Podcasts about Stent

Gaming the System: Cardiologists, Heart Stents, and Upcoding Cardiologists can criminally game the system by telling a patient they have a much more serious, unstable disease than they really have, fraud that results in unnecessary procedures, unnecessary cost, and unnecessary patient harm. Listen to today's episode written by Dr. Michael Greger at @NutritionFacts.org #vegan #plantbased #plantbasedbriefing #upcoding #stents #stableangina #unstableangina #cardiologists #heartstents ============================ Original post: https://nutritionfacts.org/blog/gaming-the-system-cardiologists-heart-stents-and-upcoding/  Related Episodes: Stents: 933: After a Stent at 32 I Reversed My Heart Disease https://plantbasedbriefing.libsyn.com/933-after-a-stent-at-32-i-reversed-my-heart-disease-by-karlynn-mccarrell-at-forksoverknivescom  840: My Aging Parents' Shocking Health Improvements Through Food https://plantbasedbriefing.libsyn.com/840-my-aging-parents-shocking-health-improvements-through-food-by-sandra-l-price-at-nutritionstudiesorg  Statins: 928: The 411 on Statins https://plantbasedbriefing.libsyn.com/928-the-411-on-statins-by-dr-michael-greger-at-nutritionfactsorg  922: Thanks to a Whole-Food, Plant-Based Diet, I No Longer Need Statins https://plantbasedbriefing.libsyn.com/922-thanks-to-a-whole-food-plant-based-diet-i-no-longer-need-statins-by-rainer-lucks-at-forksoverknivescom    ============================ Dr. Michael Greger is a physician, New York Times bestselling author, and internationally recognized speaker on nutrition, food safety, and public health issues. A founding member and Fellow of the American College of Lifestyle Medicine, Dr. Greger is licensed as a general practitioner specializing in clinical nutrition. He is a graduate of the Cornell University School of Agriculture and Tufts University School of Medicine. He founded NUTRITIONFACTS.ORG is a non-profit, non-commercial, science-based public service provided by Dr. Michael Greger, providing free updates on the latest in nutrition research via bite-sized videos. There are more than a thousand videos on nearly every aspect of healthy eating, with new videos and articles uploaded every day.   His latest books —How Not to Age, How Not to Die, the How Not to Die Cookbook, and How Not to Diet — became instant New York Times Best Sellers. His two latest books, How to Survive a Pandemic and the How Not to Diet Cookbook were released in 2020.  100% of all proceeds he has ever received from his books, DVDs, and speaking engagements have always and will always be donated to charity. ============================== FOLLOW THE SHOW ON: YouTube: https://www.youtube.com/@plantbasedbriefing     Spotify: https://open.spotify.com/show/2GONW0q2EDJMzqhuwuxdCF?si=2a20c247461d4ad7 Apple Podcasts: https://podcasts.apple.com/us/podcast/plant-based-briefing/id1562925866 Your podcast app of choice: https://pod.link/1562925866 Facebook: https://www.facebook.com/PlantBasedBriefing   LinkedIn: https://www.linkedin.com/company/plant-based-briefing/   Instagram: https://www.instagram.com/plantbasedbriefing/     

The "River" stent is a novel stent designed specifically to account for the anatomical and procedural requirements of venous sinus stenosis. A multicentre study of the device's safety and efficacy is underway, comprising 39 subjects across 5 US centres. The 1-year results have been recently published in JNIS. Editor-in-Chief of JNIS, Dr. Felipe C. Albuquerque, interviews Dr. Athos Patsalides¹, author of the paper: The River study: the first prospective multicenter trial of a novel venous sinus stent for the treatment of idiopathic intracranial hypertension 1. Department of Neurological Surgery, North Shore University Hospital, Manhasset, New York, USA   Please subscribe to the JNIS podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/4aZmlpT) or Spotify (https://spoti.fi/3UKhGT5). We'd love to hear your feedback on social media - @JNIS_BMJ.

April 18, 2025 Scott, Mark, and Ray discuss questions that came into the PRS Helpdesk:For the past 8 months, I have been in an employed position with a county hospital system that provides inpatient and ambulatory services. Their coding consultants (acsteam.net) are telling the hospital that foley catheter insertions, bladder irrigations, and a list of other procedures commonly performed in urology clinics cannot be billed if they are not performed personally by the physician according to CMS. They reference a list of procedures from CMS and state that these services cannot be billed when performed by ancillary staff regardless of the level of supervision. They use https://www.cms.gov/status-indicators as their source citing the section on PC or TC indicators. Can this be true? Is it possible that this consultant is giving advice from a hospital perspective and not aware of differences between the ambulatory setting? The urology clinic I am working in is not a department of the hospital. It is freestanding. I have never worked in a clinic that did not bill for these services performed by ancillary staff with physician supervision.I look forward to your response.Good afternoon, my question is regarding "Incident to" required documentation. When we attended your seminar this past December, on Day 2, the new "Incident to Rule" was discuss. Can you please help clarify the new rule? My notes are not clear.We are in the process of CMS Review -"Targeted Probe and Educate Round 1". The letter states we were chosen for review because of being in the 60th percentile for our jurisdiction for code 99214.Our practice has the challenge of servicing and underprivilege community and estimated population of 590,142. We have 7 Urologist, 4 Apps and 1 Radiation Oncologist in our practice. Hence our volume is overwhelming.Earlier this year we submitted a batch of approximately forty records. Today we received a notification request "Incident to documentation: needed 2 previous office visits done by MD to support physician/supervising provider's initiation and continued involvement in treatment, and documentation to support direct supervision met.I appreciate any assistance with clarifying the “Incident to” rule.Thank you in advance for your assistance.Doctor did a stent pull in the ASC but not with Cysto scope. How would we go about billing this?Free Kidney Stone Coding CalculatorDownload NowPRS Billing and Other Services - Book a Call with Mark Painter or Marianne DescioseClick Here to Get More Information and Request a Quote Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ © 2025 Physician Reimbursement Systems, Inc.Home

Sirolimus-coated Balloon Vs. Drug-eluting Stent in Elderly Patients with Coronary Artery Disease: A Propensity-score Matched Comparison

Justin Coleman speaks with Kate Ziser, a pharmacist at the Princess Alexandra Hospital in Brisbane, about her paper on the role of triple antithrombotic therapy in patients with atrial fibrillation following coronary stent insertion. Kate explains when triple therapy is indicated, the duration of therapy, and the step-down approach to antithrombotic therapy. Read the full article by Kate and her co-authors in Australian Prescriber.

 March 28, 2025 Scott, Mark, and Dr. Ray Painter discuss questions that came into the PRS Helpdesk. NGS sent a newsletter about the use of: cpt code G0463 as a primary code for G2211. Need more info if possible.Do nurse practitioners get paid at 100% for procedures like a PNE when signing notes in NM by themselves?a) Medicare NGS is denying CPT 52332 for bilateral stents with denial CO-151. This seems to be a constant problem with denials for frequency and/or bilateral stents.Has the policy been changed; I have not been able to find any changes regarding stents insertion or exchanges.Thanksb)Hi,Wondering if you can help me with this Medicare patients.NGS is denying the claim on several patients stating that this code has a frequency limit on 52332.NGS has a problem with both frequency and bilateral stentsI have searched everywhere and find no information on this code for frequency limits per year or bilateral stents.Appreciate any help on this code.Free Kidney Stone Coding CalculatorDownload NowPRS Billing and Other Services - Book a Call with Mark Painter or Marianne DescioseClick Here to Get More Information and Request a Quote Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ 

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Safety and Efficacy of Different Stent Strategies in Percutaneous Coronary Intervention: A Network Meta-Analysis

Friend of the podcast Brynley Stent returns to discuss NZ Series 2! Brynley has some hot takes which include great BTS on the 'Eat the grape' task. Brybly and Ed discuss their approaches to escape rooms and why the Guy and Laura competitiveness is so fun to watch! You can watch Brynley's new digital series with Kura Forrester here: Bryn and Ku's Singles Club youtu.be/Opf4Zyz7CGMTo get all the latest Taskmaster news visit Taskmaster.tv To watch all UK and NZ Taskmaster visit channel4.com

Retrievable Stent Therapy: The Temporary Spur Stent System Platform

N Engl J Med 2024;390:1481-1492Background: In patients with ST-elevation myocardial infarction (STEMI), opening the culprit artery improves outcomes. Nearly half of STEMI patients have disease in other coronary arteries. Whether revascularizing these non-culprit arteries improves outcomes remained uncertain. The PRAMI trial showed improvement in outcomes with complete revascularization but was relatively small, included 465 patients, and did not require the use of fractional flow reserve (FFR).Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The FFR-Guidance for Complete Nonculprit Revascularization (FULL REVASC) trial sought to assess if FFR-guided completed revascularization improves outcomes compared to culprit-only percutaneous coronary intervention (PCI).The COMPLETE trial was not published by the time the FULL REVASC trial started enrolling patients.Patients: Eligible patients had STEMI and were undergoing PCI or had high risk NSETMI undergoing urgent PCI. High risk NSTEMI included patients with dynamic ST–T-wave changes, ongoing chest pain, acute heart failure, hemodynamic instability independent of electrocardiographic changes, or life-threatening ventricular arrhythmias.Eligible patients had to have multivessel coronary artery disease, defined as one or more lesions in a nonculprit artery with a diameter of ≥ 2.5 mm and a visually graded stenosis of 50 - 99%.Patients were excluded if they had previous CABG, left main disease or cardiogenic shock.Baseline characteristics: The trial randomized 1,542 patients – 778 randomized to culprit-only PCI and 764 randomized to complete revascularization. Patients were recruited from 32 centers in 7 countries.Approximately 91% of the patients had STEMI and 9% had high risk NSTEMI.The average age of patients was 65 years and 76% were men. Approximately 51% had hypertension, 16% had diabetes, 23% were on treatment for hyperlipidemia, 8% had prior myocardial infarction, and 35% were current smokers.The number of residual coronary arteries with stenosis of 50-99% was 1 in 72% of the patients and 2 or more in the rest.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo culprit-only PCI or FFR-guide complete revascularization. The study was open label.Patients in the culprit-PCI only group did not receive further revascularization during the index hospitalization. Patients in the FFR-guided complete revascularization could receive further revascularization during the index procedure or during the index hospitalization. PCI of non-culprit lesion was recommended if FFR was 0.80 or less.Endpoints: The primary outcome was a composite of death from any cause, myocardial infarction, or unplanned revascularization. The main secondary outcomes were a composite of death from any cause or myocardial infarction and unplanned revascularizationAnalysis was performed based on the intention-to-treat principle. The estimated sample size to achieve 80% with a two-sided alpha of 0.05 was 4,052 patients. This sample size would detect 0.75 risk ratio for the composite outcome of death or myocardial infarction at 1-year assuming 9.9% event rate in the culprit-only PCI. After the publication of the COMPLETE trial, the trial was stopped early due to ethical and feasibility concerns. Consequently, the original key secondary outcome (death from any cause, myocardial infarction, or unplanned revascularization) became the new primary outcome, and events after 1 year of follow-up were included in the primary analysis.Results: The trial was stopped after randomizing 38.1% of the original sample size. Among the patients assigned to the FFR-guided complete-revascularization arm, the procedure was followed in 95.9% of the patients, and among these patients, 17.9% underwent FFR-guided complete revascularization of non-culprit lesions during the primary PCI and the rest during the index hospitalization. Among the patients assigned to culprit-only arm, the assigned strategy was followed in 99.6% of the patients. The median follow-up time was 4.8 years.FFR was 0.8 or less in 392 (47.3%) of non-culprit vessels assessed, and PCI was performed in 369 (94.1%) of these vessels. In total, PCI was performed in 18.8% of the total non-culprit vessels. The average number of stents during the index hospitalization was 1 in the culprit-only PCI group and 2 in the complete revascularization group.The primary composite outcome was not significantly different between both treatment groups (19.0% with complete-revascularization vs 20.4% with culprit-only PCI, HR: 0.93, 95% CI: 0.74 - 1.17; p= 0.53). There were also no significant differences in composite endpoint of death from any cause or myocardial infarction (16.5% with complete revascularization vs 15.3% with culprit-only PCI) or unplanned revascularization (9.2% with complete revascularization vs 11.7% with culprit-only PCI).Stent thrombosis and stent restenosis were significantly more frequent in the complete revascularization arm (2.5% vs 0.9%, HR: 2.80, 95% CI: 1.18 – 6.67) and (4.2% vs 2.3%, HR: 1.84, 95% CI: 1.03 – 3.28), respectively.Baseline risk or coronary anatomy did not significantly affect subgroup interactions for the primary outcome.Conclusion: In patients with STEMI or high risk NSTEMI, FFR-guided complete revascularization compared to culprit-only PCI, did not improve the outcomes of death from any cause, myocardial infarction, or unplanned revascularization, over a median follow up time of 4.8 years. Complete revascularization resulted in more stent thrombosis and stent restenosis.The study lost some statistical power by stopping early, resulting in a final power of 74%. We disagree with the authors' decision to halt the trial prematurely based on the findings of the COMPLETE trial. COMPLETE was the first large trial to demonstrate a benefit in hard outcomes when revascularizing stable plaques, and its results warrant further confirmation. Furthermore, COMPLETE used different strategy as FFR was not required.Note to readers: Power measures the study's ability to avoid a Type II error (false negative) and it equals 1 - β with β being the probability of a Type II error. In other words, power represents the probability of correctly rejecting the null hypothesis (H₀) when the alternative hypothesis (H₁) is true. Most clinical trials aim for 80% or 90% power. For example, a study with 80% power has a 20% risk of failing to detect a real effect.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Brynley Stent joined Alice Canton in the studio to talk about Frigidton, on at Basement Theatre from 5-8 March. 

Pants Illustrated: https://www.instagram.com/pants.illustrated?utm_source=ig_web_button_share_sheet&igsh=ZDNlZDc0MzIxNw==Andy's appearance on "Unconventional Pathways" https://open.spotify.com/episode/13Vvnv8E0ws4mHOQV1JTLS?si=QbBr7oIySE-ESOYeruvScgAndy's appearance on Pitch Bleak on Youtube: https://youtu.be/grK7kSL_T2g?si=sVX-s1mhXx9ZhQDfThere's never been a better time to order Gustav & Henri from Andy and Pete's very own online shop.You can support the pod by chipping in to our patreon here (thank you!)Join the other TITTT scholars on the TITTT discord server hereHey, why not listen to Al's meditation/comedy podcast ShusherDon't forget TITTT Merch is now available on Red Bubble. Head over here and grab yourselves some material objectsYou can find us on twitter at @twointankAndy Matthews: @stupidoldandyAlasdair Tremblay-Birchall: @alasdairtb and instaAnd you can find us on the Facebook right here Hosted on Acast. See acast.com/privacy for more information.

DAD Catheter: An Angioplasty Apparatus for Facilitating Accurate Placement of a Lumen Stent for Dilating Ostial Stenosis

Study finds the thyroid gland needs higher vitamin D levels to function optimallyWhat are your thoughts on encapsulated organ meat supplements?  Are they bioavailable?How much water should you drink per day?  Do other beverages count towards the total?I recently had a cardiac cath procedure resulting in no stent!  Phew!

Vi snackar ”På Rymmen, Folkrace, virala utskällningar, lyxburgare, flygskräck, tid, Motala, bussar och tv-program. Det blir nästan lättare att lista vad vi inte pratade om. Vi pratade inte om kontemporär magdans, ulsurös kolit och hur diamanter görs. Men bra snack var det! Håll till godo!

In this podcast, Dr. Valentin Fuster introduces a detailed review on managing coronary stent under-expansion, a critical issue that increases risks like restenosis and myocardial infarction. The discussion highlights the causes, challenges, and treatment strategies for under-expanded stents, emphasizing the importance of intravascular imaging and individualized approaches to optimize patient outcomes.

In this podcast, Dr. Valentin Fuster discusses the Target for NA trial, which compares biodegradable polymer stents to second-generation drug-eluting stents for coronary intervention. While the results showed the biodegradable stents were non-inferior in preventing target lesion failure, questions remain regarding their real-world performance and procedural handling in clinical practice.

Hey Girl! Today's episode dives into my recent healing journey from an Iliac Stent Placement to treat my PeVD (Pelvic Venous Disorder or Pelvic Congestion Syndrome) and more about what I have been working on during my recovery to help you succeed in reaching your health and wellness goals this year! Are you a busy mom or woman  who is tired of peeing your pants when you sneeze, cough, jump or run? Maybe you're postpartum and wanting to restore your pelvic floor and core so you can feel strong and confident in your body, but not sure which exercises are “safe” and which might make your problems worse? How are you supposed to exercise and heal  if you have no time or energy?

The use of assistive devices when treating unruptured aneurysms is widespread in neurointerventional practice. But there is no standard for how long patients should receive dual anti-platelet therapy after the procedure, to protect them from thrombotic complications. Durations can range from one month to one year. This episode looks at a review of patient data across 12 locations to understand the effect of therapy duration on risk of complications.  Dr Felipe C. Albuquerque, Editor-in-Chief of JNIS, interviews Dr. Andrew Ringer¹, first author of the paper:  Impact of duration of dual anti-platelet therapy on risk of complications after stent-assisted coiling of unruptured aneurysms 1. Mayfield Clinic, Cincinnati, Ohio, USA Please subscribe to the JNIS podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/4aZmlpT) or Spotify (https://spoti.fi/3UKhGT5). We'd love to hear your feedback on social media - @JNIS_BMJ.

N Engl J Med 2016;375:1242-1252Background: The first drug-eluting stent (DES) was approved by the FDA in 2003 following the publication of the RAVEL trial. Since then, newer generations of DES were developed and were tested in clinical trials. The majority of trials comparing DES to bare-metal stents (BMS) showed reduction in repeat revascularization with DES but no significant reduction in death or myocardial infarction. Following these publications, the use of DES grew rapidly and was used in more than two thirds of percutaneous coronary interventions (PCI) by 2010.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.These trials, however, were very selective, had short follow up time (TAXUS-IV followed patients for 9 months and SPRIT IV followed patients for 12 months), and had limited power to assess hard outcomes.The NORSTENT trial investigators sought to compare DES to BMS in a more pragmatic design and follow patients for longer time.Patients: All patients who were undergoing PCI in Norway were assessed for enrollment. Patients had stable angina or acute coronary syndrome. Lesions were in native coronary arteries or bypass grafts.Patients were excluded if they had prior coronary stents, bifurcating lesions requiring a two-stent technique or life expectancy less than 5 years due to a medical condition other than coronary artery disease. Patients were also excluded if they had contraindications to dual antiplatelets or were taking warfarin.Baseline characteristics: The trial randomized 9,013 patients – 4,504 randomized to receive a DES and 4,509 to receive a BMS.The average age of patients was 63 years and 75% were men. Approximately 42% had hypertension, 54% had hyperlipidemia, 10% had prior myocardial infarction, 7% had prior CABG, 12% had diabetes, and 35% were current smokers.The indication for PCI was stable angina in 29% of the patients, unstable angina in 12% and STEMI or NSTEMI in 58%.Procedures: The study was open-label but outcomes assessment was blinded. Patients were randomly assigned in a 1:1 ratio to receive DES or BMS. Patients could receive several stents as clinically indicated but can only receive the assigned stent type during the index procedure.In all patients, aspirin 75 mg daily was given indefinitely while clopidogrel 75 mg daily was given for 9 months.Follow up visits were done as clinically appropriate without specification from the study protocol. Similarly, no routine follow up coronary angiography was performed.Endpoints: The primary outcome was a composite of all-cause death or spontaneous myocardial infarction. Secondary outcomes included repeat revascularization, stent thrombosis, major bleeding and health status based on the Seattle Angina Questionnaire.Clinical outcomes were collected by linking each patient unique national identification number to the Norwegian national patient registry.Analysis was performed based on the intention-to-treat principle. The study planned to enroll 8,000 patients to be followed for a median of 5 years. Assuming the 5-year event rate of the primary outcome to be 17%, the study would provide 93% power to detect 3% absolute risk difference between the study groups (rate ratio: 1.18). Due to lower than expected mortality, the sample size was increased to 9,000 patientsResults: Among the 20,663 patients who were assessed for eligibility, 12,425 met inclusion criteria. Among patients who met inclusion criteria, 9,013 were randomized. Figure 1 in the manuscript provides details for excluding patients and for not randomizing patients who met eligibility criteria. The most common reason for exclusion was prior PCI.The number of stents implanted per patient was 1.7 and more than 98% received the assigned stent type. The median follow up time was 5 years.The primary composite outcome of all-cause death or nonfatal spontaneous myocardial infarction was not significantly different between both treatment arms (16.6% with DES vs 17.1% with BMS, HR: 0.98; 95% CI: 0.88 - 1.09; p= 0.66).For the secondary outcomes – Hospitalization for unstable angina was similar between treatment groups (5.2% vs. 5.7%; p= 0.21). Stent thrombosis was lower with DES (0.8% vs 1.2%; p= 0.05). Target-lesion revascularization was also lower with DES (5.3% vs 10.3%; p< 0.001). Bleeding Academic Research Consortium (BARC) 3, 4 or 5 was similar between groups (5.5% vs 5.6%; p= 0.88).There was no significant difference in health status based on the Seattle Angina Questionnaire.There were no significant subgroup interactions.Conclusion: In patients undergoing PCI, the use of DES did not reduce the composite endpoint of death or spontaneous myocardial infarction compared to BMS. Target-lesion revascularization was reduced with DES with a number needed to treat of 20 patients.The findings of this study align with the results of other trials comparing DES to BMS. We have reviewed several key trials and included links to additional studies in this field below. Overall, DES significantly reduce target-lesion revascularization without significant effect on all-cause mortality or myocardial infarction.An important consideration in this and other related trials is that both stent types were studied using similar durations of dual antiplatelet therapy (DAPT) following PCI. For patients with stable angina, BMS typically require only one month of DAPT, while DES often necessitate three to twelve months. Since shorter durations of DAPT are generally safer for patients, a trial comparing DES with three to twelve months of DAPT compared to BMS with one month of DAPT would be insightful.A final teaching point is that less than 50% of screened patients were ultimately enrolled in this pragmatic trial, which had minimal exclusion criteria. It's not uncommon for trials to enroll less than 5% of screened patients which limits their external validity.* Other trials of DES vs BMShttps://pubmed.ncbi.nlm.nih.gov/21080780/https://pubmed.ncbi.nlm.nih.gov/22951305/Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Boyle's father in-law is in hospital and it is chaos.

INFINITY-SWEDEHEART Complex PCI: 1-Year Landmark 6–12 Month Clinical Outcomes Among Patients with Complex Lesion Subsets Treated with DynamX Bioadaptor Compared to a Contemporary Drug Eluting Stent

Hey Friend, For those that haven't been following along, I have been struggling with symptoms of Pelvic Venous Disorder or PeVD or better known as, Pelvic Congestion Syndrome, for the last year.  It all started with an ovarian cyst like pain, but I later learned that my “menstrual cramps” I was feeling on and off throughout the month, not just during my menses, was also due to these enlarged veins.  The heaviness and cramping was starting to get so uncomfortable that standing or sitting for too long was painful, and even exercise started to become painful.  Thankfully sex was never painful, but painful intercourse or dyspareunia, especially pain or cramping with and after arousal or orgasm, is a very common symptom of PeVD.  I was not a typical presentation for this diagnosis, so it surprised me when I found out from an ultrasound.  So I share my story so that others with pelvic pain, constipation, heaviness, sharp abdominal pain, low back pain or pain with sitting, standing, or exercising, can start to become aware of this diagnosis and advocate for yourself.  As many gynecologists do not believe this condition is a cause of pain…. And I can tell you… it most definitely IS!   After two procedures using coil embolization and sclerotherapy to close off the dysfunctional varicose veins in my pelvis, it was identified that a compression of my Iliac vein was pretty severe and needed to be treated with a stent.  I am two weeks postop and recovery has been a journey.  Many things I was not expecting, so again, I wanted to share with the World so that maybe you can feel more prepared and aware of the treatment options out there for you! Thanks for following along on my health journey and sending all the love and supporting messages, it has meant a lot!  As always, if you are experiencing any pelvic floor/women's health issue like urinary incontinence/leaking, pelvic pain, pain with sex, urgency, heaviness/prolapse or any other back/hip/joint pain let's get you booked for a virtual coaching session or in person physical therapy session for a more individualized plan and one-on-one instructions so you can feel confident in your body and start healing today!!    Make Sure to reach out to> PTDes@balancedmomtality.com  AND/OR Join my FREE Facebook community for ACCOUNTABILITY and a safe and supportive place to share and support each other!> https://www.facebook.com/groups/1696216757461633/    Join my VIP Insider group and receive my Newsletter full of great tips and tricks and upcoming resources! > https://newsletter.balancedmomtality.com/   Follow and get tips/tricks on:  Facebook> @thebalancedmomtality Instagram> @the_balanced_momtality   Learn > www.balancedmomtality.com

TARGET IV International Multicenter Randomized Assessment of the Firehawk® Rapamycin Eluting Coronary Stent System

N Engl J Med 2010;362:1663-74.Background: The RAVEL and TAXUS-IV trials compared the sirolimus- and paclitaxel-eluting 2nd generation stents to 1st generation bare metal stents. Both trials reported improvements in surrogate endpoints - “in-stent luminal loss” was the primary endpoint of RAVEL and “ischemia-driven target-vessel revascularization” was the primary endpoint of TAXUS-IV. Neither trial showed differences in hard endpoints like death or MI but were not powered for such events.The observation that restenosis still occurred with 2nd generation stents drove interest in developing newer stent technology with improved bioavailability and drug delivery. The 3rd generation everolimus-eluting stent was felt to represent such a development but like its predecessors had only been tested in experiments using surrogate endpoints that were not driven by clinical symptoms. Thus, the SPIRIT IV trial sought to test the hypothesis that 3rd generation everolimus-eluting stents would reduce patient-driven clinical outcomes compared 2nd generation paclitaxel-eluting stents. Furthermore, it was designed to be large enough to provide data on important subgroups, especially patients with diabetes.Patients: Limited details are provided about inclusion and exclusion criteria in the main manuscript and readers are directed to a previous publication and supplemental appendix. Lesion characteristics had to be less than 28 mm in length with a reference-vessel diameter between 2.5 to 3.75 mm. Patients were excluded if they had features making them complex from either a clinical or angiographic standpoint. *Note to learners: Be especially skeptical of trials that do not include at least an abridged version of important inclusion and exclusion criteria in the main publication manuscript. This often indicates that the criteria are complex and that patients are highly selected, which limits the generalizability of the findings to routine practice. Baseline characteristics: The average age of patients was 63 years and 68% were men. Approximately 32% of patients had diabetes with about one quarter being insulin-dependent. Over 20%of patients smoked and a similar percentage had a previous heart attack.Three quarters of patients had 1 target lesion, 22% had 2 target lesions and 3% had 3 and 11% of patients had 1 or more complex lesions. The average lesion length was 15 mm, reference-vessel diameter was 2.75 mm, minimal luminal diameter was 0.75 mm, and average % stenosis was 72%.Procedures: Patients were randomized in a 2:1 ratio to receive an everolimus- or paclitaxel-eluting stent. They were stratified based on having diabetes or not, whether they had a single or complex lesion, and study site. Operators were not blind to the stent being used. At least 300 mg of aspirin was administered before catheterization and at least 300 mg of clopidogrel was recommended before the procedure and was required within 1 hour after stent implantation. Patients took at least 80 mg of aspirin daily for an indefinite period and 75 mg of clopidogrel for at least 12 months. Clinical follow-up visits were scheduled at 30, 180, 270, and 365 days and yearly through 5 years.Endpoints: The primary end point was ischemia-driven target lesion failure at 1 year defined by the composite of cardiac death, target-vessel myocardial infarction, or ischemia-driven target-lesion revascularization. As was the case in the TAXUS-IV trial, “ischemia-driven” did not necessarily mean “symptom-driven”. Two major secondary endpoints were also prespecified which included ischemia-driven target-lesion revascularization and the composite of death or target-vessel MI.The trial was powered for sequential testing of noninferiority and superiority for both the primary and 2 major secondary endpoints. The criteria for noninferiority would be met if the upper limit of the 97.5% confidence interval was not more than 3.1%. This was based on an assumed 1 year target-lesion failure rate of 8.2% for both groups. The trial had 90% power to show non-inferiority. Superiority testing was prespecified if the criterion for noninferiority was met. It was estimated that 3690 patients would have 90% power to detect a 2.9% absolute reduction in the primary end point, at a two-sided alpha of 0.05. The trial also had 90% power to test noninferiority for ischemia-driven target-lesion revascularization and the composite of cardiac death or target-vessel MI at a 2.1% margin. It had 90% and 91% power to test for superiority of these endpoints if noninferiority was met.*Note to learners: The statistical analysis plan for this trial demonstrates 2 important concepts in hypothesis testing. First, trials can be powered in a prespecified manner for non-inferiority and superiority testing. Second, trials can be powered for prespecified hypothesis testing of more than just a single endpoint.Results: Patients were enrolled over a 2 year period from 66 U.S. sites. There were a total of 3,687 patients included in the final analysis with 2,458 in the everolimus-eluting stent group and 1,229 in the paclitaxel-eluting stent group. There were some significant differences for patients receiving everolimus-eluting stents that included the number of stents per lesion, total stent length per lesion, the ratio of stent length to lesion length and the maximum pressure used.At 1 year, everolimus-eluting stents met non-inferiority for the primary and major secondary endpoints and met superiority for 2 of 3. Everolimus-eluting stents reduced the primary endpoint of target-lesion failure (4.2% vs 6.8%; RR 0.62; 95% CI 0.46 to 0.82) and the major secondary endpoint of ischemia-driven target lesion revascularization (2.5 vs 4.6%; RR 0.55; 95% CI 0.38 to 0.78) but not the other major secondary endpoint of cardiac death or target-vessel MI (2.2% vs 3.2%; RR 0.69; 95% CI 0.46 to 1.04). Differences in target-lesion failure were driven by statistically significant reductions in target-lesion revascularization (2.5% vs 4.6%) as well as MI (1.9% vs 3.1%) but not all-cause (1.0% vs 1.3%) or cardiac death (0.4% vs 0.4%). Stent thrombosis was also significantly reduced but rates were very low in both groups and the trial was not powered for this endpoint.Interestingly, subgroup analysis of the primary endpoint revealed a statistically significant interaction for treatment efficacy in patients with diabetes such that diabetics did not appear to benefit from everolimus-eluting stents (6.4% vs 6.9%) compared to non-diabetics (3.3% vs 6.7%; p for interaction = 0.02).Conclusions: In patients with stable CAD who underwent generally non-complex PCI procedures, 3rd generation everolimus-eluting stents compared to 2nd generation paclitaxel-eluting stents reduced a composite endpoint of ischemia-driven target-lesion failure by 38% with a number needed to treat of approximately 40 patients. This was associated with statistically significant reductions in nonfatal MI with a NNT of approximately 100 patients and ischemia-driven target lesion revascularization with a NNT of approximately 50 patients. Everolimus-eluting stents did not reduce death.There was an interaction noted for diabetic patients who did not appear to significantly benefit from everolimus-eluting stents. Notably, diabetics exhibited more severe angiographic disease with a higher prevalence of multivessel disease, diffuse plaque burden, and a greater likelihood of left main coronary artery involvement. This subgroup finding along with the highly selected nature of the study cohort reduces our confidence that the 3rd generation everolimus-eluting stent confers significant advantages over 2nd generation stents for many patients who receive them in clinical practice.One final consideration is that the trial was single blinded and operators were aware of stent type which could have biased their performance and the study results.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

“When the results came back, he was once again floored: There was no sign of cardiovascular damage, and no signs of buildup in my arteries. I did it: I reversed my disease, just as the book that I'd read in the hospital bed said I could! My doctor couldn't believe it; he wanted to know what I was doing and all the details. He advised me that I could discontinue all my medications.” Listen to today's success story by Karlynn McCarrell at @forksoverknives. #vegan #plantbased #plantbasedbriefing #stent #heartdisease #wfpb #esselstyn Original post:  https://www.forksoverknives.com/success-stories/after-stent-at-age-32-i-went-plant-based-lost-200-pounds-reversed-heart-disease  Forks Over Knives Documentary: https://www.forksoverknives.com/the-film/  Forks Over Knives was founded following the release of the world-famous documentary Forks Over Knives in 2011, showing people how to regain control of their health and their lives with a plant-based diet. Since then Forks Over Knives released bestselling books, launched a mobile recipe app and maintains a website filled with the latest research, success stories, recipes, and tools to help people at every phase of their plant-based journeys. They also have a cooking course, a meal planner, a line of food products, and a magazine. Please visit www.ForksOverKnives.com for a wealth of resources.  FOLLOW THE SHOW ON: YouTube: https://www.youtube.com/@plantbasedbriefing     Spotify: https://open.spotify.com/show/2GONW0q2EDJMzqhuwuxdCF?si=2a20c247461d4ad7 Apple Podcasts: https://podcasts.apple.com/us/podcast/plant-based-briefing/id1562925866 Your podcast app of choice: https://pod.link/1562925866 Facebook: https://www.facebook.com/PlantBasedBriefing   LinkedIn: https://www.linkedin.com/company/plant-based-briefing/   Instagram: https://www.instagram.com/plantbasedbriefing/     

Alice Canton joins Beth in-studio to kōrero with Kura Forrester and Brynley Stent about Camping, a play created and performed by Chris Parker and Tom Sainsbury with Forrester and Stent. Think The Rocky Horror Picture Show meets French and Saunders in this risqué romp through a sea of sexual tension, tantrums, and tomfoolery.  Camping is showing at Q Theatre from 14th November – 7th December. Tickets from Q Theatre's website.

Dr. Ethan Korngold is the chief medical officer and divisional vice president of medical affairs at Abbott's vascular business, which has developed a dissolvable stent technology to treat peripheral artery disease. PAD disproportionately affects Black and Hispanic communities and is often overlooked because early symptoms can be mistaken for other conditions. The Esprit BTK stent can help open up the smaller arteries below the knee and improve blood flow to the legs and feet to treat PAD and prevent severe complications and amputations. Ethan explains, "So peripheral artery disease refers to blockages in the arteries to the legs. When those blockages build up, it's because of cholesterol typically that builds up in the walls of the artery and causes limited blood flow. Initially, people can have cramping or soreness in their legs when they walk. That gets better with rest. As the blockages get worse, people can develop infections, ulcers, or non-healing wounds of their legs with what we call chronic limb-threatening ischemia. And ultimately, that can put people at risk for amputation." "A lot of people aren't aware of how common it is, and a lot of people aren't attuned to the symptoms of it. People just sort of slow down. They do less and less, and they wind up being limited in their activities, and that really affects their health and their life, and ultimately, that can threaten their limbs. One of the things that Abbott is emphatic about is spreading awareness of the disease, trying to educate patients, trying to educate families, and trying to educate physicians so that people are more on guard for looking out for the signs and symptoms of the disease." "We have been working at Abbott for many years on techniques to help open up these blockages in the arteries of the legs. They start at about the belly button and go all the way down to the toes. At the belly button, the iliac arteries are quite large. They are about a half an inch in diameter. And then, as they go down all the way to the toes, they get narrower and narrower so that they're about a quarter of an inch to an eighth of an inch in diameter. There are a variety of different techniques to get through those blockages, such as using catheters, and wires balloons, and stents and scaffolds to help open up those arteries and change people's lives. One of the biggest challenges in this space has been those smaller arteries below the knee." #Abbott #AbbottVascular #PeripheralArteryDisease #PAD #DissolvableStentTechnology abbott.com PAD-info.com Download the transcript here

Dr. Ethan Korngold is the chief medical officer and divisional vice president of medical affairs at Abbott's vascular business, which has developed a dissolvable stent technology to treat peripheral artery disease. PAD disproportionately affects Black and Hispanic communities and is often overlooked because early symptoms can be mistaken for other conditions. The Esprit BTK stent can help open up the smaller arteries below the knee and improve blood flow to the legs and feet to treat PAD and prevent severe complications and amputations. Ethan explains, "So peripheral artery disease refers to blockages in the arteries to the legs. When those blockages build up, it's because of cholesterol typically that builds up in the walls of the artery and causes limited blood flow. Initially, people can have cramping or soreness in their legs when they walk. That gets better with rest. As the blockages get worse, people can develop infections, ulcers, or non-healing wounds of their legs with what we call chronic limb-threatening ischemia. And ultimately, that can put people at risk for amputation." "A lot of people aren't aware of how common it is, and a lot of people aren't attuned to the symptoms of it. People just sort of slow down. They do less and less, and they wind up being limited in their activities, and that really affects their health and their life, and ultimately, that can threaten their limbs. One of the things that Abbott is emphatic about is spreading awareness of the disease, trying to educate patients, trying to educate families, and trying to educate physicians so that people are more on guard for looking out for the signs and symptoms of the disease." "We have been working at Abbott for many years on techniques to help open up these blockages in the arteries of the legs. They start at about the belly button and go all the way down to the toes. At the belly button, the iliac arteries are quite large. They are about a half an inch in diameter. And then, as they go down all the way to the toes, they get narrower and narrower so that they're about a quarter of an inch to an eighth of an inch in diameter. There are a variety of different techniques to get through those blockages, such as using catheters, and wires balloons, and stents and scaffolds to help open up those arteries and change people's lives. One of the biggest challenges in this space has been those smaller arteries below the knee." #Abbott #AbbottVascular #PeripheralArteryDisease #PAD #DissolvableStentTechnology abbott.com PAD-info.com Listen to the podcast here

For Stage Direction this week, Alice Canton joins Joel in studio to speak to Johanna Cosgrove and Brynley Stent about 'Hi Delusion' and 'Soft Carnage', both on at Basement Theatre tonight and tomorrow night. You can get tickets to Johanna's show here, and tickets to Brynley's here!

Author Robert W. Yeh, MD, FACC, and JACC Associate Editor Celina M. Yong, MD, FACC, discuss the results of the TARGET-IV NA trial. In the trial, 1720 patients with stable or acute coronary syndromes were randomized to undergo PCI with a BP-SES or any commonly used 2nd generation DES. At 12 months, BP-SES was non-inferior to control DES for the primary endpoint of Target Lesion Failure (cardiac death, target vessel-related myocardial infarction (MI), or ischemia-driven target lesion revascularization) which occurred in 3.4% of the BP-SES arm versus 3.3% in the control arm; p-value for non-inferiority. Secondary endpoints were also similar between groups.

"It's not entirely unique to IR, but it's something that's encountered more because it is so fast-moving, and it's what kind of drew me into the specialty. But having done this project has given me a new perspective on the importance of good, quality research and engaging with it."—Hayley Briody, MB, BCh, MSCIn this Journal of Vascular and Interventional Radiology (JVIR) audio episode, lead author Hayley Briody, MB, BCh, MSC, speaks with journal Managing Editor Ana Lewis about her October 2024 paper, Mortality, Safety, and Effectiveness of Paclitaxel-Containing Balloons and Stents in the Femoropopliteal Artery: Systematic Review and Meta-Analysis of Randomized Controlled Trials since 2018."Related resources:Read the original article, "Mortality, Safety, and Effectiveness of Paclitaxel-Containing Balloons and Stents in the Femoropopliteal Artery: Systematic Review and Meta-Analysis of Randomized Controlled Trials since 2018," by Haley Briody, MB, BCh, MSc; Conor A. Kearns, BA (Mod), MSc, MRes; and Michael J. Lee, MB, BCh, MScRead the related commentary, "Paclitaxel Meta-Analyses in the Lower Limbs: Missing the Trees for the Forest," by Konstantinos Katsanos, MD, PhDContact us with your ideas and questions, or read more about about interventional radiology in IR Quarterly magazine or SIR's Patient Center.(c) Society of Interventional Radiology.Support the show

INFINITY-SWEDEHEART – Percutaneous Coronary Intervention with a Bioadaptor Compared to a Contemporary Drug Eluting Stent- One Year Primary Outcomes

N Engl J Med 2009;360:961-972Background: After its introduction in 1968, the use of coronary artery bypass grafting (CABG) in patients with coronary artery disease grew rapidly. Although early trial results were mixed (see the Veterans Administration Cooperative study, the European Coronary Surgery Study and the CASS study), advancements in surgical techniques and the use of arterial conduits improved survival and reduced graft occlusion rates. In 1977, percutaneous coronary intervention (PCI) was introduced, and subsequent improvements in PCI techniques and stents have led to fewer complications and better stent patency. Large trials comparing CABG to PCI using drug-eluting stents were lacking.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial sought to assess the optimal revascularization strategy for patients with left main or three-vessel coronary artery disease.Patients: Eligible patients had three-vessel or left main coronary artery disease. Patients had to have 50% or more stenosis in the target vessels and either chest pain or evidence of myocardial ischemia. Exclusion criteria were previous PCI or CABG, acute myocardial infarction or the need for concomitant cardiac surgery.Baseline characteristics: The trial randomized 1,800 patients – 903 randomized to PCI and 897 to CABG.The average age of patients was 65 years and 78% were men. The average body mass index was 28 kg/m2. Approximately 67% had hypertension, 78% had hyperlipidemia, 25% had diabetes, 33% had prior myocardial infarction, 5% had congestive heart failure, and 20% were current smokers.The number of target lesions was approximately 4 in both groups. The SYNTAX score was 28.4 in the PCI group and 29.1 in the CABG group.Note to readers: The SYNTAX score is an anatomical score to grade the complexity of coronary artery disease with higher scores indicating more complex disease. A score of 22 or less is considered low whereas a score of 33 or more is considered high (this scoring was a prespecified secondary endpoint). Procedures: Patients were assigned in a 1:1 ratio to undergo CABG or PCI using Taxus Express paclitaxel-eluting stents (drug-eluting stent). Randomization was stratified by the presence or absence of left main disease and diabetes.The intent was to achieve complete revascularization in all coronary arteries of at least 1.5 mm diameter with 50% or more stenosis. The techniques for CABG and PCI and post procedural medications were chosen based on local practices.Endpoints: The primary endpoint was a composite of death from any cause, stroke, myocardial infarction, or repeat revascularization up to 12 months after randomization.Analysis was performed based on the intention-to-treat principle. The primary analysis was a non-inferiority analysis. The estimated sample size was 1800 patients assuming 13.2% event rate in the CABG group, 14.0% in the PCI group and 6.6% absolute risk difference non-inferiority margin. This sample size would provide 96% power at 5% one-sided alpha.Results: Revascularization was complete in 56.7% of the patients in the PCI group and 63.2% in the CABG group. In the CABG group, one or more arterial grafts were used in 97.3% of the patients. In the PCI group, the average number of stents implanted per patient was more than four.At 12 months, the primary outcome was lower in the CABG group (12.4% vs 17.8%, RR with PCI: 1.44, 95% CI: 1.15 – 1.81; p= 0.002). The absolute difference was 5.4% with an upper bounds of the 95% CI of 8.3%; thus not meeting non-inferiority. Stroke was lower with PCI (0.6% vs 2.2%; p= 0.003) while repeat revascularization was lower with CABG (5.9% vs 13.5%; p< 0.001). There was no significant difference in death from any cause (4.4% with PCI vs 3.5% with CABG; p= 0.37) or myocardial infarction (4.8% with PCI vs 3.3% with CABG; p= 0.11).There was a significant interaction based on the SYNTAX score where patients with high SYNTAX scores (>/=33) had significant benefit with CABG while patients with low or intermediate SYNTAX scores did not (14.7% with CABG vs 13.6% with PCI for low SYNTAX score, 12.0% with CABG vs 16.7% with PCI for intermediate SYNTAX score, and 10.9% with CABG vs 23.4% with PCI for high SYNTAX score; p for interaction= 0.01).In the subgroup of patients with left main disease, the rate of the primary outcome at 12 months was not significantly different between both treatment groups (13.7% with CABG vs 15.8% with PCI; p= 0.44). In patients with three-vessel but no left main disease, the primary outcome was significantly higher in the PCI group (19.2% vs 11.5%; p< 0.001).Stent thrombosis was 3.2% in the PCI group and graft occlusion was 3.1% in the CABG group.Conclusion: In patients with stable three-vessel or left main coronary artery disease, PCI did not meet non-inferiority compared to CABG in reducing the composite endpoint of death from any cause, stroke, myocardial infarction, or repeat revascularization over 12 months of follow up. The number of patients needed to treat with CABG to prevent one primary endpoint was approximately 19 patients, which was mainly accounted for by repeat revascularization. There was no significant difference in death or myocardial infarction and stroke was higher in the CABG group.The subgroup analysis based on SYNTAX score demonstrated a strong signal that CABG is more effective than PCI in patients with complex coronary artery disease. In patients with stable coronary artery disease, meeting the inclusion criteria of this trial, the risk of repeat revascularization with PCI should be carefully weighed against the increased stroke risk and invasiveness of CABG. Considerations regarding patient selection are crucial. It is reasonable to anticipate that less robust patients will have higher morbidity with CABG versus PCI.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Neste episódio, Mateus Prata e Marcos Meniconi recebem o renomado Dr. Ricardo Costa para uma discussão profunda sobre lesão de tronco de coronária esquerda (TCE). Eles abordam os cenários em que é possível tratar clinicamente versus a necessidade de intervenção cirúrgica ou com stent. Com referências a importantes estudos como PRECOMBAT, SYNTAX, EXCEL e NOBLE, o trio explora os vieses e os fatores que influenciam a decisão terapêutica, sempre destacando a importância do Heart Team e da avaliação personalizada de cada paciente. Um episódio essencial para quem deseja se atualizar sobre o manejo da lesão de TCE! __________________________________ Atualizações e revisões didáticas e leves, semanalmente, na DozeNews PRIME: estude semanalmente através do link dozeporoito.com/prime Ainda não se inscreveu no nosso preparatório para a prova de Título de Especialista em Cardiologia? Ainda da tempo de ser aprovado! Acesse https://www.medway.com.br/cursos/dozetec/

In this episode of B2B Better, I'm joined by Billy Hamilton-Stent, Chief Strategy Officer at Publicis Pro, to discuss assumptions in B2B marketing. We discuss how unchecked assumptions can derail even the best marketing strategies and why balancing data, intuition, and critical thinking is the key to long-term success. Billy shares insights from Publicis Pro's latest report on SMB marketing challenges and myths, while we explore real-world examples of how businesses can overcome misguided assumptions to achieve better results. We also talk about the importance of blending quick fixes with long-term strategic thinking and how to recognize when you're relying too heavily on assumptions in your demand-generation efforts. This episode has actionable takeaways for any marketer or business owner looking to challenge the status quo and make smarter decisions. Links & Resources: Publicis Pro's SMB Marketing ReportBilly Hamilton-Stent on LinkedIn Exclusive Offer for B2B Better Listeners Quick reminder that all B2B Better listeners are eligible to receive double the number of outreach credits for their first outreach campaign with Sopro.  Use them to experiment with some new messaging, try and open up a new market outside your network, or simply double your chances of closing more deals with your ideal customer.  Visit sopro.io/b2b-better-offer to find out more. 

VISIT US AT ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠NCLEXHIGHYIELD.COM⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ No matter where you are in the world, or what your schedule is like, access the entire course at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.NCLEXHighYieldCourse.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  The NCLEX High Yield Podcast was featured on ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Top 15 NCLEX Podcasts⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠! Make sure you ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠JOIN OUR NEW VIP FACEBOOK GROUP!⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://nclexhighyield.com/blogs/news/nclex-high-yield-quick-links⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ A topic that confuses many, but listen to how Dr. Zeeshan breaks this bad boy down! Many people get overwhelmed with all the information that's out there, we keep it simple! Join us weekly for FREE Zoom Sessions and be one of the many REPEAT test takers that passed the exam by spending NO MONEY with NCLEX High Yield! NCLEX High Yield is a Prep Course and Tutoring Company started by Dr. Zeeshan in order to help people pass the NCLEX, whether it's the first time , or like the majority of our students, it's NOT their first time. We keep things simple, show you trends and tips that no one has discovered, and help you on all levels of the exam! Follow us on Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@NCLEXHighYield ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠or check out our website www.NCLEXHighYield.com Make sure you join us for our FREE Weekly Zoom Sessions! Every Wednesday 3PM PST / 6PM EST. Subscribe to our newsletter at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠nclexhighyield.com⁠⁠⁠⁠⁠⁠ --- Support this podcast: https://podcasters.spotify.com/pod/show/nclexhighyield/support

Einars problemer med ny telefon ble ikke oppsummert nok i torsdagens episode, og fortsetter i dagens SnikkSnakk i anledning steintøyshopping. Produsert av Martin Oftedal, PLAN-B Hosted on Acast. See acast.com/privacy for more information.

September 6, 2024 Mark, Ray, and Scott address follow-up questions from the previous episode concerning the billability of ureteral stents during procedures. They clarify distinctions between inherent procedural components and separately billable services, emphasizing the importance of documentation.The episode also reviews coding for G2211, where Mark adjusts his stance to include hypogonadism for long-term management. Additionally, the hosts discuss the supervision levels required for radiologic services and recommend AUACodingToday.com for efficient coding. Emphasizing up-to-date knowledge and precision in documentation, the episode closes with insights on adapting to evolving coding regulations.PRS Billing and Other Services - Book a Call with Mark Painter or Marianne DescioseClick Here to Get More Information and Request a QuoteUrology Advanced Coding and Reimbursement Seminars - In-Person SeminarsRegister Now for the Urology Advanced Coding and Reimbursement SeminarClick Here for Information and RegistrationEvent DetailsLocation:Las Vegas: December 6-7, 2024, at HorseshoeNew Orleans: January 31-February 1, 2025, at Harrah'sTime: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pmIncludes: Breakfast and Lunch on both days, plus 14 AAPC CEUs   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/    Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.Click Here to Start Your Free Trial of AUACodingToday.com

August 30, 2024 Mark, Scott, and Ray talk about questions that came into the PRS Communities.Hi, I have a coding question pls. Thanks so much.Our urologist performed HIFU a month ago. Pt. had come back for Dysuria postop complication, has been having dysuria for 2 weeks. Our urologist decided to perform Cystoscopy for this.Cystoscopy performed, but we did Not bring Pt. back to OR. So, it should Not be a billable serviceBut then, Per NCCI, Diagnostic test and procedures may be paid as a separate service during global.Should we bill CPT 52000? and If so, will modifier be -58, since it did not occur in OR so -78 would not be an appropriate modifier? Please suggest, thank you!Modifier 73 Question: Can this modifier be used when the patient is in the pre op area and he/she was given Dilaudid and another mediation and then prepped for surgery but then the patient decided they did not want to proceed because the pain medication made them feel better(Patient had a Kidney Stone). It seems resources were used and a block of time was scheduled for the facility. Wording can be a little different from our MAC, CPT, etc when some state the patient has to be taken to the operating room. Thanks for your time. Hi, We are getting some pushback and would like to know when/if ureteral stents are billable intraoperatively. Our providers are placing a stent, performing pyeloplasty in the same ureter, and the stent is routinely removed one week later.Is this stent placement an inherent part of performing the primary procedure, or is this a billable service? Thank you!PRS Billing and Other Services - Book a Call with Mark Painter or Marianne DescioseClick Here to Get More Information and Request a QuoteUrology Advanced Coding and Reimbursement Seminars - In-Person SeminarsRegister Now for the Urology Advanced Coding and Reimbursement SeminarClick Here for Information and RegistrationEvent DetailsLocation:Las Vegas: December 6-7, 2024, at HorseshoeNew Orleans: January 31-February 1, 2025, at Harrah'sTime: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pmIncludes: Breakfast and Lunch on both days, plus 14 AAPC CEUs   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/    Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.Click Here to Start Your Free Trial of AUACodingToday.com

Marcus Stent is a renowned competition RC glider pilot, but also a guru on model plane setups. Marcus joins us to educate us on electric motor setups for RC planes. Whether you are into gliding, aerobatic or scale models, Marcus's way of explaining how to get the right setup is like no other. Grab a pen and paper and come along from the ride.

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

On this week's Taskmaster Podcast NZ Ed talks to the brilliant Brynley Stent! Brynley shines a light on Series 1 and gives her own rendition of the Libya song! Catch Brynley at The Soho Theatre https://sohotheatre.com/events/brynley-stent-frigid/For all things TM visit Taskmaster.tv For the live experience visit taskmasterliveexperience.comWatch all of Taskmaster at Channel4.com

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

A Note from James:Imagine you are dying or you're about to die. Let's say you were hit by a car, you're bleeding out, you're on the way to the hospital but you just have this sense that you're not going to live, and you see visions of someone you knew in the past, maybe a mother or a father, and they're saying, "Don't worry, we're here for you." Come down this light at the end of a tunnel. Does that change your experience of life if you then survive? Well, we're going to hear from Sebastian Junger, who wrote "In My Time of Dying: How I Came Face to Face with the Idea of an Afterlife." And if you don't know who Sebastian is, he's written many books about being a war reporter, his experiences in war zones, and other intense situations. But this is perhaps his most intense book that I've read, where he's not talking about deaths on the battlefield or in a war zone, but his own experience of dying and what happened to him during that experience. It really makes you think. And I've been thinking about it a lot for personal reasons this past week. I hope everybody enjoys it. If you do, please retweet it, share it with your friends, and subscribe to the podcast so all the good little algorithms work for me. Thanks so much, and here is Sebastian.Episode Description:In this compelling episode, James Altucher converses with Sebastian Junger, acclaimed author and war reporter, about his harrowing near-death experience and his exploration of the afterlife in his latest book, "In My Time of Dying." Junger shares the profound and mystifying moments he faced at the brink of death, challenging his atheistic beliefs and scientific understanding. This episode isn't just about a personal encounter with mortality but dives into the larger implications of consciousness, the mysteries of the human mind, and what it means to truly live after facing death.What You'll Learn:The profound impact of near-death experiences on one's worldview and beliefs.The intersection of scientific rationalism and mystical experiences.Insights into the psychological and emotional aftermath of surviving a near-death experience.Theories about consciousness and the potential for an afterlife from both scientific and experiential perspectives.Practical lessons on living a more appreciative and meaningful life after a brush with death.Chapters:00:01:30 - Introduction: Sebastian Junger's Near-Death Experience00:04:41 - The Moment of Crisis: Abdominal Hemorrhage and Medical Intervention00:09:00 - Encountering the Void and Seeing His Father00:14:22 - The Medical Miracle: Innovative Interventional Radiology00:24:26 - Rational Explanations vs. Mystical Experiences00:31:30 - Unexplained Phenomena: Quantum Mechanics and Consciousness00:41:29 - Personal and Philosophical Reflections on Life and Death00:52:30 - The Aftermath: Dealing with Anxiety and Fear00:56:35 - Finding Meaning and Appreciation in Life Post-Trauma01:02:15 - Writing About the Experience: Structuring the Narrative01:05:28 - Final Thoughts and TakeawaysAdditional Resources:Sebastian Junger's Official WebsiteIn My Time of Dying: How I Came Face to Face with the Idea of an AfterlifeTribe: On Homecoming and Belonging by Sebastian JungerWar by Sebastian JungerQuantum Enigma: Physics Encounters Consciousness by Bruce Rosenblum and Fred KuttnerBiocentrism: How Life and Consciousness are the Keys to Understanding the True Nature of the Universe by Robert Lanza ------------What do YOU think of the show? Head to JamesAltucherShow.com/listeners and fill out a short survey that will help us better tailor the podcast to our audience!Are you interested in getting direct answers from James about your question on a podcast? Go to JamesAltucherShow.com/AskAltucher and send in your questions to be answered on the air!------------Visit Notepd.com to read our idea lists & sign up to create your own!My new book, Skip the Line, is out! Make sure you get a copy wherever books are sold!Join the You Should Run for President 2.0 Facebook Group, where we discuss why you should run for President.I write about all my podcasts! Check out the full post and learn what I learned at jamesaltuchershow.com------------Thank you so much for listening! If you like this episode, please rate, review, and subscribe to “The James Altucher Show” wherever you get your podcasts: Apple PodcastsiHeart RadioSpotifyFollow me on social media:YouTubeTwitterFacebookLinkedIn

Commentary by Dr. Valentin Fuster

N Engl J Med 2014;371:1016-1027Background: Prior trials have demonstrated that combining P2Y12 inhibitors with aspirin in patients with acute coronary syndrome reduces cardiovascular events. Prasugrel, in the TRITON-TIMI 38 trial, and ticagrelor, in the PLATO trial, were administered in the hospital.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.Older trials had suggested that early administration of glycoprotein IIb/IIIa inhibitors improves outcomes in patients with ST elevation myocardial infarction (STEMI).The ATLANTIC trial sought to test the hypothesis that pre-hospital compared to in-hospital administration of the P2Y12 inhibitor, ticagrelor, improves outcomes in patients with STEMI.Patients: Patients were enrolled if they had STEMI and had experienced symptoms for at least 30 minutes but no longer than 6 hours, and were expected to have EKG to balloon inflation of less than 120 minutes. Patients were excluded if they had prior intracranial bleeding, moderate to severe liver disease, gastrointestinal bleeding within 6 months, planned fibrinolytic therapy or required dialysis.Baseline characteristics: The average age of patients was 61 years with 80% being men. The average weight was 80 kg. About 14% had diabetes, 9% had prior myocardial infarction, 4% had chronic obstructive pulmonary disease and 2% had chronic renal failure. TIMI risk score was 0-2 in 61% of the patients. About 90% had Killip class I. Coronary angiography was performed in 98% of the patients and percutaneous coronary intervention (PCI) with stent placement was performed in 82%. The use of glycoprotein IIb/IIIa inhibitors was high in the study and was administered before percutaneous coronary intervention in 29% of the patients.Procedures: Patients were randomized 1:1 to receive ticagrelor en route to the hospital/ catheterization lab (group 1) or at the catheterization lab (group 2). In group 1, patients received ticagrelor 180mg en route to the hospital and placebo in the catheterization lab. In group 2, patients received placebo en route to the hospital and ticagrelor 180mg in the catheterization lab. Following that, all patients received ticagrelor 90mg twice daily for at least 30 days and the treatment was recommended to continue for 12 months. Clinical endpoints were adjudicated up to 30-days post randomization.Endpoints: There were two coprimary endpoints – proportion of patients who did not have 70% or greater resolution in their ST-segment elevation before PCI and proportion of patients without TIMI grade III flow in the infarcted artery before PCI. Review of EKG and angiographic data was blinded.A secondary prespecified endpoint included the composite of all-cause death, myocardial infarction, stent thrombosis, stroke or urgent revascularization at 30 days.Analysis was performed based on the modified intention-to-treat principle, defined as patients who received at least one loading dose of the study drug. Patients with missing EKG or angiographic data were excluded from the primary endpoint analysis.The sample size estimate was based on an anticipated event rate of 15% in the control group for the EKG endpoint. They estimated that 779 patients would be needed in each group to show a 6% absolute difference with 80% power and an alpha of 2.5%.Results: The trial randomized 1,862 patients, 909 patients to the prehospital group and 953 to the in-hospital group. The median time from randomization to angiography was 48 minutes and the median time between the two loading doses was 31 minutes.There was no significant difference in the proportion of patients who did not have 70% or more ST segment resolution before PCI (86.8% for the pre-hospital group vs 87.6% for the in-hospital group, OR: 0.93, 95% CI: 0.69 – 1.25; p= 0.63) or the proportion of patients who did not have TIMI III flow in the infarcted artery before PCI (82.6% for the pre-hospital group vs 83.1% for the in-hospital group, OR: 0.97, 95% CI: 0.75 – 1.25; p= 0.82).There was also no significant difference for the secondary composite endpoint (4.5% vs 4.4%, OR: 1.03, 95% CI: 0.66 – 1.60; p= 0.91). Stent thrombosis at 30-days was lower in the pre-hospital group (0.2% vs 1.2%, OR: 0.19, 95% CI: 0.04 – 0.86; p= 0.02). Myocardial infarction was not significantly different between both groups (0.8% vs 1.1%; p= 0.53). All-cause death was numerically higher in the pre-hospital group (3.3% vs 2.0%, OR: 1.68, 95% CI: 0.94 – 3.01; p= 0.08).Major bleeding not related to CABG was not significantly different between both treatment groups (1.3% in both groups using the TIMI criteria and 2.9% in the pre-hospital group vs 2.5% in the in-hospital group, using the STEEPLE criteria).Conclusion: In patients with STEMI, pre-hospital administration of ticagrelor did not improve outcomes compared to in-hospital administration. Although pre-hospital administration of ticagrelor reduced stent thrombosis at 30-days, this did not reduce all-cause mortality. In fact, all-cause mortality was numerically higher in the pre-hospital group.A notable finding is that within the in-hospital group, definite stent thrombosis occurred in 1.2% of patients while 1.1% were adjudicated to have myocardial infarction. Stent thrombosis is a serious condition that leads to myocardial infarction. The trial protocol used many definitions for myocardial infarction. This underscores the complexity of counting and adjudicating events in clinical trials and highlights the importance of relying on outcomes less susceptible to bias, such as mortality.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

This episode features the voices of Abby Hepworth, Brian Flaherty, James Quesada, Raul Maghiar, and Brad Stuart. Become a supporter on Apple Podcasts or Patreon! Live show tickets! Leave us a message!www.soundsfunny.pizzaIt sounds funny, but does it looks funny? Check out our YouTube!Sounds Funny Radio is recorded at Mirrortone Studios in NYC.

This week, Vladimir Putin hailed a landslide win for a fifth term in an election with no real opposition, whose result was never in question. In a victory speech extending his iron grip on power, Putin warned that World War III between Russia and the West is not out of the question. Guest host and foreign affairs journalist Indira Lakshmanan and One Decision's resident spymaster, former MI6 Chief Sir Richard Dearlove speak with Sir Laurie Bristow, who served two tours in Putin's Russia as Britain's ambassador to Moscow and as deputy chief of mission, about what to expect in the next six years from the longest-serving Russian leader since Joseph Stalin. Bristow says that relations between Russia and NATO are at their most fragile point since the Cold War. Indira also spoke with Putin expert Dr. Angela Stent for her readout of the election results. Stent, a former U.S. national intelligence officer for Russia and Eurasia says the reelection of Donald Trump could be a victory for Putin, and warned of Russia's attempts to meddle in the U.S. election.

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Ramsey Al-Hakim about the inception and journey of Auxetics, a med-tech company innovating in the vein stent market. Dr. Al-Hakim is the co-founder of Auxetics and the Section Chief of the Division of Interventional Radiology at Scripps Hospital in San Diego, CA. Dr. Al-Hakim covers the initial challenges of understanding the market and securing capital, the clinical significance of addressing stent-adjacent stenosis, and the process of developing a stent with a negative Poisson effect to counteract it. Dr. Al-Hakim highlights Auxetics' approach to combining cutting-edge interventional technologies with world-class imaging tools for enhanced procedural efficiency in venous interventions. The company's progress through benchtop work, animal testing, and plans for first-in-human studies outside the U.S., aiming for commercialization within the next four to five years, is also outlined. Contributions from key figures in the vascular community and the role of mentorship and perseverance in navigating the complexities of medical device innovation are discussed as well. --- CHECK OUT OUR SPONSORS Varian, a Siemens Healthineers company https://www.siemens-healthineers.com/ Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:11 - The Market and Problem Solving 12:13 - Journey of Creating a Stent 22:28 - Birth of Auxetics 26:53 - Learning Process and Support from the University 29:16 - Building the Dream Team 33:01 - Starting a Company 36:42 - Challenges and Triumphs of Fundraising 37:44 - Current Status and Future Plans 45:32 - Importance of Community and Mentorship --- RESOURCES Auxetics: https://www.auxeticsinc.com In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction: https://pubmed.ncbi.nlm.nih.gov/34174500/ Venous Stenosis Animal Model Utilizing Endovenous Radiofrequency Ablation: https://pubmed.ncbi.nlm.nih.gov/30717966/ The Messy Middle: Finding Your Way Through the Hardest and Most Crucial Part of Any Bold Venture: https://www.amazon.com/Messy-Middle-Finding-Through-Hardest/dp/0735218072