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2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
2 episodes with ultrasonography
Amoxicillin-Clavulanate vs Amoxicillin for Acute Sinusitis in Adults* Prespecified Falsification End Points: Can They Validate True Observational Associations?* Ultrasonography versus Computed Tomography for Suspected NephrolithiasisGLP-1 receptor agonist use and cancer risk in obese nondiabetic adults* Risk for Cancer With Glucagon-Like Peptide-1 Receptor Agonists and Dual Agonists: A Systematic Review and Meta-analysis This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe
A guide to diagnosing, imaging, and managing acute renal colic and nephrolithiasis in the ED. Hosts: Brian Gilberti, MD Avir Mitra, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Nephrolithiasis.mp3 Download Leave a Comment Tags: Kidney Stones, Urology Show Notes 1. CLINICAL CORE & PHYSIOLOGIC FRAMEWORK Epidemiologic Risk Profiles Lifetime incidence parameters hover around 1 in 11, presenting with a prominent male sex skew. Peak demographic manifestation concentrated within the 30–60 age band. High-yield temporal parameter: 50% recurrence vector within a 5-year post-initial-insult window. Mineralogical Composition Vectors Calcium oxalate crystals represent the predominant structural matrix. Struvite configurations (magnesium ammonium phosphate matrix) account for 1–2% of cohorts. Struvite stones function explicitly as infection-driven configurations secondary to upper tract proliferation; higher distribution index noted in female cohorts. Etiological & Modifiable Relational Dynamics Profound systemic dehydration or low baseline fluid throughput states. High-sodium diet structures and heavy animal-protein consumption loads. Positive genetic/familial history variables. Relative risk modulation: Each variable independently operates to expand baseline risk by a factor of 2x to 3x. Pathophysiologic Symptom Complexes Acute, sudden-onset, maximum-intensity (10/10) unilateral flank pain. Classic structural radiation vector tracking downward toward the ipsilateral groin/genitourinary dermatomes. Distinctive behavioral marker: Renal colic pacing/writhing behavior with zero antalgic position availability. Concomitant autonomic triggers: Nausea and emesis manifest in 50% of acute presentations. Physical Exam Discordance Metrics Severe subjective distress contrasted with a characteristically soft, completely non-tender abdominal palpation exam. CVA tenderness is completely variable and lacks reliable negative predictive value. Atypical Presentation Classifications Vague, poorly localized abdominal pain presentations occurring in up to 20% of active cases. Isolated lower urinary tract irritative signs including acute frequency or severe urgency. Incidental & Asymptomatic Dynamics Silent intrarenal or ureteral stones found incidentally. Longitudinal tracking demonstrates up to 33.3% of initially asymptomatic cohorts convert to fully symptomatic renal colic within a multi-year tracking window. 2. EXCLUSION DIAGNOSES & CRITICAL PATHWAY RED FLAGS Vascular Mimics: AAA rupture/expansion. This is a mandatory exclusion pathway in elderly cohorts presenting with acute flank or back pain. Physical tracking requires active exploration for an expansile, pulsatile abdominal mass. Gynecologic Emergencies: Ruptured ectopic pregnancy. Demands universal screening protocols via rapid beta-hCG testing in all female patients of childbearing potential presenting with lower abdominal/pelvic localization. Infectious Upper Tract Decompensation: Acute uncomplicated pyelonephritis. Differentiated via persistent high spikes, high fevers, systemic shaking chills, and profound pyuria. Genitourinary Structural Crises: Acute testicular torsion. Mandates a thorough, explicit scrotal/testicular structural exam if the flank pain radiates into the scrotum. Gastrointestinal and Adnexal Torsional Confounds: Acute appendicitis variants, acute mesenteric/bowel ischemia, and ovarian torsion syndromes. 3. LABORATORY TESTING & PHYSIOLOGIC EVALUATION Urinalysis Interpretation Nuances Microscopic or gross hematuria presents in approximately 66% to 90% of acute cases. Critical Pathological Caveat: Complete absence of hematuria documented in 20% to 33.3% of confirmed, acute obstructing ureteral stones. Diagnostic rule: A pristine urinalysis with zero red blood cells is entirely insufficient to exclude acute ureterolithiasis. Urinary pH as a Composition Clue Consistently low urinary pH parameters (pH < 5.5) point strongly toward a uric acid crystalline composition. Elevated urinary pH parameters (pH > 7.5) indicate the presence of urease-producing microbial pathogens, pointing toward a struvite infection stone. Infectious Screening Metrics Active tracking for marked pyuria, positive leukocyte esterase, and bacterial nitrites to rule out an obstructed, infected upper urinary tract system. BMP Immediate quantification of baseline serum creatinine to establish accurate eGFR values. Targeting detection of post-renal AKI from bilateral obstruction, unilateral obstruction in a single functioning kidney, or severe volume depletion. CBC Evaluation for marked leukocytosis. Physiologic Nuance: Mild-to-moderate white blood cell count elevations frequently represent non-specific stress demargination driven by severe pain and repetitive vomiting. High-grade white blood cell shifts demand immediate exclusion of systemic bacteremia or an infected, obstructed urinary system. Adjunctive Lab Pathways Rapid qualitative urine hCG testing. Reflex urine culture execution whenever urinalysis metrics display significant inflammatory profiles or clinical suspicion of UTI is high. 4. IMAGING MODALITIES & ALGORITHMIC CLINICAL SELECTION Non-Contrast CT Diagnostics Gold standard; diagnostic sensitivity and specificity parameters exceed 95% for stones >2 mm. Provides precise quantification of stone diameter (mm), exact localization (proximal, mid, or distal ureter), and degree of secondary hydronephrosis. Excellent structural visualization for detecting or ruling out alternate retroperitoneal, vascular, or intra-abdominal pathologies. Contrast-Enhanced CT Protocols Indicated when alternative intra-abdominal surgical pathology is highly suspected over isolated renal colic. Retains diagnostic capability to identify urinary tract stones >3 mm even within contrast-enhanced phases. NCCT Structural Architecture Limitations Standard stone protocol CT scans are executed in a prone position without IV contrast enhancement. It does not opacify the ureteral lumen. Presents a cumulative radiation exposure penalty when utilized serially across recurrent ED presentations. POCUS / Radiology Ultrasound Direct stone visualization capabilities are modest, operating at approximately 50% to 60% sensitivity, and is highly dependent on anatomical positioning at the extreme proximal ureter or the UVJ. Secondary obstruction tracking: Demonstration of hydronephrosis operates at a high sensitivity of approximately 80%. POCUS Clinical Utility Metrics Eliminates ionizing radiation exposure and allows immediate, rapid real-time execution directly at the patient’s bedside. Confirmation of significant hydronephrosis within a classic clinical presentation yields high post-test probability for stone presence while lowering suspicion for vascular catastrophes like a AAA. KUB Radiography Extremely poor overall diagnostic sensitivity, hovering around 57%. Fails to image radiolucent configurations (pure uric acid matrices) or small stones measuring
Transforming healthcare delivery in resource-limited contexts around the world calls for compassionate, innovative solutions. Learn how The Luke Commission is bringing healthcare to the most isolated and underserved in Eswatini through a scalable model for advancing health equity.
What is cultural distress? It is a negative response rooted in a cultural conflict where the patient lacks control over their situation. It results in more physiologic effects on the body resulting in allostatic overload. To prevent this, healthcare practitioners must use strategies such as cultural humility to help patients navigate healthcare. Come find the best ways to deliver culturally sensitive care in any setting.
This mini-series on Behind the Knife delves into the technical aspects of the Operative Standards for Cancer Surgery, developed through the American College of Surgeons Cancer Research Program and Cancer Surgery Standards Program. This episode highlights sentinel lymph node biopsy for breast cancer.Hosts:- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a Surgical Oncology fellow at MD Anderson Cancer Center.- Lauren Postlewait, MD, FACS, is an Associate Professor of Surgery at Emory University School of Medicine and is the Medical Director of the Breast Center at Grady Memorial Hospital in Atlanta, GA.- Chantal Reyna, MD, FACS (@kprgrl3) is a Breast surgical oncologist at Loyola University Medical Center in Chicago, IL and serves as the oncology clinical lead for the breast service line.Guest:- Susan E. Pories, MD, FACS (@SusanPoriesMD) is a professor of surgery, vice chair for quality and safety, and director of the Rutger's Breast Center at the University hospital. Learning Objectives: - Understand the definition and identification of axillary sentinel lymph node. - Understand the technique for injecting tracer or dye to perform sentinel lymph node biopsy. - Understand the importance of preincision drainage evaluation and transcutaneous localization.- Understand techniques to minimize seroma formation.Links to Papers Referenced in this EpisodeOperative Standards for Cancer Surgery, Volume 1: Breast, Lung, Pancreas, Colonhttps://www.facs.org/quality-programs/cancer-programs/cancer-surgery-standards-program/operative-standards-for-cancer-surgery/purchase/Kindle edition:https://www.amazon.com/Operative-Standards-Cancer-Surgery-Section-ebook/dp/B07MWSNFSBSentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial Lancet Oncol. 2010 Oct;11(10):927-33.https://pubmed.ncbi.nlm.nih.gov/20863759/Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection J Clin Oncol. 2016 Apr 1;34(10):1072-8.https://pubmed.ncbi.nlm.nih.gov/26811528/The false-negative rate of sentinel node biopsy in patients with breast cancer: a meta-analysis World J Surg. 2012 Sep;36(9):2239-51. https://pubmed.ncbi.nlm.nih.gov/22569745/Effect of lymphoscintigraphy drainage patterns on sentinel lymph node biopsy in patients with breast cancer Am J Surg. 2005 Oct;190(4):557-62.https://pubmed.ncbi.nlm.nih.gov/16164919/Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial JAMA Oncol. 2023 Nov 1;9(11):1557-1564.https://pubmed.ncbi.nlm.nih.gov/37733364/Choosing Wisely GuidelinesSociety of Surgical Oncology. Released 2016 July 12; last updated 2020 November 13. Choosing Wisely: Five Things Physicians and Patients Should Question.https://surgonc.org/wp-content/uploads/2020/11/SSO-5things-List_2020-Updates-11-2020.pdfPlease visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
Providing primary health care in a war zone presents some extraordinary challenges. This presentation delves into the complex world of healthcare delivery amid conflict and chaos.
En este episodio nos adentramos en uno de los territorios más complejos del sistema nervioso periférico adulto: las plexopatías braquiales. ¿Qué significa realmente que el plexo se lesione? ¿Es solo un cable roto o algo mucho más complejo? Exploramos cómo se organiza un nervio, qué ocurre en lesiones por tracción, compresión o inflamación y por qué muchas plexopatías son auténticos mosaicos intraneurales. Revisamos las clasificaciones de Seddon, Sunderland, el grado VI de Mackinnon y la clasificación quirúrgica por niveles de Chuang, entendiendo que no es solo anatomía, sino estrategia y pronóstico. Hablamos de degeneración Walleriana, regeneración axonal, diferencias entre lesiones pre y postganglionares, prioridades reconstructivas y del papel clave de la neurorrehabilitación tras las transferencias nerviosas. Porque integrar cirugía, electrodiagnóstico y rehabilitación es esencial para comprender realmente el plexo braquial desde una mirada clínica y neurofisiológica. Referencias del episodio: 1. Baradaran, A., El-Hawary, H., Efanov, J. I., & Xu, L. (2021). Peripheral Nerve Healing: So Near and Yet So Far. Seminars in plastic surgery, 35(3), 204–210. https://doi.org/10.1055/s-0041-1731630 (https://pubmed.ncbi.nlm.nih.gov/34526869/). 2. Chaudhry, V., & Cornblath, D. R. (1992). Wallerian degeneration in human nerves: serial electrophysiological studies. Muscle & nerve, 15(6), 687–693. https://doi.org/10.1002/mus.880150610 (https://pubmed.ncbi.nlm.nih.gov/1324426/). 3. Chim, H., & Hagan, R. R. (2024). Consensus Recommendations for Neurogenic Thoracic Outlet Syndrome from the INTOS Workgroup. Plastic and reconstructive surgery. Global open, 12(8), e6107. https://doi.org/10.1097/GOX.0000000000006107 (https://pubmed.ncbi.nlm.nih.gov/39206209/). 4. Chuang D. C. (2010). Brachial plexus injury: nerve reconstruction and functioning muscle transplantation. Seminars in plastic surgery, 24(1), 57–66. https://doi.org/10.1055/s-0030-1253242 (https://pmc.ncbi.nlm.nih.gov/articles/PMC2887004/). 5. Fisher, S., Wadhwa, V., Manthuruthil, C., Cheng, J., & Chhabra, A. (2016). Clinical impact of magnetic resonance neurography in patients with brachial plexus neuropathies. The British journal of radiology, 89(1067), 20160503. https://doi.org/10.1259/bjr.20160503 (https://pubmed.ncbi.nlm.nih.gov/27558928/). 6. Grinsell, D., & Keating, C. P. (2014). Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. BioMed research international, 2014, 698256. https://doi.org/10.1155/2014/698256 (https://pubmed.ncbi.nlm.nih.gov/25276813/). 7. Massie, R., Mauermann, M. L., Staff, N. P., Amrami, K. K., Mandrekar, J. N., Dyck, P. J., Klein, C. J., & Dyck, P. J. (2012). Diabetic cervical radiculoplexus neuropathy: a distinct syndrome expanding the spectrum of diabetic radiculoplexus neuropathies. Brain : a journal of neurology, 135(Pt 10), 3074–3088. https://doi.org/10.1093/brain/aws244 (https://pubmed.ncbi.nlm.nih.gov/23065793/). 8. Novak C. B. (2008). Rehabilitation following motor nerve transfers. Hand clinics, 24(4), 417–vi. https://doi.org/10.1016/j.hcl.2008.06.001 (https://pubmed.ncbi.nlm.nih.gov/18928890/). 9. Larkin, M. B., Goethe, E. A., Mohammad, M., Tummala, S., & North, R. Y. (2023). Ulnar fascicle to brachialis branch of musculocutaneous nerve for restoration of elbow flexion associated with spinal cord tumor and radiation-induced lower motor neuron disease. Neurosurgical focus: Video, 8(1), V9. https://doi.org/10.3171/2022.10.FOCVID2299 (https://pubmed.ncbi.nlm.nih.gov/36628102/). 10. Ray, W. Z., & Mackinnon, S. E. (2010). Management of nerve gaps: autografts, allografts, nerve transfers, and end-to-side neurorrhaphy. Experimental neurology, 223(1), 77–85. https://doi.org/10.1016/j.expneurol.2009.03.031 (https://pubmed.ncbi.nlm.nih.gov/19348799/). 11. Rocks, M. C., Comunale, V., Sanchez-Navarro, G. E., Nicholas, R. S., Hacquebord, J. H., & Adler, R. S. (2025). Diagnostic Capability of Ultrasonography in Evaluating Peripheral Nerve Injuries of the Brachial Plexus. Hand (New York, N.Y.), 20(8), 1252–1258. https://doi.org/10.1177/15589447241277844 (https://pubmed.ncbi.nlm.nih.gov/39289880/). 12. Rubin D. I. (2020). Brachial and lumbosacral plexopathies: A review. Clinical neurophysiology practice, 5, 173–193. https://doi.org/10.1016/j.cnp.2020.07.005 (https://pubmed.ncbi.nlm.nih.gov/32954064/). 13. Sakellariou, V. I., Badilas, N. K., Mazis, G. A., Stavropoulos, N. A., Kotoulas, H. K., Kyriakopoulos, S., Tagkalegkas, I., & Sofianos, I. P. (2014). Brachial plexus injuries in adults: evaluation and diagnostic approach. ISRN orthopedics, 2014, 726103. https://doi.org/10.1155/2014/726103 (https://pubmed.ncbi.nlm.nih.gov/24967130/). 14. Schierle, C., & Winograd, J. M. (2004). Radiation-induced brachial plexopathy: review. Complication without a cure. Journal of reconstructive microsurgery, 20(2), 149–152. https://doi.org/10.1055/s-2004-820771 (https://pubmed.ncbi.nlm.nih.gov/15011123/). 15. Segal, D., Cornwall, R., & Little, K. J. (2019). Outcomes of Spinal Accessory-to-Suprascapular Nerve Transfers for Brachial Plexus Birth Injury. The Journal of hand surgery, 44(7), 578–587. https://doi.org/10.1016/j.jhsa.2019.02.004 (https://pubmed.ncbi.nlm.nih.gov/30898464/). 16. Sturma, A., Hruby, L. A., Farina, D., & Aszmann, O. C. (2019). Structured Motor Rehabilitation After Selective Nerve Transfers. Journal of visualized experiments : JoVE, (150), 10.3791/59840. https://doi.org/10.3791/59840 (https://pubmed.ncbi.nlm.nih.gov/31475970/). 17. Tjoumakaris, F. P., Anakwenze, O. A., Kancherla, V., & Pulos, N. (2012). Neuralgic amyotrophy (Parsonage-Turner syndrome). The Journal of the American Academy of Orthopaedic Surgeons, 20(7), 443–449. https://doi.org/10.5435/JAAOS-20-07-443 (https://pubmed.ncbi.nlm.nih.gov/22751163/). 18. Vancea, C. V., Hodea, F. V., Bordeanu-Diaconescu, E. M., Cacior, S., Dumitru, C. S., Ratoiu, V. A., Stoian, A., Lascar, I., & Zamfirescu, D. (2025). Functional outcomes following nerve transfers for shoulder and elbow reanimation in brachial plexus injuries: a 10-year retrospective study. Journal of medicine and life, 18(4), 375–386. https://doi.org/10.25122/jml-2025-0079 (https://pubmed.ncbi.nlm.nih.gov/40405933/). 19. Van Eijk, J. J., Groothuis, J. T., & Van Alfen, N. (2016). Neuralgic amyotrophy: An update on diagnosis, pathophysiology, and treatment. Muscle & nerve, 53(3), 337–350. https://doi.org/10.1002/mus.25008 (https://pubmed.ncbi.nlm.nih.gov/26662794/). 20. Wade, R. G., Takwoingi, Y., Wormald, J. C. R., Ridgway, J. P., Tanner, S., Rankine, J. J., & Bourke, G. (2019). MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy. Radiology, 293(1), 125–133. https://doi.org/10.1148/radiol.2019190218 (https://pubmed.ncbi.nlm.nih.gov/31429680/). 21. Willmott, A. D., White, C., & Dukelow, S. P. (2012). Fibrillation potential onset in peripheral nerve injury. Muscle & nerve, 46(3), 332–340. https://doi.org/10.1002/mus.23310 (https://pubmed.ncbi.nlm.nih.gov/22907222/).
Have you longed to integrate your Christian faith into your patient care—on the mission field abroad, in your work in the US, and during your training? Are you not sure how to do this in a caring, ethical, sensitive, and relevant manner? This “working” session will explore the ethical basis for spiritual care and provide you with professional, timely, and proven practical methods to care for the whole person in the clinical setting. https://www.dropbox.com/scl/fi/qpah9kh1lttg6cm1jjop9/Bob-Mason-Ethics-of-Spiritual-Care-revised.pptx?rlkey=0emve2ja8282nv8xc4uinq1hg&st=9033htwx&dl=0
Those who hope to honor God and advance Jesus' Kingdom face powerful opposition from spiritual, physical, and psychological enemies. Successful launching and long term fruitfulness depends on recognizing and, in dependence on the Holy Spirit, waging war against those enemies.
Medical missionaries often feel powerful emotional burden from moral injury, and it is a leading cause of departure from the mission field. But we have learned proven methods of preventing and dealing with moral injury. Use God’s powerful methods to protect yourself and your team, and to grow in wisdom and spirit!
Picture this: a patient with early-stage breast cancer is sitting in front of you in the clinic. You are about to offer your expert management plan. The age-old question arises—should you really perform a sentinel lymph node biopsy, or could omission actually help this patient more? Today, we're tackling one of the hottest debates in modern breast cancer care.Should we rethink sentinel lymph node biopsy for select patients, and can skipping it actually improve quality of life without sacrificing cancer control? The stakes couldn't be higher—balancing accurate cancer staging and minimizing harm is the name of the game. Together, we're breaking down the latest evidence from the SOUND and INSEMA trials. What do these landmark studies mean for your patients, your practice, and the future of axillary management? Ready for a journal review that might just change your next consult? Hosts:- Rashmi Kumar, MD, PhDResident, University of Michigan General Surgery Residency ProgramTwitter/X: @RashmiJKumar- Melissa Pilewskie, MDAttending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan Medicine Twitter/X: @MPilewskie- Stephanie Downs-Canner, MDAttending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training Program Twitter/X: @SDownsCannerLearning Objectives:- Understand when and for whom it is safe and beneficial to omit sentinel lymph node biopsy (SLNB) in early-stage breast cancer patients.- Identify the risks associated with foregoing SLNB, including loss of nodal staging, and analyze how this impacts treatment selection and prognosis.- Review key findings from the SOUND and INSEMA trials and their influence on axillary management.- Discuss implications for adjuvant therapy, genomic profiling, and multidisciplinary clinical practice.- Recognize which patient populations should still receive SLNB, and the importance of individualized, multidisciplinary decision-making.References:- Gentilini OD, Botteri E, Sangalli C, et al. Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial. JAMA Oncol. 2023;9(11):1557–1564. doi:10.1001/jamaoncol.2023.3759 https://pubmed.ncbi.nlm.nih.gov/37733364/- Reimer T, Stachs A, Veselinovic K, et al. Axillary surgery in breast cancer – primary results of the INSEMA trial. N Eng J Med. 2024. doi:10.1056/NEJMoa2412063.https://pubmed.ncbi.nlm.nih.gov/39665649/- Sparano JA, Gray RJ, Makower DF, Albain KS, Saphner TJ, Badve SS, Wagner LI, Kaklamani VG, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Toppmeyer DL, Brufsky AM, Goetz MP, Berenberg JL, Mahalcioiu C, Desbiens C, Hayes DF, Dees EC, Geyer CE Jr, Olson JA Jr, Wood WC, Lively T, Paik S, Ellis MJ, Abrams J, Sledge GW Jr. Clinical Outcomes in Early Breast Cancer With a High 21-Gene Recurrence Score of 26 to 100 Assigned to Adjuvant Chemotherapy Plus Endocrine Therapy: A Secondary Analysis of the TAILORx Randomized Clinical Trial. JAMA Oncol. 2020 Mar 1;6(3):367-374. doi: 10.1001/jamaoncol.2019.4794. PMID: 31566680; PMCID: PMC6777230. https://pubmed.ncbi.nlm.nih.gov/31566680/- Slamon DJ, Fasching PA, Hurvitz S, Chia S, Crown J, Martín M, Barrios CH, Bardia A, Im SA, Yardley DA, Untch M, Huang CS, Stroyakovskiy D, Xu B, Moroose RL, Loi S, Visco F, Bee-Munteanu V, Afenjar K, Fresco R, Taran T, Chakravartty A, Zarate JP, Lteif A, Hortobagyi GN. Rationale and trial design of NATALEE: a Phase III trial of adjuvant ribociclib + endocrine therapy versus endocrine therapy alone in patients with HR+/HER2- early breast cancer. Ther Adv Med Oncol. 2023 May 29;15:17588359231178125. doi: 10.1177/17588359231178125. Erratum in: Ther Adv Med Oncol. 2023 Sep 29;15:17588359231201818. doi: 10.1177/17588359231201818. PMID: 37275963; PMCID: PMC10233570. https://pubmed.ncbi.nlm.nih.gov/37275963/Sponsor Disclosure: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US
What is a call? How does a person know if God is calling them to mission service? Join in a discussion as these and other questions are addressed.
In this episode of Focal Point, the IMV Clinical team chat with two special guests about the magic that happens when vet nurses start performing ultrasound examinations in practice.It all began with a conversation about getting started with ultrasound between our Scotland Account Manager, Amy Thompson RVN, and Jodie Harper RVN at her practice, Wallace Vets in Angus. Following this, Jodie attended our Ultrasonography for Vet Nurses course and the rest, as they say, is history! We will discuss how Jodie's skills with the scanner have inspired colleagues to attend our courses, as well as arranging a bespoke in-practice training session for the vets and nurses to learn alongside each other on their own machine. Listen in as the podcast team talk pyometras, ex-laps, pericardial effusions and triage, and discuss the hugely positive effect that upskilling the team has had on the practice. Got a question or suggestion? We would love to hear from you, and you can contact us using learning@imv-imaging.com. You can also check out our other learning resources on our Website, and our CPD courses via our Academy education platform. If you want more information on our in practice training, you can find it here.
Following our discussion in 2023, we thought it would be a good time to catch up with Adam Conn and chat about how his use of colour Doppler for bovine reproductive ultrasonography has evolved.Known to many as The Vet on the Coast 19 for his superb educational content and showcasing the best of Northern Ireland's coastline, Adam Conn is an experienced farm animal vet specialising in dairy herd health and an IMV imaging brand ambassador.Listen in as we discuss how Adam uses the the Easi-Scan:Go to maximise the information gained from his routine ultrasound examinations, tips for getting started with bovine ultrasound, and the challenges of keeping a Tamagotchi alive!Got a question or suggestion? We would love to hear from you, and you can contact us using learning@imv-imaging.com. You can also check out our other learning resources on our Website and our CPD courses via our Academy education platform.
Dr. Moira Davenport discusses the #9 article of 2023, “Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures,” which was originally published in The New England Journal of Medicine in May 2023. Dr. Jeremy Schroeder serves as the series host. Dr. Davenport is a member of the AMSSM Top Articles Subcommittee, and this episode is part of an ongoing mini journal club series highlighting each of the Top Articles in Sports Medicine from 2023, as selected for the 2024 AMSSM Annual Meeting. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures https://www.nejm.org/doi/full/10.1056/NEJMoa2213883
Til and Whitney speak with fascial researcher, anatomist, and manual therapy teacher Antonio Stecco MD PhD about his research in to fascial properties, pain, and the effects of hands-on work, in this audience-favorite episode from our archives, where it originally ran as Ep. 53. Key Topics: Introduction to Dr. Antonio Stecco and his background in fascia research The role of the Stecco family in advancing fascia research Differences between superficial fascia and deep fascia The concept of fascial densification vs. fibrosis How manual therapy affects fascial lubrication and gliding The relationship between fascial stiffness/thickness and pain Mechanisms for long-lasting effects of fascial manipulation The importance of restoring proper biomechanics, not just treating pain The role of retinacula in proprioception and joint stability New MRI techniques for imaging fascial properties Molecular structure of hyaluronan in fascia Use of hyaluronidase injections for treating spasticity Resources for learning more about fascial manipulation Get the full transcript at Til or Whitney's sites! Whitney Lowe's site: AcademyOfClinicalMassage.com Til Luchau's site: Advanced-Trainings.com Resources discussed in this episode: Dr Stecco's research and publications (NYU) FM app on the Apple Store and Google Play Dr Stecco's site: fascialmanipulation.com Papers mentioned in the episode: Gerber et al., “A Systematic Comparison Between Subjects With No Pain and Pain Associated With Active Myofascial Trigger Points.” Langevin, Helene M. et al. “Reduced Thoracolumbar Fascia Shear Strain in Human Chronic Low Back Pain.” BMC Musculoskeletal Disorders 12, no. 1 (December 2011): 203. https://doi.org/10.1186/1471-2474-12-203. Stecco, Antonio at al. “Ultrasonography in Myofascial Neck Pain: Randomized Clinical Trial for Diagnosis and Follow-Up.” Surgical and Radiologic Anatomy 36, no. 3 (April 2014): 243–53. https://doi.org/10.1007/s00276-013-1185-2. Sponsor Offers: Books of Discovery: save 15% by entering "thinking" at checkout on booksofdiscovery.com. ABMP: save $24 on new membership at abmp.com/thinking. Advanced-Trainings: try a month of the amazing A-T Subscription free by entering “thinking” at checkout at a-t.tv/subscriptions/,. Academy of Clinical Massage: Grab Whitney's valuable Assessment Cheat Sheet for free at: academyofclinicalmassage.com/cheatsheet About Whitney Lowe | About Til Luchau | Email Us: info@thethinkingpractitioner.com (The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)
Dr. Adela Cope breaks down pelvic inflammatory disease, tubo-ovarian abscess, ovarian torsion, ectopic pregnancy and more in this densely packed chapter of Always on EM. Tune in as Alex and Venk also try to figure out which one has the correct mental model of PID and who will ask the first stupid question. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com LEARN MORE ABOUT RESIDENCY: https://youtu.be/gCQ0zimhhhY?si=NpsyTruGM9N_UpVM https://college.mayo.edu/academics/residencies-and-fellowships/emergency-medicine-residency-minnesota/ REFERENCES: Williams T, Mortada R, Porter S. Diagnosis and Treatment of Polycystic Ovary Syndrome. Am Fam Physician. 2016;94(2):106-113 Rutz M, Boulger C. Early Pregnancy. Sonoguide - American College of Emergency Physicians. Accessed 8/20/2024 (https://www.acep.org/sonoguide/basic/early-pregnancy) Rodgers SK, et al. A lexicon for first-trimester US: Society of radiologists in ultrasound consensus conference recommendations. Radiology. 2024; 312(2):e240122 Kreisel K, Flagg EW, Torrone E. Trends in pelic inflammatory disease emergnecy department visits, United STates, 2006-2013. Am J Obstet Gynecol 2018;218:117e1-e10 Adhikari S, Blaivas M, Lyon M. Role of bedside transvaginal ultrasonography in the diagnosis of tubo-ovarian abscess in the emergency department. JEM 2008. 34(4):429-433 Mohseni M, Simon LV, Sheele JM. Epidemiologic and clinical characteristics of tubo-ovarian abscess, hydrosalpinx, pyosalpinx, and oophoritis in emergency department patients. Cureus. 2020;12(11):e11647 CDC sexually transmitted infections treatment guidelines, 2021 - Pelvic Inflammatory Disease (PID) accessed 8-20-24 Linden JA. et al. Is the pelvic examination still crucial in patients presenting to the emergency department with vaginal bleeding or abdominal pain when an intrauterine pregnancy is identified on ultrasonography? A randomized tli. Annals of Emerg Med 2017(70):825-834 Stein JC, et al. Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: A Meta-Analysis. Annals of Emerg Med. 2010;56:674-683 Robertson JJ, Long B, Koyfman A. Emergency Medicine Myths: Ectopic pregnancy, evaluation, risk factors, and presentation. JEM. 2017(53)6819-828 Brown J, Fleming R, Aristizabal J, Rocksolana G. Does pelvic exam in the emergency department add useful information? West J Emerg Med. 2011;12(2):208-212 Lee R, Dupuis C, Chen B, Smith A, Kim YH. Diagnosing ectopic pregnancy in the emergency setting. Ultrasonography. 2018;37:78-87
Welcome to BCI Cattle Chat! The experts begin the show by discussing the pros and cons of pulling bulls during/after the breeding season. Dr. Phillip Lancaster continues this edition of Cattle Chat by relaying all the known information about Leaky gut – a new and peculiar disease to cattle production. BCI student Luis Feitoza closes out… Continue reading Removing Bulls, Leaky Gut, Ultrasonography
Get ahead with VETAHEAD and join Dr. Proença on 15 minutes of ZooMed (exotic animal medicine) content. Today, let's discover how ultrasonography is revolutionizing the diagnosis of otitis media in rabbits — no sedation required! We explore a recent 2022 JAVMA study demonstrating the feasibility and ease of this technique in live, non-sedated rabbits. Learn about the practical steps, equipment used, and the promising results that make this a game-changer for veterinary professionals. Tune in to find out how you can incorporate this cutting-edge method into your practice and improve the care for your furry patients! Do you want to access more ZooMed (exotics) knowledge directly from specialists? Come with us and #jointhemovement #nospeciesleftbehind Head to VETAHEAD Website Join our VETAHEAD Community Follow @the_vetahead on Instagram Subscribe to @vetahead channel on YouTube Follow @vetahead on Facebook
Nurses Out Loud with Nurses Michele, Jodi, Kimberly & Melissa - The Nurses address the highlights of National Nurses Week, the disadvantages of Mammograms in comparison to Ultrasonography, as well as alternative treatments for Osteoporosis utilizing the Juvent, MicroImpact Platform. This week's show also addresses Disease X and products to make sure listeners gather in their homes to be prepared...
Nurses Out Loud with Nurses Michele, Jodi, Kimberly & Melissa - The Nurses address the highlights of National Nurses Week, the disadvantages of Mammograms in comparison to Ultrasonography, as well as alternative treatments for Osteoporosis utilizing the Juvent, MicroImpact Platform. This week's show also addresses Disease X and products to make sure listeners gather in their homes to be prepared...
Event Objectives:List characteristics of point-of-care ultrasonography.Identify clinical scenarios in which the use of point-of-care ultrasonography can help guide optimal management.Describe how point-of-care ultrasonography can enhance physical exam skills, augment teamwork, and inspire learners, patients, and caretakers.Claim CME credit here!
Ronald A. Matthews joined Eastern University in 1992 and was appointed the 10th President of Eastern University effective March 1, 2018. Prior to this call, Dr. Matthews served as Professor of Music, Chair of the Music Department, and since 2010, Executive Director of the Fine and Performing Arts Division. Born and raised in Philadelphia, Dr. Matthews graduated from Central High School. Having received a Philadelphia Board of Education music scholarship, he did his undergraduate work in Church Music and Organ at Westminster Choir College where he graduated magna cum laude and received both the Senior Class Conducting Award and the Christian Leadership Award. Dr. Matthews received the Master of Music degree in Choral Conducting from Temple University, during which time he was invited to conduct the Jerusalem Chamber Orchestra for a recording project in Tel Aviv. At the age of 23, Dr. Matthews was invited to join the faculty of Nyack College as the Director of Choral Activities. He received his Doctor of Musical Arts degree from Combs College of Music in Composition with an emphasis in Orchestral Conducting. From 1982-1992, Dr. Matthews was the Chair of the Department of Music at what is now Cairn University. For several years, he was a Thomas F. Staley Foundation lecturer/artist and served on professional and denominational boards and task forces. From 2005 until 2018, he was the Pastor of Worship Arts at Church of the Saviour in Wayne, PA. Dr. Matthews has conducted, recorded, and performed in France, Germany, Ireland, Israel, Italy, Switzerland and the Vatican. He is a commissioned and published composer. He has performed and recorded regularly with his younger brother, Rev. Dr. Gary Matthews, in concerts and workshops throughout the United States and internationally. His older brother, Dr. John T. Matthews, is Professor of English at Boston University. Dr. Matthews' most recent release is a jazz piano Christmas recording, Holly and Ivory. Dr. Matthews is married to Pamela R. Matthews, who was raised in Oreland, PA and graduated from Springfield High School. She graduated from Chestnut Hill Hospital's School of Radiologic Technology. Mrs. Matthews is a registered Ultrasonographer and received her training in Ultrasonography from Jefferson University and Chestnut Hill Hospital. For over thirty years she worked in Obstetrics and Gynecology with Abington Hospital - Jefferson Health until 2017. She served as the President of the Home and School Association for the Upper Moreland Round Meadow Elementary School during which she raised funds for new playground equipment. For the Middle School, she organized a campaign resulting in the purchase of a new grand piano for the music program. Mrs. Matthews is an avid tennis player and is also interested in charitable and mission work. She has organized fundraising projects for Haiti and the Cherokee Indians in Cherokee, NC, and she has traveled to Cartagena, Colombia on a sports mission trip. Dr. and Mrs. Matthews have two adult sons.
In this episode, host Alyssa Watson, DVM, talks to Marc Seitz, DVM, DACVR, DABVP, about his recent Clinician's Brief articles, “Diagnosing Foreign Body Obstructions via Radiography” and “Diagnosing Foreign Body Obstructions via Ultrasonography.” Dr. Seitz shares excellent advice on how to use radiography to the fullest—even if it means getting a wooden spoon or carbonated beverage—and how to apply point-of-care ultrasound at the general practice level.Resources:https://www.cliniciansbrief.com/article/foreign-bodies-ultrasound-pocus-diagnosishttps://www.cliniciansbrief.com/article/foreign-bodies-diagnosis-gi-radiographContact us:Podcast@briefmedia.comWhere to find us:Youtube.com/@clinicians_briefCliniciansbrief.com/podcastsFacebook.com/cliniciansbriefTwitter: @cliniciansbriefInstagram: @clinicians.briefThe Team:Alyssa Watson, DVM - HostAlexis Ussery - Producer & Multimedia Specialist
Hashimoto's thyroiditis is an autoimmune condition that affects the thyroid. It isn't the same as hypothyroidism, but it is connected to it. Learn what Hashimoto's disease is and what you can do to help prevent it from potentially progressing into hypothyroidism. Featured Studies Our paper: https://pubmed.ncbi.nlm.nih.gov/35999903/ Our paper: https://pubmed.ncbi.nlm.nih.gov/36079838/ https://pubmed.ncbi.nlm.nih.gov/35743024/ https://pubmed.ncbi.nlm.nih.gov/3066320/ https://pubmed.ncbi.nlm.nih.gov/34766382/ https://pubmed.ncbi.nlm.nih.gov/28052092/ https://pubmed.ncbi.nlm.nih.gov/11836274/ https://pubmed.ncbi.nlm.nih.gov/760358/ https://pubmed.ncbi.nlm.nih.gov/14558922/ https://pubmed.ncbi.nlm.nih.gov/10779140/#:~:text=Ultrasonography%20(US)%20may%20demonstrate%20a,from%2019%25%20to%2095%25. https://pubmed.ncbi.nlm.nih.gov/18324487/ https://pubmed.ncbi.nlm.nih.gov/32743538/ https://pubmed.ncbi.nlm.nih.gov/20361146/ https://pubmed.ncbi.nlm.nih.gov/11836274/ https://pubmed.ncbi.nlm.nih.gov/35243857/ https://pubmed.ncbi.nlm.nih.gov/36743914/ https://pubmed.ncbi.nlm.nih.gov/25305308/ https://pubmed.ncbi.nlm.nih.gov/28900385/ https://pubmed.ncbi.nlm.nih.gov/28579842/ https://pubmed.ncbi.nlm.nih.gov/18562170/ https://pubmed.ncbi.nlm.nih.gov/32744579/ https://www.ncbi.nlm.nih.gov/books/NBK538260/ https://pubmed.ncbi.nlm.nih.gov/27607246/ Related Resources My articles: https://drruscio.com/blog/ My book: https://drruscio.com/getgutbook/ Courses, free guides, and more: https://drruscio.com/resources?utm_source=youtube&utm_medium=link&utm_campaign=drruscio.com_resources Timestamps 00:00 Intro 00:38 Hashimoto's defined 02:40 How to diagnose Hashimoto's 04:11 What to do to improve Hashimoto's 05:44 Hashimoto's symptoms 07:35 Interpreting lab ranges Get the Latest Updates Facebook - https://www.facebook.com/DrRusciodc Instagram - https://www.instagram.com/drrusciodc/ Pinterest - https://www.pinterest.com/drmichaelrusciodc DISCLAIMER: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Music featured in this video: "Modern Technology" by Andrew G, https://audiojungle.net/user/andrew_g *Full transcript available on YouTube by clicking the “Show transcript” button on the bottom right of the video.
Learn what works for Hashimoto's thyroiditis and what doesn't. Today I'll walk you through 3 research-backed treatments for Hashimoto's, and the 3 treatments you can avoid. Tune in. Featured Studies https://pubmed.ncbi.nlm.nih.gov/35999903/ https://pubmed.ncbi.nlm.nih.gov/36079838/ https://pubmed.ncbi.nlm.nih.gov/35743024/ https://pubmed.ncbi.nlm.nih.gov/11836274/ https://pubmed.ncbi.nlm.nih.gov/760358/ https://pubmed.ncbi.nlm.nih.gov/14558922/ https://pubmed.ncbi.nlm.nih.gov/10779140/#:~:text=Ultrasonography%20(US)%20may%20demonstrate%20a,from%2019%25%20to%2095%25. https://pubmed.ncbi.nlm.nih.gov/18324487/ https://academic.oup.com/jcem/article/84/2/561/2864306 https://pubmed.ncbi.nlm.nih.gov/28052092/ https://pubmed.ncbi.nlm.nih.gov/32805423/ https://pubmed.ncbi.nlm.nih.gov/20361146/#:~:text=Background%3A%20Anti%2Dthyroid%20peroxidase%20antibodies,positive%20titers%20of%20these%20antibodies. https://pubmed.ncbi.nlm.nih.gov/30078965/ https://pubmed.ncbi.nlm.nih.gov/37489370/ https://pubmed.ncbi.nlm.nih.gov/35243857/ https://pubmed.ncbi.nlm.nih.gov/27607246/ https://pubmed.ncbi.nlm.nih.gov/30215224/ https://pubmed.ncbi.nlm.nih.gov/28536577/ https://pubmed.ncbi.nlm.nih.gov/24154902/ https://pubmed.ncbi.nlm.nih.gov/34766382/ https://pubmed.ncbi.nlm.nih.gov/32588591/ https://pubmed.ncbi.nlm.nih.gov/36598468/#:~:text=The%20Paleo%20diet%20has%20been,shown%20positive%20results%20on%20AITD. https://pubmed.ncbi.nlm.nih.gov/31275780/ https://pubmed.ncbi.nlm.nih.gov/24885375/ https://pubmed.ncbi.nlm.nih.gov/35565695/ https://pubmed.ncbi.nlm.nih.gov/37554764/ https://pubmed.ncbi.nlm.nih.gov/28255299/ https://pubmed.ncbi.nlm.nih.gov/24224112/ https://pubmed.ncbi.nlm.nih.gov/33679732/ https://pubmed.ncbi.nlm.nih.gov/34871506/ https://pubmed.ncbi.nlm.nih.gov/34981556/ https://pubmed.ncbi.nlm.nih.gov/30285179/ What to Watch Next Rethinking Hypothyroidism with Dr Antonio Bianco: https://www.youtube.com/watch?v=n1jzvyEoLfI What is Thyroglobulin & What Does it Mean for Your Health? https://www.youtube.com/watch?v=JO93_vATSmM Related Resources Our Study: https://pubmed.ncbi.nlm.nih.gov/36079838/ My articles: https://drruscio.com/blog/ My book: https://drruscio.com/getgutbook/ Courses, free guides, and more: https://drruscio.com/resources?utm_source=youtube&utm_medium=link&utm_campaign=drruscio.com_resources Timestamps 00:00 Intro 02:04 What Hashimoto's Is and Isn't 03:08 A Dietary Process for Hashimoto's 05:33 Nutrients for Hashimoto's 09:45 An Overlooked Supplement for Autoimmunity 12:25 The WORST Dietary Advice 13:10 The Truth About Gluten 18:52 Treating the Numbers 20:57 Thyroid Antibodies Don't Equate to Symptoms 23:10 Hashimoto's Becoming Hypothyroidism Get the Latest Updates Facebook - https://www.facebook.com/DrRusciodc Instagram - https://www.instagram.com/drrusciodc Pinterest - https://www.pinterest.ca/drmichaelrusciodc DISCLAIMER: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Music featured in this video: "Modern Technology" by Andrew G, https://audiojungle.net/user/andrew_g *Full transcript available on YouTube by clicking the “Show transcript” button on the bottom right of the video.
Interview with Oreste Davide Gentilini, MD, author of Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial. Hosted by Jack West, MD. Related Content: Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes
Interview with Oreste Davide Gentilini, MD, author of Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial. Hosted by Jack West, MD. Related Content: Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes
Welcome to Episode 7 of the BSCOS Paediatric Orthopaedic Digest (POD)cast with guest Mr Alwyn Abraham @AlwynUK from Leicester Royal Infirmary! He's a true all-rounder as a paediatric orthopaedic & adult limb reconstruction surgeon, current clinical lead, Training Programme Director & keen on global health including developing a partnership with Gondar, North Ethiopia! We scoured 35 journals & highlighted the most impactful studies that we feel can change practice or improve outcomes in Paediatric Orthopaedics. Follow Updates on @BSCOS_UK REFERENCES: 1. The Incidence of Posttraumatic Stress Symptoms in Children. May et al. J Am Acad Orthop Surg Glob Res Rev. August 2023. PMID: 37579777 2. Comparison of Clinical Prediction Rules in Pre-school Aged Children With Septic Hip Arthritis Due to Different Pathogens. Hagedoorn et al. J Pediatr Orthop. September 2023. PMID: 37253715 3. Surgical treatment of septic arthritis of the hip in children: arthrotomy compared with repeated aspiration-lavage. Cohen et al. Int Orthop. June 2023. PMID: 36899196 4. How common are refractures in childhood? Amilon et al. Bone Joint J. August 2023. PMID: 37524339 5. Slow-motion smartphone video improves interobserver reliability of gait assessment in ambulatory cerebral palsy. Brodke et al. J Child Orthop. June 2023. PMID: 37565008 6. The role of Gender in Operative Autonomy in orthopaedic Surgical Trainees (GOAST). Downie S, BORCo Collaborative et al. Bone Joint J. July 2023.PMID: 37399113. 7. Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries. Wallis et al. JAMA Surg. August 2023. PMID: 37647075 8. Faster Rate of Correction with Distal Femoral Transphyseal Screws Versus Plates in Hemiepiphysiodesis for Coronal-Plane Knee Deformity: Age- and Sex-Matched Cohorts of Skeletally Immature Patients. McGinley et al. J Bone Joint Surg Am. August 2023. PMID: 37418510. 9. Peri-Implant Fracture After Distal Femur Percutaneous Epiphysiodesis Using Transphyseal Screws. Shaw KG & Sanders J. J POSNA. May 2023. 10. Predicting Rates of Angular Correction After Hemiepiphysiodesis in Patients With X-Linked Hypophosphatemic Rickets. Grote et al. J Pediatr Orthop. July 2023. PMID: 36952253 11. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures. Snelling et al (BUCKLED Trial Group). N Engl J Med. June 2023. PMID: 37256975 12. Reliability and Reference Norms of Single Heel-Rise Test Among Children: A Cross-sectional Study. Mishra et al. J Foot Ankle Surg. May-June 2023. PMID: 36396548 Follow Hosts: @AnishPSangh @AlpsKothari @Pranai_B See you all in December for the Christmas 2023 Episode!!!
Reference: Snelling et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures. New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. He is also a fully-fledged ultrasonographer. Casey currently splits his time […] The post SGEM#415: Buckle Down for some Ultrasound to Diagnosis Distal Forearm Fractures first appeared on The Skeptics Guide to Emergency Medicine.
Caffeinators, get your tea and biscuits ready because we're going across the pond for this episode! We recently sat down with Jack Pye, RVN, Cert VNECC, to discuss life as an RVN in the UK! Spoiler alert, as with many of our international series episodes, it's not unlike life as veterinary technician in the US! We talk about title protection, paths to licensure, legislation, specialization, the veterinarian-RVN relationship, and so much MORE! Jack now spends much of his time in Ultrasonography and teaching that to his veterinary nurse colleagues, and we talk about some of the uniqueness of that and the challenges he faces there, as well! This episode really covers a lot of ground in the life of an RVN in the UK-be sure to catch this one! Show Links: LinkedIn Profile: https://www.linkedin.com/in/jack-pye-rvn-certvnecc-a5b446a1/?locale=pt_BR IMV Imaging: https://www.imv-imaging.com/en/ https://www.facebook.com/JackPyeRVN https://www.tiktok.com/@jackpye https://www.instagram.com/pye_rvn Our Links: Follow us on Facebook: https://www.facebook.com/vettechcafe Follow us on Instagram: https://www.instagram.com/vettechcafepodcast Follow us on LinkedIn: https://www.linkedin.com/company/vet-tech-cafe Like and Subscribe on YouTube: https://www.youtube.com/channel/UCMDTKdfOaqSW0Mv3Uoi33qg Our website: https://www.vettechcafe.com/ Vet Tech Cafe Merch: https://www.vettechcafe.com/merch If you would like to help us cover our podcast expenses, we'd appreciate any support you give through Patreon. We do this podcast and our YouTube channel content to support the veterinary technicians out there and do not expect anything in return! We thank you for all you do.
This month we are joined by the wonderful Sally Griffin, European specialist in diagnostic imaging, who holds particular interest and expertise in ultrasonography of cats. From anatomy and approach, to sizes and sampling, listen in on our conversation around the particulars of feline ultrasonography. Whether you have scanned a cat or not, tune into this podcast today and challenge yourself to do more, or have a go!
Drs Stanley Cohen and Christopher Ritchlin discuss advances in basic research for psoriatic arthritis, including new research using a humanized mouse model, combination therapy trials, and more. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984269). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Psoriatic Arthritis https://emedicine.medscape.com/article/2196539-overview Transcriptional Signature Associated With Early Rheumatoid Arthritis and Healthy Individuals at High Risk to Develop the Disease https://pubmed.ncbi.nlm.nih.gov/29584756/ DC-STAMP: A Key Regulator in Osteoclast Differentiation https://pubmed.ncbi.nlm.nih.gov/27018136/ Psoriatic Dactylitis: Current Perspectives and New Insights in Ultrasonography and Magnetic Resonance Imaging https://pubmed.ncbi.nlm.nih.gov/34204773/ Transcriptome Fact Sheet https://www.genome.gov/about-genomics/fact-sheets/Transcriptome-Fact-Sheet Tumor Necrosis Factor Inhibitors https://www.ncbi.nlm.nih.gov/books/NBK482425/ Inverse Psoriasis https://www.psoriasis.org/inverse-psoriasis/ Prediction of Psoriatic Arthritis Tool (PRESTO): Development and Performance of a New Scoring System for Psoriatic Arthritis Risk https://acrabstracts.org/abstract/prediction-of-psoriatic-arthritis-tool-presto-development-and-performance-of-a-new-scoring-system-for-psoriatic-arthritis-risk/ Efficacy of Guselkumab, a Selective IL-23 Inhibitor, in Preventing Arthritis in a Multicentre Psoriasis At-Risk Cohort (PAMPA): Protocol of a Randomised, Double-Blind, Placebo Controlled Multicentre Trial https://pubmed.ncbi.nlm.nih.gov/36564123/ Use of IL-23 Inhibitors for the Treatment of Plaque Psoriasis and Psoriatic Arthritis: A Comprehensive Review https://pubmed.ncbi.nlm.nih.gov/33301128/ Association Between Biological Immunotherapy for Psoriasis and Time to Incident Inflammatory Arthritis: A Retrospective Cohort Study https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00034-6/fulltext Prevention of Psoriatic Arthritis: The Next Frontier https://www.thelancet.com/pdfs/journals/lanrhe/PIIS2665-9913(23)00055-3.pdf Ultrasound Power Doppler and Gray Scale Joint Inflammation: What They Reveal in Rheumatoid Arthritis https://pubmed.ncbi.nlm.nih.gov/31304659/ Consensus Terminology for Preclinical Phases of Psoriatic Arthritis for Use in Research Studies: Results From a Delphi Consensus Study https://pubmed.ncbi.nlm.nih.gov/33589818/ Rheumatoid Arthritis Pathogenesis, Prediction, and Prevention: An Emerging Paradigm Shift https://pubmed.ncbi.nlm.nih.gov/32602263/ Abatacept Reverses Subclinical Arthritis in Patients With High-Risk to Develop Rheumatoid Arthritis -- Results From the Randomized, Placebo-Controlled ARIAA Study in RA-at risk Patients https://acrabstracts.org/abstract/abatacept-reverses-subclinical-arthritis-in-patients-with-high-risk-to-develop-rheumatoid-arthritis-results-from-the-randomized-placebo-controlled-ariaa-study-in-ra-at-risk-patients/ Etanercept in the Treatment of Psoriatic Arthritis and Psoriasis: A Randomised Trial https://pubmed.ncbi.nlm.nih.gov/10972371/ Arthritis Mutilans https://pubmed.ncbi.nlm.nih.gov/23430715/ Usage of C-Reactive Protein Testing in the Diagnosis and Monitoring of Psoriatic Arthritis (PsA): Results From a Real-World Survey in the USA and Europe https://pubmed.ncbi.nlm.nih.gov/35032324/ Disease Modifying Anti-Rheumatic Drugs (DMARD) https://pubmed.ncbi.nlm.nih.gov/29939640/ Combination Therapy of Apremilast and Biologic Agent as a Safe Option of Psoriatic Arthritis and Psoriasis https://pubmed.ncbi.nlm.nih.gov/30499418/
Ultrasonography in the prediction of gout flares: a 12-month prospective observational studyDr Edoardo Cipolletta (Polytechnic University of Marche, Italy) joins Marwan Bukhari to discuss the March Editor's choice article on ultrasonography in the prediction of gout flares. Here, Dr Cipolletta discusses whether ultrasonography adds to the value of clinical findings in estimating the risk of flares in patients with gout.You can read this article [https://doi.org/10.1093/rheumatology/keac367] in Rheumatology. Keywords: Ultrasound, US, gout, imaging, rheumatology, rheumatologist, gout flares, gout patientsThanks for listening to Talking Rheumatology Research! Join the conversation on Twitter using #TalkingRheumResearch, tweet us @RheumJnl, or find us on Instagram. Want to read more rheumatology research? Explore Rheumatology and Rheumatology Advances in Practice.
Season 4, Episode 1. In our inaugural episode for season 1, Chuck and Chris welcome Amy Moore and Dominic Power to discuss nerve! Specifically, in this journal club format we review 4 recent JHS European articles as a format to discuss current concepts in diagnosis and treatment of carpal tunnel syndrome. Amy and Dom share their extensive experience and insights in this collaborative effort between The Upper Hand Podcast, Journal of Hand Surgery European, the British Society for Surgery of the Hand, and FESSH. Enjoy!Carita, et al High- resolution ultrasound in the diagnosis of failed carpal tunnel decompression: a study of 35 cases. JHS Eur 47:364-68, 2022Mackenzie, et al. Carpal tunnel decompression in patients with normal nerve conduction studies. JHS Eur 45: 260-4, 2020Asserson, et al. Return to work following ultrasound guided thread carpal tunnel release versus open carpal tunnel release: a comparative study. JHS Eur 47: 359-63, 2022Ratasvuori, et al. Ultrasonography for the diagnosis of carpal tunnel syndrome: correlation of clinical symptoms, cross- sectional areas and electroneuromyography. JHS Eur 47: 369-74, 2022Subscribe to our newsletter: https://wustl.us6.list-manage.com/subscribe?u=c6fe13919f69cbe248767c4e8&id=10e0c1dd85See http://www.practicelink.com for more information from our partner on job search and career opportunities. Please complete NEW Survey: https://forms.office.com/Pages/ResponsePage.aspx?id=taPMTM1xbU6XS02b65bG1s4ZpoRI9wlPhXnSF2MnEXxURVRNVDNBMEVSMU1CWFpIQVA4SEtMTFcyMS4uAs always, thanks to @iampetermartin for the amazing introduction and conclusion music.Listings at theupperhandpodcast.wustl.edu
Does the advent of new portable ultrasounds create opportunities for POCUS in both low-resource countries and combat support hospitals? Raj Gupta (@dr_rajgupta) joins leaders from the #ASRAGlobalHealth SIG (Mark Brouillette and Lena Dohlman) and #ASRAPOCUS SIG (Melissa Byrne) to discuss clinical applications, handhelds, limitations and barriers, and more. Streamed 8/23/2022. Guests:- Mark Brouillette, MD (@markbrouillette)-Commander Brendan Byrne, MD-Melissa Byrne, DO, MPH (@dr_melissabyrne)-Lena Dohlman, MD, MPH -Omar Hyder, MD, MS-Moses Siaw-Frimpong, MDReferences:Hilbert-Carius P, Struck MF, Rudolph M, et al. Point-of-care ultrasound (POCUS) practices in the helicopter emergency medical services in Europe: results of an online survey. Scand J Trauma Resusc Emerg Med. 2021;29(1):124. https://doi.org/10.1186/s13049-021-00933-yDuncan PGA, Mackey J. Point-of-care ultrasound at Role 1: is it time for a rethink? BMJ Mil Health. 2020;166(6):406-10. https://doi.org/10.1136/bmjmilitary-2020-001466Sullivan JF, Polly M, Roman JW, et al. Utility of point of care ultrasound in humanitarian assistance missions. Mil Med. 2021;186(Suppl 1):789-94. https://doi.org/10.1093/milmed/usaa348Savell SC, Baldwin DS, Blessing A, et al. Military use of point of care ultrasound (POCUS). J Spec Oper Med. 2021;21(2):35-42. https://doi.org/10.55460/AJTO-LW17Dohlman LE, Kwikiriza A, Ehie O. Benefits and barriers to increasing regional anesthesia in resource-limited settings. Local Reg Anesth. 2020;13:147-58. https://doi.org/10.2147/LRA.S236550LinksPrehospital, Austere and Tactical Ultrasound: https://www.acep.org/emultrasound/subcommittees/prehospital-austere-tactical-ultrasound/asra.com/sigs/globalasra.com/sigs/pocus________________Thanks to The Preps from Philadelphia, PA for the music: “Hindsight" and “Left Behind". The band features Steve Breslin on vocals/guitars, Bryan Schwenk on guitars/vocals, Jeff Frederick on bass, and Eric Schwenk on drums.
This month, VN Times editor Rachael Buzzel is joined by locum RVN Jack Pye, who specialises in emergency and critical care and has a passion for ultrasonography. Jack is also a member of BVNA council, sits on the VN Times editorial board, and is a regular guest, contributor and official quizmaster on VN Happy Hour. He joins Rachael to discuss his love for ultrasonography; from the lightbulb moment to speaking at BVNA Congress and now offering CPD in practices all around the country. __________________
This month, VN Times editor Rachael Buzzel is joined by locum RVN Jack Pye, who specialises in emergency and critical care and has a passion for ultrasonography. Jack is also a member of BVNA council, sits on the VN Times editorial board, and is a regular guest, contributor and official quizmaster on VN Happy Hour. He joins Rachael to discuss his love for ultrasonography; from the lightbulb moment to speaking at BVNA Congress and now offering CPD in practices all around the country. __________________
Dr. Manisha Bahl interviews Dr. Jon Jacobson to discuss Ultrasonography of Superficial Soft-Tissue Masses: Society of Radiologists in Ultrasound Consensus Conference Statement. Jacobson et al. Radiology 2022; 304:18–30. Dr. Nikita Consul's Radiology In a Minute article summary on Fully Automated Abdominal CT Biomarkers for Type 2 Diabetes Using Deep Learning. Tallam et al. Radiology 2022; 304:85–95.
Referências Bibliográficas1- Abdel Razek AA, Soliman NY, Elkhamary S, Alsharaway MK, Tawfik A. Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol. 2006;16 (7): 1468-77. 2- Ahuja A, Ying M. Sonographic evaluation of cervical lymphadenopathy: is power Doppler sonography routinely indicated? Ultrasound Med Biol. 2003; 29 (3): 353-9.3- Chong V. Cervical lymphadenopathy: what radiologists need to know. cancer imaging. 2004; 4 (2): 116-20.4- Dudea SM, Lenghel M, Botar-Jid C, Vasilescu D, Duma M. Ultrasonography of superficial lymph nodes: benign vs. malignant. Med Ultrason. 2012; 14 (4): 294-306.5- Gonçalves FG, Ovalle JP, Grieb DFJ, Torres CI, Chankwosky J, DelCarpio-O'Donovan R. Diffusion in the head and neck: an assessment beyond the anatomy. Radiol Bras. 2011; 44 (5): 308–314.6- Gupta A, Rahman K, Shahid M, Kumar A, Qaseem SM, Hassan SA, et al. Sonographic assessment of cervical lymphadenopathy: role of high-resolution and color Doppler imaging. Head Neck. 2011; 33 (3): 297-302.7- Hoang JK, Vanka J, Ludwig BJ, Glastonbury CM. Evaluation of cervical lymph nodes in head and neck cancer with CT and MRI: tips, traps, and a systematic approach. AJR. 2013; 200 (1): W17-25.8- Ludwig BJ, Wang J, Nadgir RN, Saito N, Castro-Aragon I, Sakai O. Imaging of cervical lymphadenopathy in children and young adults. AJR. 2012; 199 (5): 1105-13.9- Mouawad F, Rysman B, Russ G, Benoudiba F, Garcia G, Abgral R, Zerdoud S, et al. Cystic form of cervical lymphadenopathy. Guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery (SFORL). Part 1: Diagnostic procedures for lymphadenopathy in case of cervical mass with cystic aspect. Eur Ann Otorhinolaryngol Head Neck Dis. 2019; 136 (6): 489-496.10- Rodriguez-Takeuchi SR, Renjifo ME, Medina FJ. RadioGraphics 2019; 39:2023–203711- Testa ML, Chojniak R, Sene LS, Damascena AS. Diffusion-weighted magnetic resonance imaging: biomarker for treatment response in oncology. Radiol Bras. 2013; 46 (3): 178–180.12- Ying M, Ahuja A, Brook F. Accuracy of sonographic vascular features in differentiating different causes of cervical lymphadenopathy. Ultrasound Med Biol. 2004; 30 (4): 441-7.13- Ying M, Bhatia KS, Lee YP, Yuen HY, Ahuja AT. Review of ultrasonography of malignant neck nodes: greyscale, Doppler, contrast enhancement and elastography. Cancer Imaging. 2014;13 (4): 658-669.
This month Jack Pye RVN joins us on the podcast to discuss the ever expanding role of Veterinary Nurses in practice and how they can use their skillset to progress from supporting the patient to performing the ultrasound scan.
In today's podcast episode, we will discuss Point of Care Ultrasonography (POCUS). We examine key trends in technology, the relationship of POCUS to consultative ultrasonography, growing clinical applications, and challenges with POCUS. Our guest is Dr. Jose Luis Diaz-Gomez. Dr. Diaz- Gomez is the Chief of Transplant, Cardiovascular, and Mechanical Support Critical Care, and Director of Critical Care Echocardiography at Baylor, St. Luke's Medical Center in Houston, Texas. He is a Senior Faculty in Cardiovascular Anesthesia and Critical Care at Baylor College of Medicine. Additional Resources: Point of Care Ultrasonography. By J.L. Diaz-Gomez et al. New England Journal of Medicine 2021: https://bit.ly/3JftVPt Multi-organ point of care ultrasound for COVID-19 (PoCUS4COVID). Expert Consensus: https://bit.ly/3mrXvaF Society of Critical Care Medicine Resources for critical care ultrasound: https://bit.ly/3yZsW1m Point of care ultrasonography Certification – CHEST: https://bit.ly/32bZfyd Books Mentioned in this Episode: The Myth of Artificial Intelligence: Why Computers Can't Think the Way We Do. By Erik Larson: https://amzn.to/3ySWDRm Essentialism: The Disciplined Pursuit of Less. By Greg McKeown: https://amzn.to/3EfVeFT
Til and Whitney speak with fascial researcher, anatomist, and manual therapy teacher Antonio Stecco MD PhD about his research in to fascial properties, pain, and the effects of hands-on work. Get the full transcript at Til or Whitney's sites! Resources discussed in this episode: Dr Stecco's research and publications (NYU) FM app on the Apple Store and Google Play Dr Stecco's site: fascialmanipulation.com Papers mentioned in the episode: Gerber et al., “A Systematic Comparison Between Subjects With No Pain and Pain Associated With Active Myofascial Trigger Points.” Langevin, Helene M. et al. “Reduced Thoracolumbar Fascia Shear Strain in Human Chronic Low Back Pain.” BMC Musculoskeletal Disorders 12, no. 1 (December 2011): 203. https://doi.org/10.1186/1471-2474-12-203. Stecco, Antonio at al. “Ultrasonography in Myofascial Neck Pain: Randomized Clinical Trial for Diagnosis and Follow-Up.” Surgical and Radiologic Anatomy 36, no. 3 (April 2014): 243–53. https://doi.org/10.1007/s00276-013-1185-2. Whitney Lowe's Online Clinical & Orthopedic Massage Courses Til Luchau's site: Advanced-Trainings.com Sponsor Offers: Books of Discovery: save 15% by entering "thinking" at checkout on booksofdiscovery.com. ABMP: save $24 on new membership at abmp.com/thinking. Handspring Publishing: save 20% by entering “TTP” at checkout at handspringpublishing.com. About Whitney Lowe | About Til Luchau | Email Us: info@thethinkingpractitioner.com (The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)
Ultrasonography is an evolving skill in critically ill patients. We provide a large number of statements regarding the required ultrasonographic basic skills for the management of critically ill patients. Original article: Speakers: https://rdcu.be/cClco (Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Society of Intensive Care Medicine) Chiara ROBBA. Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genoa (IT) and Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa (IT). Chair, ESICM Neuro Intensive Care Section. Adrian WONG. Department of Critical Care, King's College Hospital, London (UK). Chair, ESICM Social Media & Digital Content Committee. Antoine VIEILLARD-BARON. Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Billancourt, Boulogne (FR) and INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif (FR). ESICM Secretary. Laura GALARZA. Hospital General Universitario, Castellón (ES); Chair-Elect, ESICM NEXT Committee
I denne episoden snakker vi med forsker Camilla Illidi som jobber ved Brunel University i London. Hovedtematikken vil være lungefunksjon og pustemekanikk. Puster vi riktig? Kan vi trene diafragma? Hjelper disse "maskene" som enkelte utøvere har på seg? Alt dette med mer får du svar på i denne episoden! God lytting! Kontaktinformasjon: Instagram Researchgate Referanser: Illidi, C. R., Stang, J., Melau, J., Hisdal, J., & Stensrud, T. (2021). Does Cold-Water Endurance Swimming Affect Pulmonary Function in Healthy Adults?. Sports 2021, 9, 7. Illidi, C. R. (2021). Ultrasonography for the assessment of contractile properties of fresh and fatigued diaphragm muscle in healthy humans (Doctoral dissertation, Brunel University London). Fernández-Lázaro, D., Gallego-Gallego, D., Corchete, L. A., Fernández Zoppino, D., González-Bernal, J. J., García Gómez, B., & Mielgo-Ayuso, J. (2021). Inspiratory Muscle Training Program Using the PowerBreath®: Does It Have Ergogenic Potential for Respiratory and/or Athletic Performance? A Systematic Review with Meta-Analysis. International Journal of Environmental Research and Public Health, 18(13), 6703. Pollock, N. W. (2008). Breath-hold diving: performance and safety. Diving Hyperb Med, 38(2), 79-86.
"POCUS Spotlight: Focused Cardiac Ultrasonography," by Ana Sjaus, MD FRCPC, Assistant Professor, Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; and Hari Kalagara, MD, FCARCSI, EDRA, Assistant Professor, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida. From ASRA News, August 2021. See original article at www.asra.com/asra-news for figures and references. This material is copyrighted.
CanadiEM Journal Club E04 Systematic reviews and meta analyses show notes Welcome back to Journal Club by CanadiEM! In this episode we go over an approach to systematic reviews and meta analyses based on Oxford centre of EBM, and learn about diagnosing pneumothorax with ultrasound vs X-ray Using the Oxford centre of EBM tool, we will ask: What question(s) did the systematic review address? Is it likely that important, relevant studies were missed? Were the criteria used to select articles for inclusion appropriate? Were the included studies sufficiently valid for the type of question asked? Were the results similar from study to study? What were the results? What is the clinical significance of the results? and then a clinical pearl on pneumothorax!! Hosts: Dakoda Herman Jayneel Limbachia Jake Domm Paper: “Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department” Cochrane Database of Systematic Reviews by Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E, Wakai A What question(s) did the systematic review address? P: Trauma patients in the ER I: chest ultrasonography by non rad physicians C: Chest xray O: diagnosis of pneumothorax, improved patient safety Secondary: investigate potential sources of hetero such as type of CUS operator, type of trauma, type of US probe on test accuracy T: inception to 10 April 2020 Is it unlikely that important, relevant studies were missed? This study included prospective, paired comparative accuracy studies in which patients were suspected of having pneumothorax. Patients must have undergone both CUS by a frontline non-radiologist and CXR, as well as CT of the chest or tube thoracostomy as the reference standard. The authors carried out systematic searches in the following electronic databases: Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; MEDLINE; Embase; Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus; Database of Abstracts of Reviews of EIects; Web of Science core collection (which includes: Science Citation Index Expanded; Social Sciences Citation Index; Arts & Humanities Citation Index; Conference Proceedings Citation Index - Science; Conference Proceedings Citation Index - Social Sciences & Humanities; and Emerging Sources Citation Index; and Clinicaltrials.gov from database creation to April 2020. The authors also handsearched reference lists of included articles and reviews, retrieved via electronic searching, for potentially eligible studies. Additionally, they carried out forward citation searching of relevant articles in Google Scholar and looked at the “Related articles” on PubMed. They did not limit the search to Englsih language only and included articles published in all languages. Their search strategy in volved the use of MeSH terms such as Pneumothorax, Radiography, Ultrasonography, and focused assessment with ultrasonography for trauma. They also used many text words. Using this search strategy 3473 records were identified. 1180 duplicated records were removed, leaving 2293 records to be screened. These records were screened by two of the authors for their relevance, when there was a discrepancy a third author decided whether to include the record or not. 2268 records were excluded, leaving 25 full-text articles that were assessed for eligibility. 12 studies were excluded - 5 missing CUS/CXR/CT chest/chest tube, 4 CUS not performed by frontline non-radiologist physicians, 2 wrong patient population, 1 wrong study design. A total of 13 studies were included in qualitative and quantitative analysis. 9 studies using patients as units of analysis included in primary analysis. 4 studies using lung fields as units of analysis included in secondary analysis. Authors provide a nice figure depicting this. Authors did not contact experts for unpublished data but were very thorough and transparent in their search strategy. I think it is unlikely that important, relevant studies were missed. Were the criteria used to select articles for inclusion appropriate? The authors of this study clearly outlined their study inclusion and exclusion criteria. They included prospective, comparative accuracy studies in which patients were suspected of having pneumothorax. They included trauma patients in the emergency department setting. Patients must have undergone both CUS by frontline non-radiologist physicians and CXR as index tests, as well as CT of the chest or tube thoracostomy as the reference standard. The two main index tests were CUS completed by a frontline nonradiologist physician and CXR, both being performed in the supine position. If data on specific CUS findings (such as the absence of lung sliding, absence of B-lines or comet-tail artefact, presence of lung point, and absence of lung pulse) were available, they planned to assess the diagnostic accuracy of these individual CUS findings. The target condition was traumatic pneumothorax of any severity. They defined a pneumothorax identified on CT scan of the chest or via clinical findings of a rush of air or bubbling in a chest drain after tube thoracostomy as the reference standard. The authors excluded studies involving participants with already diagnosed pneumothorax (i.e. case-control studies); studies involving participants with nontraumatic pneumothorax; studies involving participants who had already been treated with tube thoracostomy; and studies in which a frontline non-radiologist physician did not perform CUS. These criteria were appropriate for inclusion. However, many studies did differ in their units of measurement - lung fields vs. patients, which could introduce significant bias into the results of individual studies. Were the included studies sufficiently valid for the type of question asked? The authors used the QUADAS-2 tool to assess risk of bias and the applicability of each included study. This tool assesses risk of bias in four domains: patient selection; index tests; reference standard; and flow and timing. In addition, they examined concerns about applicability in the first three domains. They tailored the tool to their review question - one of the signalling questions in the patient selection domain was not applicable because they excluded case-control studies; therefore they deleted this question from the tool. Two review authors performed the assessments independently. They discussed and resolved any disagreements that arose through consultation with a third review author. They included a figure describing their assessments of study quality. Of the nine studies that we included in the primary analysis: One had a low risk of bias, two had an unclear risk, and six had high risk of bias in the patient selection domain, mostly due to convenience sampling or inappropriate exclusion criteria, such as excluding haemodynamically unstable patients, lack of access to CUS, chest wall injuries precluding CUS, or if CT was not indicated. The risk of bias in the interpretation of CUS results was low in five studies, unclear in two studies, and high in two studies; this was related to unclear blinding methodology of outcome assessors interpreting CUS and CXR results. The risk of bias in the interpretation of CXR results was low in two studies, unclear in six studies, and high in one study; this was largely due to unclear blinding methodology of outcome assessors interpreting CXR and CT results, as in some studies it was not clear whether radiologists had access to both imaging results or not. The risk of bias introduced in interpretation of the reference standard results was low in three studies but unclear in the remainder for similar concerns regarding blinding methodology. The risk of bias in the flow and timing domain was low in two studies, unclear in four studies, and high in three studies; this was due to the exclusion of patients based on missing CT data or unclear/inappropriate time intervals between CUS, CXR, and CT. They judged applicability concerns regarding patient selection as low for six studies but high for three studies; this was due to the exclusion of haemodynamically unstable patients or lack of access to CUS despite the study focusing on comparing CUS. They judged one included study to have unclear concern regarding applicability of the reference standard used as there was insuIicient reporting of the method of assessment. They deemed all other domains for applicability concerns as low risk for all studies. Studies that used lung fields as their unit of analysis had several limitations including missing CUS data for some lung fields and using two CUS tests (one for each lung field) compared to one CXR (for both lungs) on the same patient. Inherently, there would be an inability to blind the CUS operator during collection of CUS data while performing the two CUS tests (one on each side of the patient), as well as during the interpretation of the CXR and CT results between the two lung fields. By analysing lung fields separately, it is diIicult to ascertain whether patient characteristics, past medical history, or traumatic injury pattern could have affected one or both lungs and may have confounded the diagnostic accuracy. Out of the four studies included in the secondary analysis: The risk of bias in the patient selection domain was low in one study, unclear in two studies, and high in one study; this was due to inappropriate exclusion criteria, such as excluding haemodynamically unstable patients or chest wall injuries precluding CUS, or due to unclear sampling technique. The risk of bias introduced in interpreting CUS results was low in two studies and unclear in two studies due to lack of clarity about blinding of the outcome assessors interpreting CUS and CXR results. The risk of bias introduced in interpreting CXR and CT results to be low in one study, unclear in two studies, and high in one study; this was again due to definite unblinded interpretation of test results or unclear blinding methodology of outcome assessors interpreting CXR and CT results. The risk of bias in the flow and timing domain was low in two studies and high in two studies due to missing patient data. They judged applicability concerns in the patient selection domain as low for two studies, unclear for one study, and high for one study, due to unclear patient selection methods and exclusion of haemodynamically unstable patients or chest wall injuries precluding CUS. They judged one study to have unclear concern regarding applicability of the reference standard, as blinding of the outcome assessor interpreting the results of CUS, CXR, and CT was unclear. We deemed all other domains as 'low concern' for all studies. The authors were thorough in their assessment of each study's quality and discussed how this may have impacted the results. The most common area of bias seemed to be in patient selection where 11/13 studies were judged to be at unclear or high risk of bias. Were the results similar from study to study? Substantial heterogeneity in sensitivity analysis of supine CXR Based on Figure 4, Forest plot: Sensitivity ranged from 0.09 to 0.75 Wide and non overlapping confidence intervals are suggestive of high variability between studies Limits the evidence But they do not list the reasons for why such heterogeneity exists Some possibilities for the heterogeneity include the high or unclear risk of bias of included studies There is no I squared statistic shown - a statistical measure that confirms the presence of significant heterogeneity in a meta-analysis Results of the study: Included 13 studies, 1271 trauma patients with 410 who had a pneumothorax 9 studies used patients as unit of analysis 4 studies used lung field as unit of analysis Most studies were high or unclear risk of bias - 11/13 CUS sensitivity and specificity: 0.91 (95% CI: 0.85 - 0.94) and 0.99 (95% CI: 0.97 - 1.00) CXR sensitivity and specificity: 0.47 (95% CI: 0.31 - 0.63) and 1.00 (95% CI: 0.97 - 1.00) Difference in sensitivity: 0.44 (95% CI: 0.27 - 0.61) Practise Changing? This is an excellently executed Systematic Review that makes the most of the limited evidence available and presents such in a transparent way. The results of this study suggest that CUS has better sensitivity in detecting pneumothorax in the emergency department than CXR, and comparable specificity. This publication adds to the body of research that is building in support of US in the primary care setting, and promotes a change in culture as US adoption rates grow. Clinical pearl: Pneumothorax, or, air in the pleural space, is a fairly common complication of thoracic traumas, occurring 15-50% of the time. History: If you're able to get a history, and often you won't be able to, you'll hear about a Sudden, severe, chest pain, sometimes referred to shoulder and maybe associated pleuritic pain or SOB. On Exam: Exam findings range from nothing to respiratory distress and shock. May have decreased chest wall motion, subcutaneous emphysema, or poprock skin, hyperresonance, or decreased or absent breath sounds on the affected side. Imaging: traditionally via x-ray or US depending on physician. On xray: Absence of lung markings beyond the edge of the lung. The edge of the scapula or upper ribs are often mistaken for a pneumothorax. On US: Scan over the most upright part of the patient's chest. if supine go right over the top of their chest (third or fourth intercostal space in the midclavicular line and is repeated on both sides) and if upright scan the apices. Looking for lung sliding and the classic “seashore sign” in M-mode in normal lungs, or absence of lung sliding and “barcode sign” seen in pneumothorax. There are tons of good videos online to take a look at. CT is gold standard, but rarely necessary - Rush of air on thoracostomy is also diagnostic. - Treatment: varies based on severity, from no treatment if patient tolerating well, to drains and chest tubes, to needle or finger thoracostomy for immediate decompression if pneumothorax clinically indicated and hypotension.
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In this Journal Jam we have Dr. Michelle Lin from Academic Life in EM interviewing two authors, Dr. Rebecca Smith‑Bindman, a radiologist, and Dr. Ralph Wang an EM physician both from USCF on their article “Ultrasonography versus Computed Tomography for suspected Nephrolithiasis” published in the New England Journal of Medicine in 2014. There is currently a wide practice variation in the imaging work-up of the patient who presents to the ED with a high suspicion for renal colic. On the one extreme, some EM physicians use CT to screen all patients who present with renal colic, while on the other extreme, other EM physicians do not use any imaging on any patient who has had previous imaging. The role of POCUS and radiology department ultrasound as an alternative to CT in the work up of renal colic has not been clearly defined in the ED setting. This study was a pragmatic multi-centre randomized control trial of patients in whom the primary diagnostic concern was renal colic, that tried to answer the question: is there a significant difference in the serious missed diagnosis rate, serious adverse events rate, pain, return visits, admissions to hospital, radiation dose and diagnostic accuracy if the EM provider chose POCUS, radiology department ultrasound or CT for their initial imaging modality of choice. This Journal Jam is peer review by EMNerd's Rory Spiegel. [wpfilebase tag=file id=618 tpl=emc-play /] [wpfilebase tag=file id=619 tpl=emc-mp3 /] The post Journal Jam 3 – Ultrasound vs CT for Renal Colic appeared first on Emergency Medicine Cases.
Drs. M.P. (Rien) Heijboer, orthopedic surgeon, works at the Dept at Orthopedic at the Erasamus Medical Centre in Rotterdam. He has extensive experience with sports-related injuries and has worked for more than 30 years as medical adviser of football club Feijenoord in Rotterdam. He is a member of the medical staff of the Dutch National Soccer Team and visited the world soccer championships in Brasil in 2014, which he describes as a "life-time experience"! He is president of the Dutch Orthopedic Society (NOV). He has a great interest in sports-related injuries and today Rien discusses his lifetime experience of managing difficult stress fractures in sport. Further reading: Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review. http://bjsm.bmj.com/content/49/6/370.long Mallee WH, Weel H, van Dijk CN, van Tulder MW, Kerkhoffs GM, Lin CW. Br J Sports Med. 2015 Mar;49(6):370-376. doi: 10.1136/bjsports-2013-093246. Epub 2014 Aug 19. Review. Ultrasonography of fractures in sports medicine. http://bjsm.bmj.com/content/49/3/152.long Hoffman DF, Adams E, Bianchi S. Br J Sports Med. 2015 Feb;49(3):152-60. doi: 10.1136/bjsports-2014-094217. Epub 2014 Dec 24. Fifth metatarsal fractures among male professional footballers: a potential career-ending disease. http://bjsm.bmj.com/content/47/12/754.long Ekstrand J, van Dijk CN. Br J Sports Med. 2013 Aug;47(12):754-8. doi: 10.1136/bjsports-2012-092096. Epub 2013 Apr 9.
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