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What’s the evidence been for the use of PPIs in mechanically ventilated patients? What do more recent studies reveal about PPIs and possible harmful side effects of aspiration pneumonia and C. difficile colitis? To find out, tune into the second season of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.
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Timestamps:
(02:13) | Define the problem / Clinically important bleeding Outcome/Risk benefit /Risk factors]
(05:58) | Hx and H2 antagonists
(10:42) | SUP-ICU
(15:12) | PEPTIC
(19:30) | REVISE trial
(27:28) | Deprescribing
(29:06) | Outstanding questions
Transcript and Show Notes
Tags: CoreIM, InternalMedicine, CriticalCare, Proton Pump Inhibitors, GIbleeding, ICU, ICU bleeding, Clinical Trials, Evidence Based Medicine, Patient Centered Outcomes, Deprescribing
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Why are we missing peripheral arterial disease (PAD)? How is it diagnosed using the Ankle-Brachial Index (ABI)? What treatments improve symptoms and reduce cardiovascular risks? When should revascularization be considered?
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Transcript and Show notes
Behind The Scenes YouTube Interview
Timestamps:
(02:23) | PEARL 1: When to suspect PAD? Risk factors?
(07:34) | PEARL 2: How to work up PAD?
(16:26) | PEARL 3: Improving symptoms and quality of life
(25:38) | PEARL 4: Approach to therapy: Preventing CV mortality
(33:53) | PEARL 5: Deeper Dive into Antithrombotic Therapy and Anticoagulation
(39:09) | PEARL 6: Who needs revascularization?
Tags: CoreIM, PAD, Peripheral Arterial Disease, ABI, claudication, vascular medicine, revascularization, internal medicine, smoking cessation, lipid management, primary care, physician assistant, nurse practitioner, cilostazol. supervised exercise therapy
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How is TPN and PPN similar and how is it different? When should each be used? How does bacterial overgrowth lead to complications? Does TPN cause diarrhea?
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Reducing administrative burdenEnhancing patient careMedical education innovationOptimizing work-life balanceTranscript and Show notes
Behind the Scenes Youtube Interview
Timestamps:
(01:35) | PEARL 1: Basics of PN: What makes up parenteral nutrition?
(06:54) | PEARL 2: Indications and Contraindications for TPN and PPN: When should I order parenteral nutrition?
(13:40) | PEARL 3: Complications of parenteral nutrition: What are the common adverse effects of parenteral nutrition?
(19:41) | PEARL 4: Parenteral nutrition myths: What should patients know before they start TPN?
(23:56) | PEARL 5: Recap on Tube Feeds: How do we determine the amount of free water to give out patients on tube feeds?
Tags: IMCore, CoreIM, parenteral nutrition, TPN, PPN, clinical nutrition, nutritional support, complications, patient safety, gastrointestinal disorders, critical care, internal medicine, fluid management, ICU, Crit Care, GI, gastroenterology
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Limitations to urine drug screening (UDS) in primary care? What are common false positives and false negatives with the urine drug screen test?
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Transcript and Show notes
Behind The Scenes YouTube Interviews
Timestamps:
(03:01) | PEARL 1: Basics to Urine Drug Screen (UDS)
(08:03) | PEARL 2: Types of urine drug tests, and what are immunoassays (IA)?
(18:44) | PEARL 3: What are gas chromatography/mass spectrometry (GC/MS)-based tests?
(26:51) | PEARL 4: How do you address unexpected test results on a UDS?
(30:29) | PEARL 5: Throwback to “5 Pearls on Stigma in Opioid Use Disorder” episode
Tags: IMCore, CoreIM, primary care, urine drug screening, opioid use disorder, substance use, harm reduction, addiction medicine, clinical toxicology, patient safety, compassionate care
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What if a patient can't afford hospice? Which medications do you deprescribe when on hospice? What happens when patients who are on hospice return to the hospital or ED?
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Behind the Scenes Youtube Interview
Show notes & Transcript
Hospice 101 Episode 1
Timestamps:
A hospitalized patient elects to enroll in hospice, now what?
What treatments are typically covered by hospice?
What medications to continue and discontinue?
Code status in hospice
Approaching the hospice patient coming back to the hospital
Hospice enrollment and re-enrollment is voluntary.
Tags: IMCore, CoreIM, primary care, palliative care, end-of-life, oncology nurse practitioner, pharmacist, physician assistant
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Can the MINT trial change how we treat anemia in acute MI? The largest trial of its kind compared liberal vs. restrictive transfusion strategies in patients with myocardial infarction.
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Transcript and Show Notes
Timestamps:
(01:29) | History of Transfusion Guidelines/Studies
(06:49) | Pathophysiology of Anemia in heart disease
(10:04) | Transfusion in MI Studies
(13:45) | MINT Trial
(22:20) | Takeaways/Discussion
Tags: Tags: CoreIM, IMCore, cardiology, internal medicine, myocardial infarction, anemia, transfusion, physician assistant, nurse practitioner, pharmacist, clinical trials, MINT trial, transfusion strategies, restrictive vs. liberal transfusion, heart attack
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Strategies to address moral distress and moral injury — hear from the experts on their work on the topic!
Transcript and Show notes
Timestamps:
(01:07) | Strategies for Addressing Moral Distress
(09:25) | Strategies for Address Moral Injury
(20:52) | Conclusion
Tags: IMCore, CorelM, Burnout, Moral Distress, Moral Injury, Moral Residue, Medical Humanities, medical ethics
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What is moral residue vs. moral injury vs moral distress? How do these concepts impact us as clinicians?
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Transcript and Show notes
Timestamps:
(04:59) | Definitions
(06:50) | Moral Distress
(09:01) | Moral Residue
(09:01) | Moral Residue
(11:34) | Moral Injury
(13:32) | Causes of Moral Distress and Moral Injury
(18:18) | Consequences
Tags: IMCore, CorelM, Burnout, Moral Distress, Moral Injury, Moral Residue, medical humanities, humanism
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Listen to 3 cardiorenal cases that highlight that “without flow it really doesn't matter what you're doing with the diuretic!”
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Transcript and Show notes
Cardiorenal Considerations: 5 Pearls Segment
Timestamps:
(01:53) | Case 1: Diuretic Resistance from Ascites and Intra-abdominal Hypertension
(09:57) | Case 2: Diuretic Resistance from Low Cardiac Output
(26:34) | Case 3: Diuretic Resistance from Inadequate Renal Perfusion Pressure
Tags: IMCore, CoreIM, Diuretics, Cardiorenal, Medical Education, nephrology, cardiology, CCU, ICU, critical care
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Signouts! How can we do them better? Hear these memorable stories & ask yourself these FIVE questions when getting your handoff ready for the covering team.
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Show notes & transcripts
Behind the Scenes YouTube Interview
Timestamps:
(02:44) | What makes this patient different from others with similar symptoms or diagnosis?
(07:28) | Does your covering team have the tools to follow up on tasks and information they need for success?
(16:06) | Is the handoff updated?
(18:26) | What information about goals of care and prognosis should be communicated to the night team, especially for critically ill patients?
(22:41) | What are we still uncertain about?
(25:30) | Closing thoughts
Tags: IMCore, CoreIM, Contingency Planning, Handoffs, Medical Education, Nocturnists. Signouts, hospitalist
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Behind the Scenes Youtube Interview
Show notes & Transcript
Timestamps:
(03:04) | What is the philosophy of hospice?
(06:13) | Who qualifies for hospice?
(08:17) | Who makes up the hospice team?
(17:24) | Who pays for hospice?
(21:31) | What are the different levels of care?
(31:57) | What are some limitations of the hospice medicare benefit?
Tags: IMCore, CoreIM, primary care, palliative care, end-of-life, oncology nurse practitioner, pharmacist, physician assistant
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Dive into 4 microskills from the book “Microskills: Small Actions, Big Impact” that offer tangible tools for navigating the professional world with grace and intention.
Book by Dr. Adaira Landry, Dr. Resa E. Lewiss:
MicroSkills: Small Actions, Big Impact
Show notes & Transcript
Tags: IMCore, CoreIM, primary care, humanities, nurse practitioner, pharmacist, physician assistant
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Does colonoscopy prevent colon cancer, and does it save lives? There has never been a randomized controlled trial on screening colonoscopies before NordICC trial, even though it is a guideline based recommendation for everyone over 45! How did this come to be? What do we tell our patients who are on the fence about undergoing screening colonoscopy? To find out, tune into the sixth episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group.
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Show notes & Transcript
Timestamp:
(00:00) | Introduction
(02:28) |Pathophysiology of Colorectal Cancer & Why Screening Makes Sense
(06:15) | General Cancer Screening – Observational Studies
(09:17) | General Cancer Screening – Randomized Controlled Trials
(14:40) | NordICC Trial
(22:36) | Implications for Patient Care
Tags: IMCore, CoreIM, primary care, gastroenterology, nurse practitioner, pharmacist, physician assistant, sigmoidoscopy, per protocol analysis and intention to treat analysis
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Behind The Scenes YouTube Interviews
Transcript and Show Notes
Timestamps:
(01:59) | What causes HFpEF?
(11:22) | Does diastolic dysfunction imply HFpEF?
(19:21) | Is the BNP level helpful in HFpEF?
(25:06) | What scoring systems can be helpful in ruling in HFpEF?
(32:03) | What's the treatment for HFpEF?
Tags: cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, nursing education, heart failure with preserved ejection fraction
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Behind the Scenes YouTube Interview
Transcript and Show Notes
Timestamps:
(01:56) | How do immune checkpoint inhibitors work?
(07:15) | How do you organize the different immune-related adverse events (irAEs)?
(13:42) | Generally, when do different adverse events can present?
(22:20) | What makes someone more likely to develop an adverse effect?
(26:38) | What role does complementary & alternative medicine play in this patient population?
Tags: Side effects, oncology, cancer, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, pharmacology
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Transcript and Show Notes
Timestamps:
(02:05) | Urinalysis in a patient with AKI from purely cardiorenal syndrome?
(08:47) | What is bioavailability, duration of action, and outcomes with furosemide, torsemide, and bumetanide?
(18:08) | How can spot urine sodium measurements be used to assess diuretic response?
(27:35) | What are the differences between thiazides (PO Metolazone vs. IV Chlorothiazide) and acetazolamide augment diuresis?
(35:08) | Spaced Repetition: RAAS inhibitors or SGLT2 inhibitors as GMDT in CKD?
Tags: nephrology, cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, diuretic resistance
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What are the benefits of early rhythm control versus rate control alone? When is electrical cardioversion used and what information can it tell us? What side effects for amiodarone, dofetilide, and sotalol, propafenone and flecainide? When should catheter ablation be considered in patients with atrial fibrillation?
Behind the Scenes YouTube Interview
Transcript and Show Notes
Time stamps:
(02:05) | Pearl 1 - Rhythm control
(11:23) | Pearl 2 - Electrical cardioversion
(17:53) | Pearl 3 - Class III antiarrhythmics and side effects
(26:31) | Pearl 4 - Class Ic antiarrhythmics and side effects
(31:55) | Pearl 5 - Catheter ablation
Tags: cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, nursing education, atrial fibrillation
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Should your patients be reaching for albuterol when their asthma flares up? Some of us may have been treating asthma exacerbations incorrectly for many years… What is the right approach? Tune in to the fifth episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group, to learn about the latest asthma management trials and guidelines, and how to translate them into better patient care.
Show Notes & Transcript
Timestamps:
(01:47) | Evolving story of asthma management
(03:26) | Pathophysiology of asthma management
(06:01) | Key players & terms
(08:56) | Story of asthma through the decades
(17:55) | MANDALA Trial
Tags: IMCore, CoreIM, primary care, pulmonary, nurse practitioner, pharmacist, physician assistant, inhalers
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How do you choose btw PO vs. IV iron? What is the best counseling for oral iron formulations? How do you choose between different IV iron formulations? Should you use the Ganzoni formula? What is a Fishbane reaction? And how is it different from anaphylaxis?
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Behind the Scenes YouTube Interview
Transcript and Show Notes
Time stamps:
(02:09) | Spaced repetition from the last Gray Matters Episode
(05:29) | Choosing between oral and IV iron
(11:17) | Considerations with oral iron repletion
(24:02) |Considerations with IV iron repletion
(32:36) | Complications and side effects of IV iron
Tags: hematology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant
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What do the different iron labs mean?! How to interpret iron labs in the setting of inflammation? How to take a good menstrual history?
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Behind The Scenes YouTube Videos
Transcript and Show Notes
Time stamps:
(03:43) | Iron deficiency labs and interpretation in inflammation
(16:08) | Heavy menstrual bleeding evaluation
(27:04) | When should a premenopausal woman with iron deficiency have endoscopy?
(35:15) | Recap
Tags: hematology, women's health, gastroenterology, heavy menstrual bleeding, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, iron deficiency diagnosis
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