advocacy for the patient. Physicians are powerful. Use that power to advocate. 3.  Your mentor and your role model don't have to be the same person. Having multiple people as mentors offers a variety of perspectives. 4. Think about the long-haul. Is what you're worrying about now going to matter in five years?

Thank you for listening to Mormon Sex Info. This episode is an archived episode and is only now becoming publicly available. Mormon Sex Info relies on contributions. To contribute, please visit: mormonsex.info Katherine Wela Bogen joins Natasha on this episode of Mormon Sex Info to discuss the data behind false reporting. She made a facebook post during the Brett Kavanaugh hearings when Christine Blasey Ford spoke out about her experience with Kavanaugh in high school. The post went viral and you fan find it here: Katherine is a clinical research program coordinator at Rhode Island Hospital in the department of Psychiatry, working in violence protection research for over 3 years She started out as a pediatric violence resistant research assistant at the University of Pittsburgh Medical School, working with vulnerable populations. Bogen is currently collaborating on a chapter with her boss, Dr. Lindsay Orchowsky, and with Alan Berkowitz who was one of the founding father of “Social Norms Theory.” They are collaborating on a chapter that will be in “The Handbook for Interpersonal Violence” to be published in 2020. The chapter is on false reporting and how common (or uncommon) false reporting is, what some of the barriers to reporting are to begin with, how false reporting is qualified, etc. Resources mentioned during podcast: Katherine’s Facebook Post Alan Berkowitz’s paper “An Overview of the Social Norms Approach”

In this episode of Intel on AI guests Lama Nachman, Intel Fellow and Director of Anticipatory Computing Lab, and Hanlin Tang, Sr. Director of the Intel AI Lab, talk with host Abigail Hing Wen about the intersection of humans and AI. The three discuss a wide range of topics, from keeping humans in the loop of AI systems to the ways that AI can augment human abilities. Lama talks about her work in building assistive computer systems for Prof. Stephen Hawking and British roboticist Dr. Peter Scott-Morgan. Hanlin reveals work on a DARPA program in collaboration with Brown University and Rhode Island Hospital that’s trying to restore the ability of patients with spinal cord injury to walk again. Follow Intel AI Research on Twitter: twitter.com/intelairesearch Follow Hanlin on Twitter: twitter.com/hanlintang Follow Abigail on Twitter at: twitter.com/abigailhingwen Learn more about the Intel’s global research at: intel.com/labs

In this episode of Intel on AI guests Lama Nachman, Intel Fellow and Director of Anticipatory Computing Lab, and Hanlin Tang, Sr. Director of the Intel AI Lab, talk with host Abigail Hing Wen about the intersection of humans and AI. The three discuss a wide range of topics, from keeping humans in the loop of AI systems to the ways that AI can augment human abilities. Lama talks about her work in building assistive computer systems for Prof. Stephen Hawking and British roboticist Dr. Peter Scott-Morgan. Hanlin reveals work on a DARPA program in collaboration with Brown University and Rhode Island Hospital that’s trying to restore the ability of patients with spinal cord injury to walk again. Follow Intel AI Research on Twitter: twitter.com/intelairesearch Follow Hanlin on Twitter: twitter.com/hanlintang Follow Abigail on Twitter at: twitter.com/abigailhingwen Learn more about the Intel’s global research at: intel.com/labs

Don Dizon, MD, FACP, is Professor of Medicine at Brown University and a medical oncologist with research interestes in novel therapies of breast and pelvic cancers (e.g. ovarian, uterine, cervical cancers), survivorship particularly as it pertains to sexual health for men and women with cancer, and social media. He is the Director of the Breast and Pelvic Malignancies Program at Lifespan Cancer Institute and Director of Medical Oncology at Rhode Island Hospital. Additionally, he is the Chair of Digital Engagement for SWOG Oncology Research Network. Co-Chief Medical Officer at the Global Cancer Institute, and serves on the Board of The Hope Foundation and Young Survival Coalition. He is a prolific author and writes columns for multiple sites, including the professional journal, The Oncologist, ASCO's networking site, Connection, and for Medscape. Dr. Dizon is on social media on Twitter, Facebook, Instagram, and TikTok as @drdonsdizon.

වෛද්‍ය භෞතිකවිද්‍යාව පිලිබඳ පර්යේෂණ කරන සහ විකිරණ භෞතික විද්‍යාව හා මාත්‍රාමිතිය ඇසුරෙන් පිළිකා රෝගීන් හට ප්‍රතිකාර නිර්දේශ කිරීමෙහි යෙදී සිටින ආචාර්ය මධුක කළුආරච්චි සමග සංවාදය. ඔහු වර්ජිනියා සරසවියෙන් භෞතික විද්‍යාව පිලිබඳ PhD උපාධිය ලබාගෙන Harvard University හා St. Jude Children's Research Hospital යන ආයතන වල පුහුණුව ලැබ දැනට Rhode Island රෝහලේ medical physics resident කෙනෙක් ලෙස සේවය කරයි. Today we talk with a medical physics resident Dr. Maduka Kaluarachchi at Brown University, Rhode Island Hospital, USA. He is involved in treating cancer patients utilizing radiation physics and dosimetry. He got his PhD in physics from the University of Virginia. --- Send in a voice message: https://anchor.fm/ncastronomy/message

In this narrative, a musician, a nurse and a doctor come together to provide a virtual bedside music concert for some of their sickest patients with COVID-19. The article is read by its authors. First, Melanie Ambler, the musician and aspiring physician, then Laura Wodecki, nurse manager at Rhode Island Hospital, and ending with Dr. Timothy Amass, intensive care physician in Denver, Colorado. They wrote a Humanities Encounters article published in CMAJ called "Virtual bedside concerts for patients with COVID-19: a trio of perspectives." To read the article: www.cmaj.ca/lookup/doi/10.1503/cmaj.201662 Melanie Ambler developed musICforU and received the Rosalind Swenson Enrichment Award from the French American Fulbright Commission to begin a live virtual concert program for hospitals and nursing homes in France, called Petite Pause Musicale. Any hospitals interested in live virtual concerts are welcome to contact her, at petitepausemusicale@gmail.com. ----------------------------------- Music: "Sun Up," composed in 2008 by cellists Stephen Katz and Derek Snyder, originally written for 6 cellos, performed by Melanie Ambler. ----------------------------------- Subscribe to CMAJ Podcasts on Apple Podcasts, iTunes, Google Play, Stitcher, Overcast, Instacast, or your favourite app. You can also follow us directly on our SoundCloud page or you can visit www.cmaj.ca/page/multimedia/podcasts.

Bill Bartholomew welcomes Rhode Island Hospital emergency room physician and Brown University Associate Professor Dr. Megan Ranney for a local look at the current state of Covid19 in Rhode Island and beyond.  The M.D. is a frequent guest on national news and a leading voice in the management of the pandemic.Follow @billbartholomew on Twitter and InstagramJoin the BTOWN Facebook Group at www.BTOWN.streamSupport the show (https://www.patreon.com/bartholomewtown?fan_landing=true)

Keeping up with our Chronic Illness Spotlight Series, this week I have a conversation with Laura Varnum. Laura is a clinical pharmacist at Rhode Island Hospital and advocated and assists patients with their care. Laura has Crohn's disease and openly talks about her journey, including what it was like being pregnant with Crohn's Disease. Laura is part of the Young Professionals Committee and is committed to raising money and awareness for the Crohn's and Colitis Foundation. She gives some seriously great fundraising tips! Speaking of fundraising! Here's a link to my latest one for the foundation: https://www.facebook.com/donate/955027051646880

In this episode, I'm joined by Dr. Barbara Hamilton. Barbara is a mom, writer, and a leader. She's the Chief of Interventional Radiology in Desert Regional Medical Center at Palm Springs, California. I was so delighted to have a fellow physician on this show and being that there are very few women in the field of interventional radiology, Barbara was the perfect guest. We talk about the need for leadership training for women, the false assumption that childbirth and childrearing is a liability, self-development tips for female leaders, and much more.  Barbara created TiredSuperheroine.com, a blog and a network dedicated to giving work and life advice to students, early career doctors, and premeds. She also has a book coming this October entitled Tired Superheroine's Guide to Finding Your Place in Medicine. For more information on her blog and upcoming book, click here. Episode highlights: Her childhood and how it shaped her today Her biggest influences in pursuing interventional radiology The importance of financial empowerment for women Her inspiration for her blog's name  How she balances being both a mother and a physician The value of having female colleagues in the workplace Obstacles she faced throughout her training and career The lack of leadership training for women Advice she would give to someone who wants to enter into her field About the guest: Barbara Hamilton, MD is a mom, content writer, interventional radiologist, and a physician leader. She's the Chair of Interventional Radiology in Desert Regional Medical Center for about four years.  Dr. Hamilton began writing for her blog, tiredsuperheroine, in October 2018. She completed her residency in diagnostic imaging in Rhode Island Hospital in 2013 and acquired her medical degree from Rutgers Robert Wood Johnson Medical School in 2008. Connect with Barbara: Website Tired Superheroine LinkedIn @barbara-hamilton Facebook @Tired-Superheroine Instagram @tiredsuperheroine Twitter @TSuperheroine --- Did you enjoy today's episode? Please click here to leave a review for The 6%, with NancyMD. Be sure to subscribe to your favorite podcast app to get notified when a new episode comes out!  Do you know someone who might enjoy this episode? Share this episode to inspire and empower! Let's get social! Instagram @_nancymd Facebook @nancymdpdx Twitter @_nancymd LinkedIn @nancyyenshipleymd Website www.nancymd.com   Subscribe to The 6%, with NancyMD ++ Apple Podcasts ++ Spotify ++ Google Podcasts

Rabies post exposure prophylaxis, or PEP, consists of a rabies vaccine series and human rabies immune globulin (HRIG). Kedrion Biopharma's human rabies immune globulin, Kedrab, was FDA approved in 2017. And now for the first time, the safety of HRIG (Kedrab) was studied in children. Joining me today to discuss rabies, PEP and the pediatric trial is James Linakis, MD, PhD. Dr. Linakis is Professor of Emergency Medicine and Pediatrics at Brown Medical School and Associate Director of Pediatric Emergency Medicine at Rhode Island Hospital's Hasbro Children's Hospital.

In this week's Face Facts Podcast episode, Dr. Chang, a board-certified dermatologist, and nationally recognized Top Doctor 2018 joins us to discuss Facial Injectables with Dr. Gary Linkov. She is an associate staff member at Rhode Island Hospital. She has over a decade of experience in providing customized care in both medical and cosmetic dermatology. Dr. Gary Linkov is an experienced facial plastic surgeon with extensive skill and talent in facial artistry. Whether you are considering some non-invasive cosmetic injections to smooth away age lines or want to explore more permanent rejuvenation options, meet with Dr. Linkov. You will get a personalized consultation to discuss your goals and desires for improving your appearance. Dr. Linkov, or Dr. Gary as many of our patients refer to him, will listen and give you his recommendation for treatment. Whatever you decide, you can trust that you are incapable, skilled hands when you choose us for your facial cosmetic procedure. City Facial Plastics: Dr. Gary Linkov 635 Madison Ave #1402E New York, NY 10022 (212) 439-5177 https://cityfacialplastics.com Dr. Gary Linkov on Social Media: Instagram: https://www.instagram.com/drgarynyc Facebook: https://www.facebook.com/cityfp Twitter: https://twitter.com/drgarynyc Dr. Chang on Instagram: https://www.instagram.com/drcarolinechang Facial Injectables with Dr. Chang - Dr. Gary Linkov Topic Timestamps: 01:26 - Do you believe in prejuvenation? 04:22 - Do you think that there's something prejuvenating about certain types of fillers? 06:07 - Favorite places to inject 10:51 - Favorite fillers 12:11 - What filler do you prefer for cheeks and lips? 15:00 - Do you have a lot of post-procedure swelling with silk? 19:00 - Favorite neuromodulators 24:49 - Needle vs. cannula 30:53 - Do you do masseters? 32:22 - Combination treatments 33:25 - Threshold for recommending surgery 43:28 - What do you do to improve patient comfort and limit pain during procedures? 45:57 - Thoughts on DIY Injectables 49:24 - How should patients pick their injector?

Eleftherios Mylonakis, MD, PhD, FIDSA, is the Charles CJ Carpenter Professor of Infectious Diseases at the Brown University. He is also the Chief of Infectious Diseases at Rhode Island Hospital and the Miriam Hospital and the Director of the COBRE Center for Antimicrobial Resistance and Therapeutic Discovery. He has eight patents, has edited five books, and has published more than four hundred articles in peer reviewed literature. Pearls of Wisdom: Focus on being a good doctor and let the titles follow our work Rather than trying to think about the whole path that lies ahead, focus on the next steps. Because when we shine the torch five feet, the next five feet will be visible Go and be proactive in reaching out to mentors, especially those who are not afraid to be honest with us

Chadwick Moore Recently while collaborating with Peter Boykin of #GaysForTrump and #GoRight News wrote an article on https://censored.tv/newsposts/jesse-ousleys-dad-confirms-son-wore-maga-hat-during-fatal-assault (Facebook bans their links)https://youtu.be/M_IbYXIzafEMeanwhile, Mainstream and LGBT media remain completely silent on the assault and death of a gay Trump supporter from Rhode Island.Jesse Ousley, 37, was allegedly assaulted in Fall River, MA on July 8 and later died from injuries sustained. Over the weekend, social media reports flooded in that Ousley had been assaulted because he was wearing a baseball hat in support of President Donald Trump."I can tell you certain things about what happened to my son but I can't say too much because of the investigation. Let me start by saying Jesse was a huge Trump supporter and he is gay [...] Jesse did leave the hospital that night and was beaten and he did have a MAGA hat on. He died later at his cousin's house where the paramedics performed CPR and was pronounced dead at Rhode Island Hospital all the information in between and is under investigation pending results from the autopsy. From what I can tell you he had head and chest trauma from being stomped on. Jesse was a great young man who loved life and didn't deserve to die this way."When will we learn more? This we hope real soon.https://www.spreaker.com/user/9922149/jesse-ousleys-murdered-gay-trump-support######GoRight is planning on Sponsoring #CPAC 2021 if you would like to donate we need to raise over 7k asap.All those that donate will be listed as donors. Please reach out to Peter Boykin at 919-758-0597 (leave a message) or email peterboykin@gorightnews.com or donate at https://paypal.me/magafirstnews we are looking for top donors as well so contact us.Also, we have a rally in DC Sunday, Oct 4th coming up and a Whitehouse tour Oct 2nd you can DM Peter Boykin for info.It is time for The Great American Revival and it is time to #GoRight for America#####

On today's episode, Nia Clark and Kerry interview Dr. Abby McElroy, Doctor of Veterinary Medicine about EDS in many different animals. Dr. McElroy has an EDS-like syndrome herself and her work focuses on the research and treatment of animals with EDS. Dr. McElroy received her bachelor’s degree in neuroscience from Smith College, her DVM from the Cummings School of Veterinary Medicine at Tufts University, and her Master of Science degree from Michigan State University College of Veterinary Medicine. Dr. McElroy currently works as a postdoctoral research associate in the Department of Neurosurgery at Rhode Island Hospital, where her research focuses on occult tethered cord any myodural bridge dysfunction in EDS. She also works part time as a small animal veterinarian, and consults worldwide on veterinary EDS cases. The information discussed on this podcast episode relates to the treatment of animals and is educational only and not intended to be used in the treatment of any specific animal. This episode also includes off label discussion of treatments used in veterinary practice. https://metro.co.uk/2020/01/15/cat-ehlers-danlos-syndrome-finds-loving-home-researcher-condition-12029489/ https://www.instagram.com/reed_eds/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6565730/

Oncologist Don S. Dizon, MD, joins the podcast to discuss how the COVID-19 pandemic has affected him personally and professionally. Dr. Dizon is the director of women’s cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital, both in Providence. Dr. Dizon tells host David H. Henry, MD, how COVID-19 affected his patients, colleagues, and research as well as his personal life. Dr. Dizon chronicled some of these developments in a series of columns published on Medscape. Disclosures: Dr. Dizon has relationships with Regeneron, Astra-Zeneca, Clovis, Bristol-Myers Squibb, and Kazia. He is a columnist for Medscape, which is owned by the same parent company as MDedge News. Dr. Henry has no relevant disclosures. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

Dr. Iannuccilli (Dr. Ed), a retired gastroenterologist, has had extensiveexperience in academics, management, governance and entrepreneurialendeavors. Former Chairman of the Board at Rhode Island Hospital and aformer member of the Lifespan Board, he is a Clinical Professor Emeritus atThe Warren Alpert Medical School at Brown University.As a founding father of Ocean State Physicians Health Plan (UnitedHealth Care), he became the third chairman of its Board. He was the founderof CME Consultants, a national physician and professional educationcompany.Dr. Iannuccilli is a graduate of Providence College and AlbanyMedical College.He is a published author of medical articles and of stories of hischildhood. Dr. Iannuccilli has been on numerous boards and was honored asthe distinguished alumnus of Albany Medical College in 1991.He is the author of the following books: Growing up Italian, Grandfather’s Fig Tree and Other Stories What Ever Happened to Sunday Dinner and Other Stories My Story Continues; from Neighborhood to Junior High SchoolAnd his eBook, Growing Up Italian: Collected StoriesDr. Ed writes a weekly column for an online newspaper, GoLocalProvSupport the show (https://www.patreon.com/bePatron?u=30519446)

Arun Singh, M.D., preeminent cardiac surgeon, has personally performed over 15,000 heart surgeries. He has earned numerous awards as a physician including the American Heart Association's Hero at Heart Award and the Milton Hamolsky Outstanding Physician Award. In practice at Rhode Island Hospital since 1975, Dr. Singh has been voted "Top Doc" by Rhode Island Monthly Magazine for the last 16 years. He was also elected to the Rhode Island Heritage Hall of Fame, only the second person of Indian descent to receive this distinction. His new book is entitled, Your Heart, My Hands: An Immigrant's Remarkable Journey to Become One of America's Preeminent Cardiac Surgeons. Visit https://yourheartmyhands.com. Get the new Your Inner World – Guided Meditations by Sister Jenna. Like America Meditating & on Twitter.  Visit www.americameditating.org. Download our free Pause for Peace App for Apple or Android.

In episode #7 of the Princeton Spine & Joint Center Podcast, Dr. Zinovy Meyler, Co-Director of the Interventional Spine Program at PSJC https://princetonsjc.com, spoke with Dr. Matthew McDonnell, Board Certified Orthopaedic Surgeon with University Orthopaedics Associates in Princeton New Jersey https://www.uoanj.com. They discussed in detail lumbar discectomy, spinal fusion and the conditions appropriate for each diagnosis and treatment, as well as lumbar spine, cervical spine, and a variety of disc diseases and trauma. Dr. Matthew McDonnell specializes in degenerative conditions and traumatic injuries of the cervical, thoracic and lumbar spine. He treats conditions such as stenosis, myelopathy, radiculopathy, disc herniation, spondylolisthesis and fractures of both the spine and the extremities. He has an extensive bibliography of original papers, book chapters and abstracts and has presented both nationally and internationally. He obtained his medical degree from New Jersey Medical School in Newark, NJ, after completing his undergraduate degree at The College of New Jersey. He completed his internship and residency training in Orthopaedic Surgery at Brown University and Rhode Island Hospital in Providence, RI. Dr. McDonnell then completed a fellowship in Orthopaedic Trauma at Brown University followed by a fellowship in Spine Surgery at Rothman Institute and Thomas Jefferson University Hospital in Philadelphia, PA. Dr. Zinovy Meyler is a board certified, fellowship trained physician specializing in the non-operative care of spine, joint, muscle and nerve pain. After graduating from New York University and receiving his medical degree from the New York College of Osteopathic Medicine, Dr. Meyler performed his specialty training in Physical Medicine and Rehabilitation at New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, where he was honored to serve as Chief Resident. Following residency, Dr. Meyler received additional training in ultrasound guidance at the Mayo Clinic and completed his fellowship training in interventional spine and joint medicine at the prestigious Beth Israel Spine Institute in Manhattan. Dr. Meyler is the author of multiple medical chapters and peer-reviewed papers. He serves as a reviewer for medical journals and lectures widely. Dr. Meyler’s expert medical opinion has been sought in newspapers and on radio shows, as well as on this podcast.

Arun Singh, M.D., preeminent cardiac surgeon, has personally performed over 15,000 heart surgeries. Dr. Singh has earned numerous awards as a physician including the American Heart Association's Hero at Heart Award and the Milton Hamolsky Outstanding Physician Award. In practice at Rhode Island Hospital since 1975, Dr. Singh has been voted "Top Doc" by Rhode Island Monthly Magazine for the last 16 years. He was also elected to the Rhode Island Heritage Hall of Fame, only the second person of Indian descent to receive this distinction. He lives in Providence, RI.   Get Arun's book: https://amzn.to/2WwslTV Free Book Dominating Your Mind Connect with Bert Martinez on YouTube. Connect with Bert Martinez on Twitter. Connect with Bert Martinez on Instagram. Click here for more episodes. 

Today's guest is Dr. Don Dizon, a renowned oncologist specializing in women's cancers and affiliated with a handful of top medical institutions including Lifespan Cancer Institute, Rhode Island Hospital, and Brown University. Don and I met in 2017 when we were both speaking at a patient experience conference held by Teva Pharmaceuticals in Barcelona. Like discovering a lost sibling we were joined at the hip the entire conference, and have been friends ever since. This conversation is full of fascinating twists and turns. We discussed how Don created a balance between his beautiful family and a prestigious career, why he believes all medical professionals should be embracing social media, and of course, Don shares his story of a chance encounter with lasting impact. Our interview was scheduled for the day of crazy snowstorm, so Don ended up calling in from his home office, which means you might hear a bit of his family jostling around in the background. As far as I'm concerned, it made the conversation that much more relatable. Show Notes Don's ASCO column Follow Don on Twitter and Instagram @drdonsdizon

Dr. Kerry Foley with the Physicians Committee for Responsible Medicine. #WPRO The group staged a rally calling on Rhode Island Hospital and Brown University to stop using live animals in training emergency medicine residents. The hospital and Brown respond that they abide by industry and government standards. https://www.pcrm.org/

Dr. Kerry Foley with the Physicians Committee for Responsible Medicine. #WPRO The group staged a rally calling on Rhode Island Hospital and Brown University to stop using live animals in training emergency medicine residents. The hospital and Brown respond that they abide by industry and government standards. https://www.pcrm.org/

Session 90 Dr. Philip Chan is an academic Infectious Diseases physician at Brown University in Rhode Island. He has been out of training now for about 8 years. He talks about his typical day, why he chose this specialty, the training path, and an inside look into this field. Meanwhile, be sure to check out all our other podcasts on MedEd Media Network. [01:22] Interest in Infectious Disease Philip recalls being interested in Infectious Diseases (ID) back during undergrad. With a Major in Microbiology, he was basically interested in bacteria, viruses, infections, and how to solve such problems. Although Philip's dad is a cardiologist, he was already interested in fixing things at an early age. So he went to college majoring in Engineering. Then he realized he wanted to go to medical school so he shifted to Biology. However, he thought it was too generic so he then changed to Microbiology, specifically focusing on genetic engineering. [02:40] Traits that Lead to Becoming a Good Infectious Diseases Physician Philip says you've got to have the ability to think through a problem from top to bottom. You also have to have a particular attention to details. He advises medical students, especially early in their career, is to think about a problem in a timeline. You have to be able to put things together in a timely fashion and think through the different problems and problem-solving critically. He initially got into the field of HIV early on in his career mainly due to the research aspect of it. But as he progressed, he had gotten so much interested in the intersection of HIV, social justice, and health disparities. A lot of his work is presently focused on public health at the community level and engaging populations across their state. [04:20] Other Specialties of Interest During medical school, Philip found everything to be interesting. He loved his surgical rotations as well as OB-GYN, Medicine, Pediatrics, and Oncology. But when he got to residency, he felt he was fully committed to Infectious Diseases. He did consider Oncology due to the genetic research he did at that time. But he eventually landed on his current specialty and he's happy he did. What he likes about ID is that it touches every part of the body. There's a broad overlap of lots of other fields and disciplines. You can actually cure a lot of infection. A lot of medicine now is managing chronic diseases. That's fine. But one thing that appealed to him about infections is that you can cure a majority of them. You can make people 100% back to normal. "A lot of medicine now is managing chronic diseases... but one thing that appealed to me about infections is that you can cure a majority of them." [06:00] Types of Patients Philip categorizes patient care in two types. He does consult in the hospital where he'd be dealing with "bread and butter infectious diseases" These include endocarditis, osteomyelitis, diabetic skin, and tissue infections. They also treat a spectrum of all other infections from malaria to TB and to many other sorts. Moreover, the outpatient side has become more of his "bread and butter." This includes HIV care. He started the prep/prophylaxis clinic at their site. He also runs their STD clinic. He didn't receive enough training in these through fellowship and residency. But the outpatient ID care has taken a lot of his time now. About a third of the time, there are clear culture data to help guide the decisions. Then a third of the time, they don't have culture data. Cultures may not be accurate, negative, or they're not drawn correctly. Then there are also lots of bugs that don't grow. Philip believes that about a quarter of the time, they're shooting dark and making their best guess. Then they're just guided by other aspects of the clinical patients. The other third of their time, they deal with random things that they get called for. Majority of the cases would be fever. For instance, there's a rising blood count. Others would be taking random questions that may be unclear to the primary care team. 10% of the time would be people getting diseases from other countries like malaria, TB, etc. And a small percent of that time, they're able to nail the diagnosis of some really random diseases. They give them the appropriate antibiotics and cure them. "You've given the appropriate antibiotics and you cure them. That's one of the greatest feelings in ID." [09:40] Is His Job Just Like the TV Show House? Funny how Philip thinks that none of it does look anything like his job. 1 out of every 10 patients, he sees the complete mystery and you try to piece things together. One thing they really love to do as ID doctors is to dive into the social history. This includes the person's demographics and how you frame them epidemiologic-wise. And just to be clear, there is no housebreaking involved. "For many parts of medicine, the social history doesn't necessarily matter quite as much. But in ID, the social history can really be everything." [10:45] Academic vs. Community Setting Philip believes there are pros and cons to each. Basically, it's about what you like to do. In private practice, there's incredible flexibility especially if you work for yourself. You can make much more in the private world depending on what you do. He describes his career as being very academic and research-oriented. He's also the PI of several NIH grants and other grants, which you can't do in the private world. For academic ID careers, you can get involved in research and public health. You have the chance to get involved in lots of other different committees and leadership roles and stewardship. You can work for the Department of Health. "There's a lot of other opportunities in the career of ID to really spread out." [11:50] Doing Research without a PhD Philip is doing a ton of research at a major Ivy League institution, yet he doesn't have a PhD. This is concrete proof that it is possible to do research without that PhD. After his undergrad, he got a masters in Genetics. So he has some research experience that he has built on. What he recommends to students is that if you're really interested in research, really collaborate. One of the keys to successfully writing NIH grant is he always leads the grant with a PhD person. The NIH loves this as there are two different complementary skill set – one a clinically oriented researcher and the other a PhD-driven researcher. [13:00] Typical Week Philip holds clinics on Thursday and Friday afternoons. For about 4-8 weeks of the year, he does inpatient service time where he sees most of the bread and butter disease cases. Then the rest of this time is spread out running various research and the programmatic aspects of what they do. He's spread across various institutions, pushing different agendas related to HIV and other STDs. [14:00] Doing Procedures and Taking Calls Compared to other fields, ID is a less procedure-driven field. But there are a lot of things you can do, which are quite parallel to what an internist does. For instance, they do lumbar punctures, thoracentesis, and other procedures. There are other physicians who feel comfortable doing biopsies.  Nevertheless, they routinely take cultures. "Compared to other fields, ID is a less procedure-driven field." According to Philip, the beauty of this field is that there's not many emergencies where you have to go into the hospital ever. Hence, this gives them a very good quality of life in terms of taking calls. He personally takes calls a couple of months where he has to answer phones through the night. However, for academic institutions, there's a fellow who takes all the calls. And if there's something they can't answer, they then refer it to the attending. And this happens to him only about 1-2x  a year. For a lot of the calls, they'd usually give the patient antibiotics and see them in the morning for evaluation. Philip says he has a good work-life balance. His wife works full-time so he actually does a lot of the childcare in their household especially in the evenings. Although you have flexible time, you have to put in the time to be successful. But you can be flexible in terms of how time is managed. He makes sure he exercises everyday. "As an academic ID physician, you have the flexibility of your time." [16:55] The Training Path and Competitiveness Infectious Diseases is a fellowship after internal medicine residency. You go through the traditional 3-year internal medicine residency. In general, you go through a two-year clinical fellowship after that. There are numerous variations such as research-oriented fellowships combined clinical research fellowships for 3+ years. Given that ID is an especially research-driven field, there are lots of places that combine clinical and research together. The typical pathway is two years of ID fellowship. A number of his colleagues come from Med-Peds residencies to do Adult ID and Pediatric ID fellowship over 3-4 years as well. Pediatric ID is a specialty so you can go from a pediatric residency into a pediatric ID fellowship. The top programs in ID tend to be competitive but there is not as competitive per se as Cardiology or GI. To be competitive, you should do well in residency as a rule of thumb. Be involved in something that really demonstrates your interest. ID is very diverse as there are a lot of people from various backgrounds and experiences that are interested in the field. For instance, there are people interested in infection control, antibiotic management, international health, HIV/STD pathway, etc. So try to explore these through residency. Do research or other projects with a mentor to really show and demonstrate your interest. Or to find out if this is really something you're interested in and that you want to continue this pathway. Just do something outside of your normal residency duties. If you're interested in academic medicine, you can get involved in some grants or publications. [20:45] Subspecialty Opportunities There are various routes to become certified in HIV care. One is to do a fellowship in Infectious Diseases. As an internal medicine doctor, there are certification programs where you can become a certified medicine physician in HIV care. This is generally a one-year fellowship. Once you've become specialized, there isn't any "next step" in terms of specialty. Those that really take the next level are research experts. These are people who have developed research expertise in drug resistance, for instance or a neurological complication-related to HIV/AIDS. Usually, these are people who have done research on a specific topic of HIV. These are world-renowned experts in a specific aspect of HIV. Within your typical ID fellowship program, there are usually no specific tracks where you can get certified in. Usually, it's based on where you spend your time on. There are elective months as well as clinical care. A lot of these are self-directed and self-driven. There are programs, workshops, and courses being offered at academic institutions where you can start to develop specific interest and focus within aspects of infectious diseases. "Most of what happens in how one develops one's interest and expertise, within infectious diseases, is based on where you spend your time." Alternatively, the people that develop expertise in meningitis or fungal inspection or STDs are people who have developed programs and research portfolios around those different topics. [24:15] Bias Against DOs One of Philip's mentors is a DO who runs infectious control at Rhode Island Hospital. He routinely calls him for pieces of advice. He knows other fantastic mentors who are DOs. "It's less about the degree after your name and more about what you make of yourself and how your career transpires." [25:10] Working with Primary Care and Other Specialties Philip also provides primary care himself to his HIV positive patients. The way medicine has gone, as he puts it, is that everything is subspecialized that it's so impossible to be good at everything. You can't just keep up with every single aspect of literature or every single disease. He found that through the years, he has become less comfortable managing aspects of diabetes and primary prevention related to cardiovascular disease. Moreover, there are some diseases like HIV that if you engage all primary care physicians, we would all have the potential to make huge strides in addressing the HIV epidemic. So they're trying to engage the primary care community in assisting patients with HIV testing and STD testing. Other specialties ID physicians work the closest with include internists/primary care and hospitalist internists. [27:22] Special Opportunities Outside of Clinical Medicine There are tons of opportunities for ID physicians to get involved. He has colleagues across the world who work internationally. There are people who provide care at international sites and those who consult with NGOs and the WHO. Nationally and locally, there are many health departments across the country that have consulting physicians. Some even have full-time physicians for infectious diseases within public health. Personally, Philip consults part-time for the Department of Health aspects related to HIV and STD. There are also opportunities at other outpatient health centers. Some of his colleagues provide consulting services related to Hepatitis C treatment, HIV care, and other aspects of ID care to community health centers, NGOs, etc. A lot of community-based organizations have medical director roles related to substances treatment, AIDS service organizations, STD clinics, etc. [28:45] What They Don't Teach in Medical School For Philip, leadership was something he had to learn on the fly. He currently manages a team of over a dozen people. The business aspect is something they don't teach you in medical school, as well as how to manage people and how to be a leader. They train you very well throughout medical school and residency to be a clinician. But for basic business/leadership/managing skill was something he had to learn on the fly. This was something he had to do everyday. That being said, it was something he wished he had formal training with given his current positions. What he has done though was to find key mentors or people who have been through this time and time again. He'd lean on them heavily and ask them questions about how to navigate different situations. "Seek out a couple of key trusted people that you can ask confidentially some tricky situations if you ever find yourself in them." [30:50] The Most and Least Liked Things Philip has gravitated more into the preventative side of infection, which was something he didn't anticipate through his training. He started their HIV preexposure prophylaxis program. He sees a lot of people that are at risk of HIV and one of his jobs is to keep them negative. He enjoys interacting with young HIV positive people. Preventative care wasn't something he saw doing 10-15 years ago. But he has now found this to be the most enjoyable aspect. "I feel like I do a lot of education, counseling, teaching, and mentorship to my patients – guide them through difficult situations, mostly, but not all related to their health." On the flip side, what he likes the least about his practice is the administrative aspect that can become sometimes overwhelming. At some point, the administrative side of medicine may start to weigh heavily on your career. So just set some clear boundaries and structures to help manage that time. In fact, Philip just sat on a panel for physician burnout and found that the EMR is one of the number of causes for physician burnout. [33:10] Major Changes in the Future Philip says that for those considering careers in HIV specifically, is to consider places where HIV is affecting people most, including the deep south. A lot of money and resources are now being redirected to such places where HIV is hit the hardest. In terms of HIV cure, Philip sees an optimistic future in the fact that it can be done. a couple of patients now have received bone marrow transplants with HIV mutations to make them resistant to HIV infections. And when implanted with a bone marrow transplant, these people can now be cleared of HIV. There could still be remnants of HIV but people in the field are considering this as functional care. However, this is not something really applicable to the general HIV population. Reason being is that in order to get a bone marrow transplant, you have to destroy one's immune system. Bone marrow transplant is for those with leukemia and other blood-borne cancers. Also, there's a 25% mortality rate with bone marrow transplants. And you wouldn't want to risk that percentage for putting HIV medication that can keep you controlled for life. All this being said, it has the potential to cure HIV. Ultimately, Philip would still have chosen to be an ID doctor if he had to do it all over again 110%. His advice to students is to do it early. It's a fantastic career and he's 100% glad he did it. There are tons of opportunities with some overlaps with international careers, public health, and public policies. "Try to explore a career in ID especially if you're interested in public health, social determinants of health, addressing health disparities." Links: MedEd Media Network

This week we join Chris Jehle, a fourth year plastic surgery resident at Rhode Island Hospital, for a conversation about creativity and risk within a "safe" profession, innovation in medicine, trendsetting with plastic surgery, and the silver lining of having lots of problems to solve. Topics include pride in your profession, what plastic surgery really is, issues with the medical insurance industry, and treating your patient like you'd treat your family. Show Notes Trendsetting in plastic surgery Risks within the safety of a standard profession Plastic surgery doesn't have an age, gender of body system Issues with the medical insurance industry Links Follow Chris on his Instagram (https://www.instagram.com/chazjehle/) or learn a little about him on the brown website (https://www.brown.edu/Departments/Plastic_Surgery/chris-jehle%2C-md.html) What is plastic surgery? (https://en.wikipedia.org/wiki/Plastic_surgery) Want to become a plastic surgeon after listening to this episode? Here's an 8-step plan... (https://money.howstuffworks.com/how-to-become-plastic-surgeon.htm) Big thanks to NGHTSWM (https://itunes.apple.com/us/artist/nghtswm/1316607579) for the use of their song, Fiji (https://itunes.apple.com/us/album/fiji-single/1436041716), on this show.

Katherine Wela Bogen joins Natasha on this episode of Mormon Mental Health. She is a returning guest as she recently joined Natasha to discuss false reporting when it comes to sexual assaults. In this episode, Katherine discusses her relationship with Judaism and especially how her advocacy for it has been affected in the Trump Era. She discusses the 8 stages of Genocide: http://www.genocidewatch.org/images/8StagesBriefingpaper.pdf Katherine is a clinical research program coordinator at Rhode Island Hospital in the department of Psychiatry, working in violence protection research for over 3 years. A Facebook post she made in response to false reporting during the Brett Kavanaugh hearings when Christine Blasey Ford came out went viral in which she gave data on false reporting. You can find the post here: https://www.facebook.com/katherine.bogen/posts/2141527535858774   To help keep Mormon Mental Health going past 2019, please consider donating at mormonmentalhealth.org.

Dr. Terrance Healey, Rhode Island Medical Imaging Radiologist and Director of Thoracic Radiology at Rhode Island Hospital. #WPRO The American Lung Association recommends cancer screening for those who have been smoking for more than 30 years or are over age 55. http://www.rimirad.com/2017-diagnostic-services/lung-cancer-screening

Dr. Terrance Healey, Rhode Island Medical Imaging Radiologist and Director of Thoracic Radiology at Rhode Island Hospital. #WPRO The American Lung Association recommends cancer screening for those who have been smoking for more than 30 years or are over age 55. http://www.rimirad.com/2017-diagnostic-services/lung-cancer-screening

Katherine Wela Bogen joins Natasha on this episode of Mormon Mental Health to discuss the data behind false reporting. She made a facebook post during the Brett Kavanaugh hearings when Christine Blasey Ford spoke out about her experience with Kavanaugh in high school. The post went viral and you can find it here: https://www.facebook.com/katherine.bogen/posts/2141527535858774 Katherine is a clinical research program coordinator at Rhode Island Hospital in the department of Psychiatry, working in violence protection research for over 3 years. She started out as a pediatric violence resistant research assistant at the University of Pittsburg Medical School, working with vulnerable populations. Bogen is currently collaborating on a chapter with her boss,Dr. Lindsay Orchowsky, and with Alan Berkowitz who was one of the founding fathers of “Social Norms Theory.” They are collaborating on a chapter that will be in “The Handbook for Interpersonal Violence” to be published in 2020. The chapter is on false reporting and how common (or uncommon) false reporting is, what some of the barriers to reporting are to begin with, how false reporting is qualified, etc. You can find Berkowitz “An Overview of the Social Norms Approach” paper here: http://www.alanberkowitz.com/articles/social%20norms%20approach-short.pdf   To help keep Mormon Mental Health going past 2019, please consider donating at mormonmentalhealth.org.

Michael Bitzer of Catawba College on North Carolina elections fraud. Henry Greely of Stanford University on the world’s first gene-edited babies causing an uproar. Laura Kray of UC Berkeley on women lies. Ron Harris of BYU on preparing and forecasting the next big earthquake. Carl Saab of Brown University and Rhode Island Hospital on EEG test provides more effective way to measure pain. Norman Ellstrand on banana risks.

Shihab Ali is a third-year resident and emergency physician at Rhode Island Hospital, and he understands the extreme toll that a bullet can take on the human body. Listen in on our conversation with Shihab as he walks us through the unique challenges that arise from treating gunshot wounds, both personally and institutionally.

Welcome to a Kessler Foundation stroke research lecture podcast. This episode features Dr. Michael Reznik presenting “Delirium After Brain Injury” Dr. Reznik is a neurologist in the division of Neurocritical Care at Rhode Island Hospital and assistant professor of Neurology and Neurosurgery at the Warren Alpert Medical School at Brown University. He completed residency training at University of Pittsburgh Medical Center and fellowship training at Columbia University and Weill Cornell Medical Center. His research interests include delirium and disorders of consciousness after stroke and other forms of acute brain injury, along with their impact on neuro-rehabilitation and ultimate outcomes. This episode was recorded on Monday, July 16, 2018 at the at the Kessler Institute for Rehabilitation, Conference Center, West Orange, New Jersey and was edited and produced by Joan Banks-Smith, Creative Producer for Kessler Foundation. For more information about Kessler Foundation and our researchers, go to KesslerFoundation.org Like us on FaceBook, follow us on Instagram, listen to us on Soundcloud, and tweet with us on Twitter!

Dr. Steven Toms of Rhode Island Hospital and the Lifespan Cancer Institute joins Steve Klamkin to discuss Senator John McCain's brain cancer diagnosis

In 2017 the Society for Critical Care Medicine updated its guidelines for sepsis management. These new guidelines differ significantly from ones in the past in that they no longer recommend protocolized resuscitation and emphasize early and aggressive fluid resuscitation when patients present with septic shock. This is the first podcast in the Surviving Sepsis guideline series. The next episode discusses why the new sepsis guideline changed. Article discussed in this episode: Management of Sepsis and Septic Shock Speakers: Laura Evans, MD, MSc, of Bellevue Hospital and NYU Medical Center Andrew Rhodes, MBBS, MD, of St George’s University Hospitals NHS Trust and co-chair of the Surviving Sepsis guideline panel Mitchell M. Levy, MD, of the Alpert Medical School of Brown University and Rhode Island Hospital  

In 2017 the Society for Critical Care Medicine updated its guidelines for sepsis management. These new guidelines differ significantly from ones in the past in that they no longer recommend protocolized resuscitation and emphasize early and aggressive fluid resuscitation when patients present with septic shock. This is the first podcast in the Surviving Sepsis guideline series. The next episode discusses why the new sepsis guideline changed. Article discussed in this episode: Management of Sepsis and Septic Shock Speakers: Laura Evans, MD, MSc, of Bellevue Hospital and NYU Medical Center Andrew Rhodes, MBBS, MD, of St George’s University Hospitals NHS Trust and co-chair of the Surviving Sepsis guideline panel Mitchell M. Levy, MD, of the Alpert Medical School of Brown University and Rhode Island Hospital    

In this introductory podcast of Felipe Albuquerque, the new Editor-in-Chief of JNIS talks with Ryan McTaggart, who co-authored the study, "Decreasing procedure times with a standardized approach to emergent large vessel occlusion (ELVO) cases". The study was run at the single comprehensive stroke center at the Rhode Island Hospital and concluded that a standardized approach to the equipment used and process for ELVO cases at a single institution can dramatically reduce procedure times. Read the full paper at the JNIS website: http://jnis.bmj.com/content/9/1/2.

Dr. Alan Berkowitz, a nationally renowned consultant recently came to Rhode Island to evaluate a $1.7 million Centers for disease Control and Prevention grant to Day One and Rhode Island Hospital, developing sexual assault prevention programs for middle and high school students.

In this episode of the Jewish Sacred Aging Podcast, Rabbi Address has a conversation with Dr. Don Friedman, a retired rheumatologist and faculty member at the Sidney Kimmel School of Medicine at Thomas Jefferson University in Philadelphia. About Dr. Friedman: Donald M. Friedman M.D. received his undergraduate A.B. degree from Princeton University in 1966 and his M.D. from The University of Pennsylvania School of Medicine in 1970.  He was trained in Internal Medicine at Rhode Island Hospital in Providence, RI and Hahnemann Hospital in Philadelphia, PA.  Following his Medical Internship and Residency, he did a Fellowship in Medical-Psychiatric Liaison at Downstate Medical Center in Brooklyn, NY where he learned about the emotional aspects of medical illness. He was also a Fellow in Rheumatology at Temple University Hospital where he was trained to treat arthritis, and musculoskeletal and collagen diseases. For more than twenty five years, Dr. Friedman was Chief of the Section of Rheumatology at Crozer-Chester Medical Center, a large community teaching hospital in suburban Philadelphia.  He is Board Certified in Rheumatology and Internal Medicine. Since retiring from medical practice, Dr. Friedman has been interested in Spirituality and Healthcare and has taken courses at Harvard Medical School in the Benson-Henry Institute for Mind Body Medicine and at the George Washington Institute of Spirituality and Health.  He completed a workshop program on SoulCare in HealthCare at The Omega Institute with Drs. Joan Borysenko and Gordon Dverin.  He currently teaches courses in Professionalism, Introduction to Clinical Medicine, and the Healer's Art at Jefferson Medical College in Philadelphia, PA. Recording and post-production services for the podcasts is provided by the Professional Podcasts division of The Lubetkin Media Companies, which also manages this website. Now, you can subscribe to an RSS feed for either of Rabbi Address' podcast series separately. Subscribe to the RSS feed for the Jewish Sacred Aging podcasts.   Subscribe to the RSS feed for Boomer Generation Radio podcasts.     Subscribe to both of these podcast series in the Apple iTunes Music Store. [spp-optin]

Katherine Phillips, MD, and director of the body dysmorphic center (BDD) at the Rhode Island Hospital, explains the nature, manifestations, prevalence, early signs of, and treatment issues for the BDD. BDD is more common than realized and is found in both sexes and across a wide age range.

Society of Critical Care Medicine president Mitchell Levy, MD, FCCM, discusses his goals and vision for the Society during his 2009 term. Levy stresses the importance of professional collaboration and compassionate caregiving. Levy is professor of medicine at Brown University School of Medicine and director of the medical ICU at Rhode Island Hospital.

Host: Beverly Hashimoto, MD Guest: Jonn Cronan, MD, FACR Thanks to extremely sensitive ultrasound technology, thyroid nodules are being detected and treated at unprecedented rates. Host Dr. Beverly Hashimoto welcomes Dr. John Cronan, professor of diagnostic imaging at the Brown University School of Medicine and chairman of the diagnostic imaging department at Rhode Island Hospital, to discuss the phenomenon of over-treatment of thyroid nodules. Is this pattern of care helping or harming our patients?

Host: Beverly Hashimoto, MD Guest: Jonn Cronan, MD, FACR Thanks to extremely sensitive ultrasound technology, thyroid nodules are being detected and treated at unprecedented rates. Host Dr. Beverly Hashimoto welcomes Dr. John Cronan, professor of diagnostic imaging at the Brown University School of Medicine and chairman of the diagnostic imaging department at Rhode Island Hospital, to discuss the phenomenon of over-treatment of thyroid nodules. Is this pattern of care helping or harming our patients?

Guest: Mitchell Levy, MD Host: Shira Johnson, MD Who delivers the best critical care, the critical care specialist or the physician without those credentials? Dr. Mitchell Levy, Professor of Medicine at Brown Medical School and Medical Director of the Medical Intensive Care Unit at Rhode Island Hospital discusses his recent study on the association between critical care management and patient mortality in the ICU. The answer may surpise you! Join host Shira Johnson.

Guest: Mitchell Levy, MD Host: Shira Johnson, MD What is the impact of re-education on outcomes in sepsis in an ICU? Host, Dr. Shira Johnson is joined by Dr. Mitchell Levy, professor of medicine at Brown Medical School and Medical Director of the Medical Intensive Care Unit at Rhode Island Hospital, who discusses the "Surviving Sepsis Campaign." Re-education of physicians and nurses in this global study had a remarkable impact on reducing mortality and morbidity. Dr. Levy explains why outcomes were so dramatically affected.