Take a deep dive into common CBC abnormalities. We recorded LIVE at joint grand rounds between Walter Reed NMMC and Uniformed Services University with hematologist, Dr. Mary Kwok MD. Topics include: which parts of the complete blood count (CBC) are most important, interpreting the differential, when to order flow cytometry, who needs a hematology consult and simplified approaches to patients with leukocytosis, leukopenia, erythrocytosis and thrombocytopenia. 

Full show notes at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written, Produced and Edited by: Matthew Watto MD, FACP
• Cover Art and Infographic by: Matthew Watto MD, FACP
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
• Guest: Mary Kwok MD

Sign Up for a course w/our Chief of POCUS, Dr. Renee Dversdal!

ACP - acponline.org/pocus

AIUM - Check out https://aium.org for upcoming events. 

TRUST (Train the Ultrasound Trainers) https://www.ultrasoundtraining.com.au/courses/category/train-the-ultrasound-trainer-trust

Time Stamps

• 00:00 Intro; Paul shame’s the audience; Guest bio
• 03:17 Guest one-liner, book recommendation* -Emperor of All Maladies (book) by Siddhartha Mukherjee, When Breath Becomes Air (book) by Paul Kalanithi; Career advice -set goals for whatever you’re learning.
• 08:43 Picks of the week: John Wick 3 (film); The Movies That Made Me (podcast) by Joe Dante; The Tim Ferriss Podcast with Julie Rice of Soul Cycle; Infinity Chamber (film) by Travis Milloy
• 11:50 A case of asymptomatic leukocytosis; Red flags; Repeat the CBC until it’s normal
• 17:30 The peripheral smear; Leukemoid reaction
• 20:00 The physical exam; When to send flow cytometry?
• 22:18 A case of lymphopenia; benign ethnic neutropenia; What to look for in the history
• 27:10 A case of erythrocytosis; Checking EPO levels; JAK2 mutation; Differential Diagnosis; Therapeutic Phlebotomy; Physical findings of Polycythemia Vera
• 36:53 A case of thrombocytopenia; Lab workup; Differential diagnosis; Pathophysiology; Culprit meds
• 45:35 Advice for internists
• 46:36 Take Home Points
• 47:46 Dr. Kwok’s disclaimer
• 48:10 Outro and post credit scene

Join us for this roundtable discussion of advocacy in healthcare and a rundown of hot topics: coding and billing, the Affordable Care Act, universal healthcare, gender equity, women’s health, gun violence and more! Returning guest, Dr. Robert McLean (@rmmclean84), current president of the American College of Physicians, helps us answer questions like, What is advocacy in healthcare? What are the issues that are impacting your profession? What can your medical home do for you? He’s been heavily involved in advocacy throughout his career including testifying before Congress. Guest hosts Drs. Fatima Syed MD, MSc and Deep Shah MD, MSc join! 

Full show notes available at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and Produced by: Fatima Syed, MD, MSc; Matthew Watto MD, FACP
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP; Fatima Syed, MD, MSc; Deep Shah, MD, MSc
• Editor: Matthew Watto MD, FACP
• Guest: Robert McLean MD, FACP

Time Stamps

• 00:00 Intro, disclaimer, and guest bios
• 03:22 How can new docs in practice get involved in advocacy and shaping healthcare policy
• 11:30 Medicare’s proposed changes to billing and documentation
• 13:40 Who’s involved in changing Medicare policies?
• 16:09 What’s the purpose of policy papers? How are they written?
• 19:12 Getting involved in local and national councils as a student or resident
• 25:22 The Affordable Care Act and Universal coverage
• 29:25 What’s the risk of non-ACA approved insurance plans?
• 31:40 Why do people oppose the ACA?
• 34:40 Universal healthcare defined
• 40:23 The gender pay gap; Shout out to ACP’s CEO Darilyn Moyer MD, FACP
• 45:10 Women’s health policy paper
• 47:40 Gun violence and how advocacy issues take off
• 55:00 Take home points; Plug for Bob Doherty’s blog
• 60:36 Outro

Discover more common practices that persist in the hospital wards despite no proven benefit! We review how hospitals prescribe a “crapload” of docusate which only clogs up the medication list, how unnecessary echocardiograms are ordered enough times to make your head spin, and how basal insulin needs to slide back into your inpatient diabetes management instead of correctional insulin monotherapy. Join high-value care specialist Dr. Lenny Feldman (@DocLennyF, Hopkins) and tweetorialist Dr. Tony Breu (@tony_breu, Harvard) as they walk us through round 2 of “Things We Do For No Reason™.” 

SHM members can claim CME-MOC credit at https://www.shmlearningportal.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). Note: The planners and faculty for this activity have no relevant relationships or conflicts to disclose.

Full show notes at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and Produced by: Justin Berk, MD MPH MBA, Matthew Watto MD
• Infographic: Justin Berk MD MPH MBA
• Cover Art: Matthew Watto MD
• Hosts: Stuart Brigham MD, Matthew Watto MD, and Paul Williams MD  
• Editor: Matthew Watto MD, Emi Okamoto MD
• Guest: Lenny Feldman MD, Tony Breu MD

Sponsor

The Society of Hospital Medicine / Journal of Hospital Medicine - Things We Do For No Reason™series. Check out all the Things We Do For No ReasonTM articles here: Master Index of TWDFNR articles .

Time Stamps

• 00:00 CME-MOC announcement https://www.shmlearningportal.org/curbsiders 
• 00:50 Intro, disclaimer, guest bios
• 05:20 Guest one-liners, picks of the week
• 14:32 Things We Do for No ReasonTM (TWDFNR) defined
• 18:06 A case of syncope; definition
• 19:58 Do all patients with syncope need an echo?
• 23:30 What’s the diagnostic yield of echo for syncope?
• 29:36 Workup for new onset syncope
• 33:54 Aortic stenosis murmur
• 35:55 Docusate. Mechanism of action. Why is it so popular? What’s the harm?
• 42:08 Docusate. What does the evidence say? What should we use instead
• 50:05 A case of Sliding scale insulin (SSI); a brief history of insulin therapy and monitoring; SSI monotherapy: Risks, benefits, alternatives
• 59:30 Metformin in the hospital
• 65:35 Starting insulin in the hospital
• 68:20 Plugs- Things We Do For No ReasonTM. Become an author.
• 72:10 Outro and post-credits scene

Point-of-care Ultrasound AKA POCUS ain’t no hocus. Dr. Renee Dversdal (@ReneeDversdal) Director of the Oregon Health & Science University Point of Care Ultrasound and General Medicine Ultrasound Fellowship Director, joins The Curbsiders to discuss her craft. Topics include: Defining POCUS, the value POCUS adds to the physical exam, training pathways and the appropriateness of billing. This episode is sponsored for CME-MOC credit by the American College of Physicians. ACP members can claim free credit at www.acponline.org/curbsiders (goes live at 9am on release date). Follow this link to read the ACP’s statement in support of POCUS in Internal Medicine. 

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written by: Christopher Chiu MD, FACP and Renee Dversdal MD, FACP 
• Produced and CME questions by: Christopher Chiu MD, FACP
• Edited by: Matthew Watto MD, FACP 
• Hosts: Matthew Watto MD, FACP; Stuart Brigham MD; Christopher Chiu MD, FACP 
• Guest Expert: Renee Dversdal MD, FACP 

Special thanks to our POCUS friends!

ACP

We can speak first hand that the following courses are amazing POCUS learning experiences! Sign up today

Point-of-Care Ultrasound: Foundational Skills for Internists

• November 7-8, 2019 and November 9-10, 2019 (same 2-day course repeated back to back)
• Crowne Plaza O’Hare Hotel and Conference Center, Rosemont, IL
• Registration is now open at acponline.org/pocus

Point-of-Care Ultrasound: Foundational Skills for Internists

• April 21-22, 2020 (during Internal Medicine Meeting 2020)
• Los Angeles Convention Center
• Registration will open at the end of September 

Point-of-Care Ultrasound: Advanced Skills for Outpatient Practice

• April 22, 2020 (during Internal Medicine Meeting 2020)
• Los Angeles Convention Center
• Registration will open at the end of September

AIUM

A special thanks to our Chief of POCUS Dr. Renee Dversdal and the AIUM for hosting The Curbsiders at another fantastic AIUM Point of Care Ultrasound (POCUS) Conference in Portland, Oregon at OHSU, July 2019. Check out https://aium.org for upcoming events. Next year’s IM POCUS course will be July 2020 in Portland! Dates are still TBD. Stay tuned.

TRUSTTM (Train the Ultrasound Trainers)

Are you looking to boost your skills teaching POCUS? Well, Our Chief of POCUS in collaboration with Kashlak West & Zedu Ultrasound Training Solutions created a course just for people like you. Sign up here: https://www.ultrasoundtraining.com.au/courses/category/train-the-ultrasound-trainer-trust

Time Stamps 

• 00:00 Intro, Disclaimer, POCUS announcements
• 05:00 Guest one liner, book recommendation, rapid fire Q & A
• 11:00 Dr Dversdal shares a story about failure/struggle
• 15:00 POCUS defined
• 19:00 Uptake of POCUS in Internal Medicine
• 22:45 Getting into the game. Cost, choice of device and how to get training
• 26:40 Dr Dversdal shares her journey into POCUS 
• 31:00 Clinical case of indeterminate volume status and how POCUS helped
• 35:00 IVC and IJ POCUS exam discussed in detail
• 37:55 How to choose a machine and bring US to your institution
• 41:00 How to troll the wards and introduce yourself to patients for practice of POCUS
• 43:00 Billing and documentation for POCUS
• 46:43 How POCUS can improve physical exam
• 51:27 Uses for POCUS in the primary care clinic
• 53:40 Dr Dversdal’s top 5 POCUS exam findings
• 56:27 Patients love POCUS
• 58:30 Outro

Update your management of stroke and TIA in primary care. Stroke neurologist, Chris Favilla MD (University of Pennsylvania), walks us through the plumbing of the brain, so we can identify ischemic risks in stroke and TIA patients to prevent recurrences.  Learn factors that make a TIA high risk, which imaging studies to order, new research around aspirin dosing, dual antiplatelets, DOACs, cardiac monitoring and more! ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Full show notes at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Producers: Molly Heublein MD; Matthew Watto MD, FACP
• Writer (including CME questions): Molly Heublein MD
• Cover Art: Bryan Brown MD
• Hosts: Stuart Bringham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
• Editor: Emi Okamoto, MD; Matthew Watto MD, FACP
• Guest: Chris Favilla, MD

Time Stamps

• 00:00 Intro, disclaimer, guest bio, and a bad pun
• 04:20 Chris’ one-liner, advice as a teacher, book recommendation -The Goldfinch, 
• 07:40 Molly’s pick of the week -Extreme Measures (book) by Jessica Zitter
• 08:40 A case of TIA; definition of TIA
• 12:14 Stroke territories
• 14:24 New definition of TIA
• 16:00 Differentiation from complex migraine
• 19:17 Risk stratifying TIA and ABCD2 score
• 22:00 A bit on tPA
• 24:01 Workup for TIA; workup for amaurosis fugax
• 25:36 CNS imaging studies after stroke or TIA; Choice of imaging study
• 33:15 HINTS exam for posterior circulation stroke
• 34:48 Is an echo necessary? Bubble study for PFO?
• 38:32 Duration of afib monitoring
• 40:24 Echo reports: what to look for in patient with stroke or TIA; “soft markers”
• 41:55 Blood testing after Stroke and TIA (lipid panel, HbA1C; +/- RPR, coags, CBC)
• 43:50 Folic acid; Sparkle trial: high dose atorvastatin versus placebo for secondary prevention
• 47:00 Incidental finding: multiple patchy infiltrates in a patient without stroke or TIA; Is it significant?
• 48:50 Aspirin therapy after TIA; Dosage adjustment based on weight?
• 51:10 A case of stroke; TOAST trial and classification of acute stroke; ESUS; aortic arch atheromas
• 55:58 Large artery strokes (hypoperfusion, acute thrombosis, artery to artery embolization)
• 57:15 Antiplatelets after stroke and TIA; DAPT and duration of therapy
• 62:57 Antidiabetic drugs and stroke
• 63:40 Lightning round: CHA2DS2VASc score and women; how much afib is significant?; 66:32 Are all DOACs created equal?; 68:20 Regaining function after a stroke; 69:47 Silent infarcts on imaging
• 71:54 Resources for stroke: Decision making in neurology textbook
• 73:28 Outro

Summary

The sun is shining, the cakes are hot, and the takes are even hotter. Welcome to our July 2019 Hotcakes episode! Join us as our beloved hosts Chris, Matt, Stuart and Paul share some of the latest practice-changing knowledge, news and research in medical science. Today’s discussion covers studies on the use of IV iron supplementation for heart failure, aspirin as VTE prophylaxis after arthroplasty, and the relationship between physician burnout and ability to address patients’ social determinants of health. Honorable mentions include a throwback to the life-changing magic of Pokémon GO.   

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits 

• Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD
• Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD
• Editor: Christopher Chiu MD, Emi Okamoto MD
• Cover-Art: Matthew Watto MD

Time stamps

• 00:20 Disclaimer, intro
• 02:30 Clinic capacity, provider burnout, and social determinants of health
• 15:00 Iron deficiency and heart failure meta-analysis (Zhou et al., 2019)
• 17:15 Iron deficiency and stable heart failure RCT (Ponikowski et al., 2015)
• 19:00 Iron deficiency and decompensated heart failure RCT (Yeo et al., 2018)
• 26:00 Aspirin as VTE prophylaxis after arthroplasty
• 38:00 Honorable mention (Pokémon Go!)
• 39:00 Wrap-up and outro

Dr. Reshma Jagsi (TIME’S UP Healthcare; UMichigan) schools us on sexual harassment and describes the systemic and cultural changes that need to happen to effect real change. She unpacks the definition of sexual harassment, describes the state of the #MeToo and TIME’s UP movements across the science and medicine fields and highlights how we all can recognize/respond to harassment.

This is the third episode of our Women in Medicine series. Last August, you heard us talk to Dr. Vinny Arora about the paucity of women in leadership positions, finding sponsors for career advancement, and being bold about career decisions. In December, we spoke to Dr. Susan Hingle about work-life integration. Her advice? Stop worrying about what other people think, acknowledge that being a doctor is hard, especially for women due to disproportionate out-of-work responsibilities, and define a beautiful life that is individualized to you. 

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits  

• Written and produced by: Leah Witt MD, Shreya Trivedi MD, Nora Taranto MD, Sarah P. Roberts MPH.
• Editor: Matthew Watto MD
• Hosts: Shreya Trivedi MD, Chris Chiu MD, Leah Witt MD
• Guest: Reshma Jagsi MD, DPhil
• Special thanks to: Hannah Abrams MS4, Beth Garbitelli MS2, and Molly Heublein MD 

Time Stamps 

• 00:00 Intro, disclaimer and guest bio
• 03:10 Guest one-liner, WIM moment of awakening, Dr. Jagsi’s advice to her younger self
• 10:40 TIME’S UP Healthcare, how to get involved
• 13:10 Picks of the week: This American Life (podcast); The Bon Appétit (YouTube), The Nocturnists (podcast); Twitter
• 17:05 Defining sexual harassment
• 21:05 A case of sexual harassment; Predictors of harrassment; Duty to report
• 27:30 Creating a system that makes reporting easy
• 30:19 How pervasive is sexual harassment?
• 34:33 Why/how does bad behavior go unreported?
• 36:22 Pregnancy, parenting and promotion 
• 39:10 How is gender equity related to harassment? What can we do in our day to day?
• 42:13 An example from Radiation Oncology
• 46:43 How identity as sex intersects with many other identities (e.g. religion, sexual orientation) 
• 48:15 Examples of how can institutions are changing academic culture and addressing gender equity
• 53:28 Anonynmous reporting of sexual harassment
• 58:01 Take Home Points
• 60:25 Outro

Tackle rashes with wisdom from Kashlak’s resident Skinternist (or Internist-Externist) Dr. Helena Pasieka (MedStar, Georgetown), board certified in both Internal Medicine and Dermatology.  She offers “a rash approach to rashes” including: initial triage, ‘inside job’ vs ‘outside job’, differential diagnosis, a review of common culprits, basic management techniques, and how to determine if the reaction is life-threatening. Plus, Dr Pasieka teaches us how to handle family and friends asking, “Can you take a look at this rash?”. 

Full show notes at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and Produced: Beth Garbitelli MS2
• Infographic and Cover Art: Beth Garbitelli MS2
• Hosts: Stuart Bringham MD, Matthew Watto MD, Paul Williams MD  
• Editor: Matthew Watto MD
• Guest: Helena Pasieka MD 

Time Stamps

• 00:00 Intro, disclaimer, guest bio
• 04:10 Guest one-liner, book recommendations 
• 09:56 Case of a rash; initial thought process (sick versus not sick); review of systems
• 18:05 Grouping rashes: inside job versus outside job
• 22:07 Terminology: Many people dont speak derm
• 26:03 Skin itching versus Skin pain; Morbilliform drug eruption
• 30:08 Urticaria (hives) vs morbilliform rash; Cotton tipped applicators and dermatographism
• 35:42 Itching is not all about histamine; Treatment of hives
• 38:26 Treatment of morbilliform rash
• 40:00 Case summary and review of concepts learned thus far
• 41:00 AGEP
• 45:14 SJS/TEN; Nikolsky’s sign
• 53:20 Complications of TEN - Ocular surface disease; Vulvar disease
• 58:02 DRESS (now DIHS)
• 66:30 Tips for asking about time course of meds and symptoms; Recap of DRESS (DISH)
• 70:00 How to handle family and friends ask for rash evaluation
• 76:20 Outro
• 78:00 Post-credits scene

Confession: we have been holding out on you. Specifically, we’ve been sitting on a special episode of Hotcakes and Hot Takes that we recorded this March, with featured guest Armand Gottlieb, MD of the online publication The Scope. But here it is! We hope you’ll enjoy our discussion of topics like the ever-controversial e-cigarettes for smoking cessation question, outcomes related to antibiotic treatment of UTIs among elderly adults, and the role of sacubitril-valsartan for acute decompensated heart failure in inpatient settings (the PIONEER-HF study).  Special guest is Dr. Armand Gottlieb @ArmandGottlieb, who was a third year internal medicine resident at Columbia University Medical Center in New York City at the time of recording. He is a co-Editor of the The Scope, a free and brief weekly roundup of the most recent and relevant medical literature.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits 

• Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD
• Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD
• Guest Presenter and Content Planning: Armand Gottlieb, MD
• Editor: Christopher Chiu MD
• Cover-Art: Christopher Chiu MD

Pick of the Week

The SCOPE. The week’s best in evidence-based medicine, written in plain language and delivered to your inbox. Sign-up for weekly emails or download the app. 

Time stamps

• 01:00 Disclaimer, intro, guest bio
• 06:30 E-cigarettes vs. nicotine replacement therapy (NRT)
• 15:50 Antibiotic treatment of urinary tract infections (UTIs)
• 27:45 Sacubitril-valsartan for acute decompensated heart failure (PIONEER-HF study)
• 42:30 Wrap-up and outro

Take control of atrial fibrillation with expert insights and pearls from cardiologist, Dr. James Furgerson, in this jam-packed episode! You’ll learn why atrial fibrillation is such a big deal, how to diagnose it, how to treat it and when to call in for reinforcements. Dr. James Furgerson, MD  is a cardiologist from San Antonio, Texas with over 20 years in academics. Buckle up - This episode is going to send your heart racing! You might even skip a beat! Full notes at https://thecurbsiders.com.

ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Writer and Producer: Cyrus Askin MD
• Infographic: Cyrus Askin MD
• Cover Art: Cyrus Askin MD
• Hosts: Matthew Watto MD, Paul Williams MD, Cyrus Askin MD
• Editors: Matthew Watto MD
• Guest: James Furgerson MD

Time Stamps

• 00:00 Intro, disclaimer and guest bio
• 03:45 Guest one liner, a bit on physician well-being and some other randomness
• 08:15 A case of palpitations; risk factors for atrial fibrillation
• 12:17 Subclinical atrial fibrillation, overdiagnosis of afib; How much afib burden matters? 
• 15:08 Case summary and next steps in initial work up
• 18:48 Counseling patient about afib and its consequences
• 21:40 Ischemic heart disease and atrial fibrillation
• 24:17 Recap of diagnosis, initial work up and risk stratification in atrial fibrillation
• 25:25 Rate versus rhythm control; AFFIRM trial
• 30:50 Strict versus lenient rate control;  RACE trial
• 33:30 Deciding on rate versus rhythm control; Downside of antiarrhythmic therapies; When to switch from rate to rhythm control strategy
• 36:52 Ablation for atrial fibrillation; CASTLE-AF, CABANA trials
• 40:40 When to refer to cardiology and electrophysiology
• 42:42 Choice of agent for anticoagulation and latest guidelines for atrial fibrillation; New definition for valvular atrial fibrillation
• 45:22 DOACs in CKD and some other nuances in choice of agent
• 52:27 Bleeding and anticoagulation
• 58:38 Cardioversion for atrial fibrillation (initial versus delayed)
• 63:32 Anticoagulation before and after cardioversion
• 67:48 Lifestyles measures for atrial fibrillation
• 70:45 Atrial fibrillation during critical illness, after CABG and in hyperthyroidism
• 74:12 Aspirin monotherapy is not appropriate for atrial fibrillation
• 76:42 Take home points
• 78:50 Outro

Expand your knowledge about how--and how well--we manage the health of incarcerated patients in the United States, with the expert knowledge of correctional health experts Drs. Aaron Fox @adfoxmd, Jon Giftos @JonGiftosMD, and Emily Wang @ewang422. Correctional medicine is a black box for many providers who do not work in prison and jail settings. But it’s ever more relevant to primary care physicians everywhere, with increasing rates of incarceration the last decade.  In this episode, recorded live at SGIM 2019 #SGIM19, Dr. Fox, Dr. Giftos, and Dr. Wang talk us through the variability of the correctional healthcare systems throughout the country, the challenges to health for patients both while incarcerated and in the transition after release, and some essential nuts and bolts for providers about how to provide better care to this vulnerable population.  

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and produced by: Justin Berk MD MPH MBA, Nora Taranto MD
• Cover Image: Beth Garbitelli MS2
• Infographic: Beth Garbitelli MS2
• Hosts: Matthew Watto MD, Paul Williams MD, Justin Berk MD MPH MBA
• Edited by: Matthew Watto MD
• Guests: Aaron Fox MD, Jon Giftos MD, Emily Wang MD MAS

Sponsor

This episodes was recorded LIVE at #SGIM19 in Washington DC! Join the Society for General Internal Medicine today!

Time Stamps

• 00:00 Intro, disclaimer and guest bios
• 05:10 One liners, book recommendations, career advice
• 13:00 Why does incarceration matter for healthcare?; Defining terms: jail, prison, probation
• 18:47 What is healthcare like during incarceration? What services are available? Who provides the care? How does it breed “passive patients”?
• 21:10 HIV in incarcerated patients
• 27:02 Opioid use disorder in prisons -MAT is rarely available
• 31:44 Prison is a toxic environment —exposure to solitary confinement, PTSD, self harm
• 34:23 How to ask about incarceration
• 36:49 Trauma informed care and the unique challenges to providing patient care after release from prison
• 43:22 Systemic barriers after release from jail or prison e.g. lifetime ban from public housing or food stamps
• 44:45 Discharge planning and transitioning care after release from prison; community health workers
• 51:32 Resources for learning more and advocacy —AAJH, The Fortune Society, Just Health, Dr Wang’s research —why you should visit and learn more about the correctional settings in your locale
• 57:20 Outro

Bring back Bedside Rounds with tips from a master clinician educator, Jeff Wiese MD MACP (Tulane). How to accomplish teaching in the hospital is not on the curriculum for most folks in medical school or residency. This can feel especially daunting as you move from resident to attending. We address strategies to assess, monitor, teach, and coach the medical learners under your leadership with teaching wizard and coach extraordinaire, Dr. Jeff Wiese, recipient of over 50 teaching awards! ACP members can claim CME-MOC credit at https://acponline.org/curbsiders (CME goes live at 0900 ET on the release date).

Full show notes available at http://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and Produced by:  Matthew Watto MD FACP and Beth Garbitelli MS1 (almost MS2!)
• CME questions by: Matthew Watto MD FACP
• Hosts: Stuart Brigham MD, Paul Williams MD FACP, Matthew Watto MD FACP
• Images and infographics: Beth Garbitelli MS1
• Edited by: Matthew Watto MD FACP, Emi Okamoto MD
• Guest: Jeff Wiese MD MACP

Time Stamps

• 00:00 Intro, disclaimer, guest bio
• 03:28 Guest one-liner, love of Aaron Sorkin, book recommendations
• 10:52 Setting goals and expectations on day one
• 23:52 Preparing the resident for autonomy and assessing their place on the scale of supervision to autonomy
• 28:18 How to prepare for rounds as an attending to set yourself up for efficiency and success; The cardinal rule for being an attending
• 33:50 How long does it take determine a resident’s readiness for autonomy; Give your colleagues an “educational signout”
• 38:31 How to handle a request for card flipping; Prodiving a rationale for bedside rounds
• 43:54 The three Ds of Rounding; Should there be a fourth D
• 47:28 The choreography of bedside rounds; Privacy concerns; More on the rationale
• 63:00 How to handle unanswered questions in front of the patient
• 67:19 Resident as a “proud parent” on rounds
• 68:30 Rounding without the team (the afternoon)
• 73:18 Hand sanitizer (the Purell)
• 79:45 Advice to new PGY2s
• 81:35 When and how to incorporate teaching on high value care (specifically labs)
• 83:22 What’s the role of medical student on the wards team
• 85:18 Take home points
• 89:04 Plug: Teaching in the Hospital Deux
• 90:12 Outro

Rethink how you’re diagnosing and managing chronic pain with high-yield tips from pain experts and primary care doctors Soraya Azari MD @azarimugs (UCSF), and Phoebe Cushman MD, MS (UMass Memorial). Because let’s face it, managing chronic pain can be very difficult. Expand your toolbox for management-- including the importance of activity, empowering your patient, risk stratification for patients prior to opioid initiation, how to identify opioid use disorder, and how to taper opioids. Plus, updates on recent practice changing articles in chronic pain.

Full show notes at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and produced by: Nora Taranto MD
• Hosts: Nora Taranto MD, Paul Williams MD, Matthew Watto MD
• Edited by: Emi Okamoto MD, Matthew Watto MD
• Guests: Soraya Azari MD; Phoebe Cushman MD, MS

Sponsor

This episodes was recorded LIVE at #SGIM19 in Washington DC! Join the Society for General Internal Medicine today!

Time Stamps

• 00:00 Intro, disclaimer, guest bios
• 04:50 Guest one-liners, book recommendations, picks of the week, career advice
• 14:50 A case of chronic pain; Group pain into 1 of 3 buckets
• 18:48 Use of pain scales; and taking a pain history; affirming positive behaviors surrounding pain
• 23:13 Nonpharmacologic measures for chronic pain
• 26:30 Cognitive behavior therapy (CBT) for chronic pain; remote CBT vs traditional CBT
• 30:32 Apps for Meditation, Affirmations
• 31:53 Back to the case: Should we trial opioids for our patient’s chronic pain? Our guests give their recommendations and how they counsel patients about opioids
• 34:55 Counseling about risk of opioids
• 37:42 Risk stratifying patients requesting opioids; Some risk tools (COMM, Opioid Risk Tool, DIRE); Don’t forget to screen for mood disorders
• 42:10 What to do if pain is not improved on high dose opioids; How to identify an opioid use disorder
• 45:13  How to taper patients off opioids; Forced tapers and the CDC guidelines; how to taper the right way
• 50:34 Buprenorphine for opioid use disorder and/or chronic pain
• 57:38 Gabapentin and risk for misuse and/or unintentional overdose in patients also using opioids
• 61:42 Plugs: Get your x-waiver, or better yet advocate for getting rid of the waiver

Build your knowledge base to improve primary care for LGBT patients! This episode is chock full of clinical pearls and updates for LGBT health from SGIM presenters, Dr. Jenny Siegel (Boston University) and Dr. Megan McNamara (Louis Stokes Cleveland VAMC). They define common gender identity terms and provide tips on how to take a sexual history. You’ll develop an approach to the unique clinical concerns of LGBT patients and learn how to phrase medical information in a gender neutral framework. This is a must listen episode for all health care providers!

Full show notes at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and Produced by: Carolyn Chan MD

Graphics: Hannah Abrams

Hosts: Carolyn Chan MD, Paul Williams MD, Matthew Watto MD

Guest: Megan McNamara MD, Jenny Siegel MD

Sponsor

This episodes was recorded LIVE at #SGIM19 in Washington DC! Join the Society for General Internal Medicine today!

Time Stamps

• 00:00 Intro, disclaimer, guest bios
• 02:45 Guest one-liners, movie recommendations; favorite failures; Paul’s pick of the week
• 10:52 Defining terms of gender identity
• 14:20 What to do when you misgender someone or use the wrong term
• 17:10 Is it a mistake to think of the entire LGBT group as the same?
• 19:19 How to take a sexual history, the 5Ps
• 22:00 Unique clinical concerns of LGBT patients; what screening should be performed
• 24:20 Avoid focusing too much on sexuality and gender identity. Don’t forget to address their medical concerns
• 24:42 Screening for mental health disorders and asking about suicide
• 27:16 Cancer screening in transgender patients; a bit on transgener terminology; how to take an anatomy inventory
• 34:18 Vaccinations
• 37:05 Contraception considerations and VTE risk with hormonal therapy
• 41:40 Pre-exposure prophylaxis and risk of STIs
• 43:30 Impact of discriminatory state laws on LGBT mental health
• 47:32 Plugs: Fenway Health; UCSF trans health website; Guidelines from the Endocrine Society
• 49:35 Closing remarks
• 51:05 Outro

What do Judas Priest, surfing, and clots have in common? They are the passionate interests of expert Dr. Michael Streiff who guides us through the diagnosis and management of DVT and PE aka venous thromboembolism (VTE). By the end of the episode you will know how to catch a clot very Wells! We dive deep into the treatment options, literature, and some unique cases. ACP members can claim CME-MOC credit at https://acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and produced by (including CME questions): Justin Berk MD, MPH, MBA
• Cover art by: Kate Grant MBChB DipGUMed
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham MD
• Edited by: Matthew Watto, MD, FACP
• Guest:  Michael Streiff MD

Time Stamps

• 00:00 Intro, disclaimer and guest bio
• 04:40 Guest one-liner, book and music recommendations, advice about rejection, how to think about studies
• 11:15 A case of DVT and some basic terminology
• 15:37 Which DVT risk factors are most important?
• 18:40 Use of the Wells score and D-dimer testing; should we use an age adjusted D-dimer; What about the YEARS criteria
• 22:55 Classifying DVT; determining need and duration of anticoagulation [distal (calf vein) DVT, proximal DVT]; brief discussion of IVC filters & catheter directed therapies
• 27:56 IVC filters for trauma
• 29:30 Upper extremity DVT
• 33:12 Proximal vs whole leg ultrasound for diagnosis of DVT
• 36:25 A case of pulmonary embolism; how to diagnose pulmonary embolism and a bit on V/Q scans
• 40:35 PESI score and HESTIA criteria
• 42:05 Summary of how to diagnose DVT and PE
• 43:34 Choice of initial anticoagulation
• 45:29 DOACs for cancer
• 48:14 DOACs for patients with very high or very low BMI
• 49:33 Why apixaban is Dr Streiff’s favorite DOAC?
• 51:20 Duration of therapy for DVT and PE
• 53:33 Unprovoked DVT/PE: Risk scoring models
• 57:52 Is thrombophilia workup necessary?
• 58:28 Antiphospholipid antibody syndrome
• 59:58 An extensive cancer workup is unnecessary
• 60:33 Subsegmental pulmonary embolism: To treat or not to treat
• 61:49 Apixaban dosing in CKD and ESRD
• 63:51 AUGUSTUS trial for dual versus triple therapy
• 64:52 Plug for National Blood Clot Alliance “Stop the Clot”; Anticoagulation Forum website; new 2019 ASH guidelines
• 66:35 Outro
• 68:00 Post credit scene

Expand your idea of ischemic heart disease to include non-obstructive patterns, which as our guest, Dr Noel Bairey Merz, a clinical investigative cardiologist whose multiple roles include Director of the Barbra Streisand Women’s Heart Center and the Preventive Cardiac Center at the Smidt Cedars-Sinai Heart Institute, shares with us, is incredibly common, especially in women.  Learn to recognize these women and treat according to guidelines, preventing unnecessary IHD mortality in our female (and some male) patients. We review a variety of non-obstructive pathologies and the best techniques to evaluate them.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and produced by: Shreya Trivedi MD, Molly Heublein MD
• Hosts: Paul Williams MD, FACP; Shreya Trivedi MD; Molly Heublein MD
• Edited by: Matthew Watto MD, FACP; Emi Okamoto MD
• Graphics by: Hannah Abrams
• Guest: Dr. C Noel Bairey Merz MD, FACC, FAHA

Curbsiders' Schwag!

We’ve got the perfect father’s day gift for every internal medicine nerd. The Curbsiders have opened our own online shop. Get your Curbsiders t-shirts, hoodies, stickers, and coffee mugs. Help support the show and gain instant bragging rights. Note: All purchases come with admitting privileges at Kashlak Memorial Hospital!

Time Stamps

• 00:00 Intro, disclaimer and guest bio
• 04:36 Guest one-liner; Advice for success in research and clinical practice
• 07:07 A case of shortness of breath and chest tightness; Why the paradigm of obstructive coronary artery disease is flawed.
• 12:04 Why is there a sex difference in ischemic heart disease?
• 14:52 How to recognize ischemic heart disease in women; Are certain symptoms more likely in women; Categorizing angina
• 20:13 Who needs stress testing?; Screening for ischemic heart disease in women
• 24:52 How guidelines make good doctors great doctors
• 27:00 Diagnosis of NSTEMI in a woman without obstructive coronary disease
• 29:33 Medical therapy for non-obstructive ischemic heart disease
• 33:18 Additional testing: Cardiac MRI for myocarditis; perfusion reserve testing; CT coronary angiograms
• 35:48 How current non-invasive techniques fail to identify microvascular ischemic heart disease in women
• 39:10 Antianginal therapy
• 41:40 HFpEF in women
• 47:10 Weight loss for paroxysmal atrial fibrillation
• 48:45 New nomenclature for ischemic heart disease
• 50:18 Take home points
• 52:40 Outro

Dare to lead. Master the transition to PGY2 with tips from expert educator Abby Spencer MD, MS, FACP, IM Residency Program Director and Vice Chair for Education for the Medicine Institute at Cleveland Clinic and Shreya Trivedi MD, GIM Fellow at NYU School of Medicine. Topics include: how to run work rounds, preparing your team for attendings rounds, how to teach on the fly, finding your leadership style, and what to read during residency. This is the first of three episodes that we’re co-developing with the American College of Physicians for their Resident Transitions Series.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and produced by: Shreya Trivedi MD
• Graphics and Show Notes by: Hannah R Abrams
• Hosts: Paul Williams MD, FACP; Stuart Brigham MD; Matthew Watto MD, FACP; Shreya Trivedi MD
• Guest: Abby Spencer MD, MS, FACP

Sponsor

The Resident Transitions Series is brought to you by The American College of Physicians with support from its Council of Resident/Fellow Members. Visit acponline.org/resident to learn more about the benefits of Resident/Fellow Membership and join our proud internal medicine community today!

Time Stamps

• 00:00 ACP’s Resident Transitions Series - Sponsor
• 01:50 Disclaimer, intro and guest bio
• 06:05 Guest one liner, book recommendations, favorite failure, advice for learners
• 14:10 Stuart’s tale of struggle from residency
• 18:05 New PGY2 resident thinks she has nothing to teach her learners
• 20:20 How to run work rounds and set expectations
• 31:55 How, when and where to teach as a resident
• 46:09 Leadership skills, understanding your learners, and giving difficult feedback
• 60:08 What to read during residency, how to find time, and some strategies to achieve your learning goals
• 71:30 Take home points
• 75:28 Outro
• 77:10 End credit sequence

Recognize common presentations of anaphylaxis and stop under-treating this deadly allergic reaction with tips from Dr. Olajumoke Fadugba, Assistant Professor of Medicine, University of Pennsylvania! We review the basic pathophysiology and the standard criteria for diagnosing anaphylaxis, treatment basics, the primary importance of epinephrine, and the utility of adjunctive therapies. Also included are great tips on counseling patients about auto-injectable epinephrine, and a reminder not to panic...even when you inject your own thumb?! ACP members can claim CME-MOC credit at https://acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).

Full show notes available at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Writer (interview, show notes & CME questions) and cover art: Emi Okamoto MD
• Infographic by: Emi Okamoto MD
• Hosts: Matthew Watto MD, FACP; Stuart Brigham MD
• Editors: Matthew Watto MD, FACP
• Guest: Olajumoke Fadugba MD
• Special thanks to Sarah Phoebe Roberts MPH for booking!

Time Stamps

• 00:00 Intro and disclaimer
• 03:00 Guest one-liner, book recommendation, advice to fellows and trainees
• 07:15 Case of anaphylaxis with mucocutaneous and GI symptoms
• 09:05 Anaphylaxis (IgE mediated mast cell action) vs anaphylactoid (non-IgE mediated mast cell activation; e.g. contrast allergy, vancomycin)
• 12:34 Vancomycin and non-IgE mediated reactions
• 14:40 Common presentations of anaphylaxis and the three diagnostic criteria
• 22:09 Biphasic reactions and predicting severity
• 26:42 Counseling patients on the use of epinephrine
• 28:35 Stuart’s thumb question
• 30:00 Adjuvant medications: antihistamines and corticosteroids
• 33:20 Are there any contraindications to epinephrine use?
• 34:25 Use of tryptase levels when the diagnosis of anaphylaxis is uncertain
• 37:10 Outro

HFpEF (heart failure with preserved ejection fraction) with master cardiologist, Dr Clyde Yancy MD, Chief of Cardiology and Professor of Medicine (Cardiology) and Medical Social Sciences, Northwestern, Feinberg School of Medicine. Topics include: pathophysiology, HFpEF phenotypes, how to interpret a borderline ejection fraction, evidence based therapies, diuretics, and future directions (pulmonary artery monitors, intra-atrial shunts, ARNI compounds), and more!

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and produced by: Paul Williams MD, FACP; Sarah Phoebe Roberts MPH
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham MD
• Show Notes: Justin Berk MD, MPH, MBA; and Beth Garbitelli MS1
• Infographics: Beth Garbitelli MS1
• Editor: Matthew Watto MD, FACP
• Guest: Clyde Yancy MD, MSc, MACC, FAHA, MACP, FHFSA

Time Stamps

• 00:00 Thanks to our producers Sarah Phoebe Roberts, Beth Garbitelli and Justin Berk
• 00:50 Intro and guest bio
• 04:00 Guest one liner, career advice
• 08:20 Ms Diana Stolic has HFpEF. What’s the difference in HFpEF and diastolic dysfunction?  
• 11:33 How should we think about borderline ejection fraction?
• 15:24 Pathophysiology and Phenotypes of HFpEF
• 18:57 More on the pathophysiology of HFpEF (nitric oxide, fibrosis, inflammatory signaling)
• 21:00 Are there morbidity and mortality differences for HFpEF versus HFrEF?
• 24:45 What historical factors are most important in HFpEF?
• 27:50 Pulmonary artery monitors for HFpEF
• 29:00 Does Diuretic therapy differ in HFpEF and HFrEF?
• 33:44 Ischemic workup for new HFpEF
• 35:33 Right heart cath for HFpEF
• 36:53 Future of HFpEF
• 41:04 Will ARNI compounds work for HFpEF? What are the current medications for HFpEF?
• 45:20 SGLT2 inhibitors for heart failure
• 46:30 Outro

Recap of random pearls and highlights from SGIM19 Day 2 including: methadone and buprenorphine, perioperative buprenorphine, medical cannabis, HPV vaccination, young adult medicine, academic promotions, long term sequelae of childhood kidney disease, stage 1 hypertension, some great free resources in addiction medicine, and more! Special thanks to the Society for General Internal Medicine for their hospitality.

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written, produced, and cohosted by: Paul Williams MD, Matthew Watto MD, Justin Berk MD, Carolyn Chan MD, Shreya Trivedi MD, Nora Taranto MS4 (soon to be MD!)
• Edited by: Matthew Watto MD

Time Stamps and Links are included below

• 00:00 Intro and Disclaimer
• 02:30 Generalists receive the same number of grants, but publish fewer publications and are less likely to achieve professorship versus medical or surgical subspecialists (JGIM 2017)
• 05:30 GIM division directors differ in their emphasis on peer-reviewed publications for academic promotion (Acad Med 2015)
• 07:30 Only about 30% of patients are started on MAT after an overdose despite a known mortality benefit and a known mortality rate of 5% twelve month mortality in this population (Larochelle Annals Int Med 2018)
• 08:48 A representative in NYC has proposed a bill to get rid of the buprenorphine waiver program.
• 11:00 Stimulant use is not a contraindication to continuing buprenorphine (expert opinion from SGIM session on Addiction Medicine).
• 11:45 Perioperative buprenorphine: 1) Consider switching to full agonist therapy or 2) Dose buprenorphine 3-4 times daily and continue use during the perioperative period (Expert opinion from SGIM session titled “Buprenorphine 2.0”)
• 12:40 Options to transition from methadone to buprenorphine: Option 1) Taper methadone to 30-40 mg once daily. Then, hold methadone for 72 hours before starting buprenorphine. Option 2) “Microdosing” with buprenorphine patch while still on methadone and then start oral buprenorphine. Note: This is expert opinion so consult with your local expert before attempting this on your own!
• 13:46 UCSF has a “Warm Line” for free consultation about substance use https://nccc.ucsf.edu.
• Get a free buprenorphine waiver from https://pcss.org
• 15:10 New joint guidelines on transitions remind providers that young adults need help navigating the healthcare system. Many young adults have never accessed healthcare resources on their own (Pediatrics 2018)
• 18:50 Childhood kidney disease increases risk for end stage renal disease as an adult (NEJM 2018)
• 20:35 Two studies concluded that stage 1 hypertension in young adults confers an increased risk for morbidity and treating it confers a benefit (Yano AMA 2018; Son JAMA 2018)
• 23:35 HPV update: The 9 valent vaccine was approved for young adults age 27-45 years old, but this has not yet made it into the guidelines. The HPV vaccine is effective for preventing cervical cancer (Cochrane Review 2018) and provides some herd immunity (Clin Inf Dis 2018)
• 26:40 Dr Chan offers tips on how to handle resident mistreatment and phrases that you can use to defuse the situation.
• 31:30 Some broad comments on the use of medical cannabis for pain management (Expert opinion from SGIM session)
• 36:30 Newer data suggests that even one drink daily might have adverse health outcomes (Lancet 2019).
• 39:00 Outro

Citation

Paul Williams MD, Matthew Watto MD, Justin Berk MD, Carolyn Chan MD, Shreya Trivedi MD, Nora Taranto MS4. Recap SGIM19 Day 2”. The Curbsiders Internal Medicine Podcast https://thecurbsiders.com. May 17, 2019.

Recap of random pearls and highlights from SGIM19 Day 1 including: Kidney stone treatment (roller coasters, sex and tamsulosin), aspirin, SGLT2 inhibitors to reduce kidney events, oral antibiotics for endocarditis, preferred physician attire, sexual harassment, writing letters of recommendation, triple therapy for COPD, DAPT for stroke, and more! Special thanks to the Society for General Internal Medicine for their hospitality.

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written, produced, and cohosted by: Paul Williams MD, Matthew Watto MD, Justin Berk MD, Carolyn Chan MD, Shreya Trivedi MD, Abby Spencer MD, MS, Nora Taranto MS4 (soon to be MD!)
• Edited by: Matthew Watto MD
• Special Guest: Abby Spencer MD, MS 

Time Stamps and Links are included below

• 00:00 Intro and Disclaimer
• 02:33 Abby explains what it means to attend SGIM
• 04:35 Tips for writing letters of recommendation
• 08:54 How to handle lapses of professionalism in a trainee
• 10:30 How to address sexual harassment
• 12:42 Oral antibiotics after 10 days of IV antibiotics are noninferior for left sided endocarditis in non-IVDU (NEJM 2019)
• 14:22 Patients prefer physicians to dress in more formal attire. (BMJ Open 2018)
• 16:29 Kidney stone passage occurs more frequently when sitting in the back car of a roller coaster (J Am Osteopath Assoc 2018)
• 18:00 Sexual intercourse three times weekly improves rate of kidney stone passage (Urology 2015)
• 18:58 Vancomycin coverage for hospital acquired pneumonia can safely be stopped after four days if cultures remain negative for MRSA (Chest 2019)
• 20:00 Notes that contain stigmatizing language are associated with negative provider feelings and less aggressive pain management (JGIM 2018)
• 21:10 Medication errors are less frequent if the medication reconciliation is performed at time of ICU discharge (Ann Intensive Care 2018)
• 21:56 Five of six pediatricians found Lego heads in their stool after intentional ingestion (J Paediatric Child Health 2018).
• 24:40 Canagliflozin (SGLT2 inhibitor) improved renal outcomes and cardiovascular events (Credence trial, NEJM 2019; Check out the Freely Filtered (NephJC podcast coverage))
• Triple therapy for COPD with LAMA/LABA/ICS is superior to dual therapy (IMPACT trial NEJM 2018)
• 27:20 The ASCEND trial of aspirin for primary prevention in patients with diabetes contained 97 percent white patients and showed similar NNT to NNH for cardioprotection and bleeding respectively (ASCEND trial NEJM 2018)
• 28:45 Consider a short course of dual antiplatelet therapy for minor stroke or high risk TIA (BMJ 2018)
• 30:07 Omega-3 fatty acids decreased cardiovascular events in patients whose triglycerides remained elevated despite statin therapy (REDUCE-IT trial NEJM 2019)
• 30:24 Tamsulosin did not help pass stones under 5 mm, but might be effective for stones >5 mm (J Fam Pract 2018)
• 31:06 Trainees who are stressed during residency tend to stay stressed (I was unable to quickly locate this citation. Sorry. -Dr. Watto)
• 32:02 How does our team choose their pearls for the recap show
• 35:21 A needs assessment at University of Michigan found that female residents want to learn skills on leadership, negotiation and giving pitches to prepare them for careers in medicine (Poster by Dr Jennifer Lukela).
• 36:57 Abby Spencer received an AAIM Innovations grant: “Key steps to rise for women trainees in leadership development”.
• 38:42 Outro

Identify and treat the most common causes of hip pain in the outpatient setting with returning guest, Dr Ted Parks. A large majority of hip pain in the office setting will be due to one of three conditions (hip osteoarthritis, greater trochanteric pain syndrome, and lumbo-sacral back pain). Learn to easily identify these conditions, how to initiate conservative treatment, and more about hip replacements. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Molly Heublein MD, Nora Taranto MS4

CME questions by:  Molly Heublein MD, Nora Taranto MS4

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD, Molly Heublein MD

Edited by: Matthew Watto MD, Emi Okamoto MD

Guest Presenter: Ted Parks MD

Time Stamps

• 00:00 CME announcement, disclaimer, intro and guest bio
• 04:05 Guest one-liner; advice for teachers and learners
• 08:30 Case of hip pain, review of hip anatomy, and the three buckets of hip pain
• 15:35 Greater trochanteric pain syndrome
• 16:20 The zebras of hip pain
• 18:12 Physical exam for hip pain
• 21:33 Hip osteoarthritis: imaging and initial therapy
• 24:18 Hip injections: Do steroids work? What about hyaluronic acid?
• 29:00 Who needs hip replacement surgery? How long will it last?
• 32:30 Greater trochanteric pain syndrome
• 35:58 Lumbar spine versus hip pain from OA
• 38:58 Hip replacement technology: materials; etiology of component loosening and need for re-operation
• 42:03 Take home points and outro

Electric cars, virtual reality, nanotechnology, and now… telemedicine? We chat with Dr. Ana María López MD, FACP about the future of telehealth, how to implement it in your practice, and the challenges you might face in doing so. Dr. López is immediate past president of the American College of Physicians (ACP) as well as Vice Chair of Medical Oncology and Chief of New Jersey Division Sidney Kimmel Cancer Center of Thomas Jefferson University. Her main areas of professional interest and expertise include cancer prevention and equity, integrative oncology, implementation of innovations in health care including telemedicine, and women’s health. We learned immensely from our talk with her and we hope you will, too! ACP members can claim free CME & MOC credit at https://acponline.org/curbsiders. Download Dr Brigham’s telehealth cheat sheet as a PDF at http://thecurbsiders.com/podcast.

Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Hannah Abrams, Stuart Brigham MD

Cohosts: Matt Watto MD, Stuart Brigham MD, Paul Williams MD, Hannah Abrams

Guest: Ana María López MD

Time Stamps

• 00:00 Disclaimer, intro and guest bio
• 04:20 Guest one line, poetry recommendations, favorite failure
• 12:00 Defining telemedicine
• 14:12 What kind of services exist in telemedicine? How can the technology make your practice easier?
• 20:18 Is there good evidence for telehealth and telemedicine?
• 24:20 Concerns about telehealth and the loss of touch as part of the doctor-patient relationship; haptics and the remote physical exam
• 30:17 Providing telehealth across state lines
• 34:35 Consultation codes for telehealth and ECHO (remote consultations)
• 40:20 Basic steps and best practices to start implementing telehealth
• 44:30 Stuart’s shares some preliminary data on use of telehealth and workforce satisfaction
• 49:12 Adding access by using telehealth in primary care
• 51:40 Take home points
• 54:42 Stuart shares a pun

This week we narrow in on the enlarging prostate and decipher the common issue of benign prostatic hyperplasia with Adam C. Reese MD, Associate Professor of Urology at the Lewis Katz School of Medicine at Temple University and Chief of Urologic Oncology at Temple University Hospital. Learn how to interpret the symptom profile for patients presenting with common urinary issues, what to feel for in the digital rectal exam, how to treat BPH, and when to refer.

ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

See you at SGIM 2019!

Find us in our red Curbsider’s t-shirts handing out Curbsiders and Kashlak stickers/patches at SGIM 2019 in Washington DC! We’ll be recording full length shows and daily recaps!

Credits

Written and produced by: Paul Williams MD

Hosts: Paul Williams MD, Matthew Watto MD

Images and infographics: Elena Gibson, Beth Garbitelli

Show Notes: Elena Gibson, Beth Garbitelli

Edited by: Matthew Watto MD, Chris Chiu MD

Guest: Adam Reese MD

Time Stamps

00:00 SGIM announcement

00:30 Disclaimer, intro and guest bio

03:20 Guest one liner, book recommendation, favorite failure and surgical M&M

10:56 Case of benign prostatic hyperplasia, defining terms and obstructive/voiding versus storage/irritative symptoms

16:11 IPSS score and evaluating symptoms

22:10 Digital rectal exam. Will this give any useful information?

26:55 Taking a history about BPH and some lifestyle modifications

29:20 Lab studies for urinary tract symptoms and interpreting PSA and free PSA

36:20 Initial therapy for BPH and managing patient expectations, alpha blocker side effects

39:25 Choice of agent and monitoring symptoms on therapy

42:25 Nonpharmacologic management of bladder complaints

45:10 Who and when to refer to urology

47:33 Counseling about use of 5 alpha reductase inhibitors, their side effects and is there a risk for high grade cancer?

52:35 Phosphodiesterase inhibitors for BPH symptoms

53:50 Urethral milking. NOT prostate milking

54:55 Desmopressin for nocturia

56:20 Take home points

59:03 Prostate volume and PSA

61:10 Outro

Full show notes available at http://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Random pearls from ACP #IM2019 Day 3. The Curbsiders crew is joined by Dr Alan Dow of VCU to discuss highlights from ACP’s Internal Medicine Meeting in Philadelphia including: sleep deprivation, the glymphatics system, inflammatory back pain, heart failure, dermatology pearls, a new definition for pulmonary hypertension and more!

"Sorry, no time stamps or full show notes for this one. We're too tired." -The Curbsiders

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

#IM2019 Curbsiders Crew

• Guest: Renee Dversdal MD, Alan Dow MD, Alia Chisty MD
• Cohosts: Paul Williams MD, Stuart Brigham MD, Shreya Trivedi MD, Molly Heublein MD, Emi Okamoto MD, Justin Berk MD, Cyrus Askin MD, Matthew Watto MD, Chris Chiu MD
• Director of operations: Chris Chiu MD
• Twitter: Cyrus Askin MD, Hannah Abrams MS3
• Instagram: Beth Garbitelli MS1
• Facebook: Chris Chiu MD
• Off-air producer: Sarah Phoebe Roberts MPH, Nora Taranto MS4
• Marketing: Jen Watto

Random pearls from ACP #IM2019 Day 2. The Curbsiders crew is joined by Dr Alia Chisty (future PD at Penn State Hershey) at ACP’s Internal Medicine Meeting in Philadelphia to discuss highlights including: baloxavir a new drug for flu, stress testing and coronary CT angiography pearls, celiac disease, H. pylori pearls, and a bunch of random pearls from infectious diseases, palliative care and more!

"Sorry, no time stamps or full show notes for this one. We're too tired." -The Curbsiders

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

#IM2019 Curbsiders Crew

• Guest: Renee Dversdal MD, Alan Dow MD, Alia Chisty MD
• Cohosts: Paul Williams MD, Stuart Brigham MD, Shreya Trivedi MD, Molly Heublein MD, Emi Okamoto MD, Justin Berk MD, Cyrus Askin MD, Matthew Watto MD, Chris Chiu MD
• Director of operations: Chris Chiu MD
• Twitter: Cyrus Askin MD, Hannah Abrams MS3
• Instagram: Beth Garbitelli MS1
• Facebook: Chris Chiu MD
• Off-air producer: Sarah Phoebe Roberts MPH, Nora Taranto MS4
• Marketing: Jen Watto

Random pearls from #IM2019 Day 1. The Curbsiders crew is joined by Kashlak’s POCUS Chief, Renee Dversdal MD at ACP’s Internal Medicine Meeting in Philadelphia to discuss day 1 highlights inlcuding: POCUS, lyme rash, back pain, syphilis, women’s health, patient handoffs, the flip-flop fungal sign a ton of cardiology pearls (ie diuretics, paracentesis for CHF, beta blockers, LBBB, when is it safe to have intercourse after an MI?) and more!

"Sorry, no time stamps or full show notes for this one. We're too tired." -The Curbsiders

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

#IM2019 Curbsiders Crew

• Guest: Renee Dversdal MD, Alan Dow MD, Alia Chisty MD
• Cohosts: Paul Williams MD, Stuart Brigham MD, Shreya Trivedi MD, Molly Heublein MD, Emi Okamoto MD, Justin Berk MD, Cyrus Askin MD, Matthew Watto MD, Chris Chiu MD
• Director of operations: Chris Chiu MD
• Twitter: Cyrus Askin MD, Hannah Abrams MS3
• Instagram: Beth Garbitelli MS1
• Facebook: Chris Chiu MD
• Off-air producer: Sarah Phoebe Roberts MPH
• Marketing: Jen Watto

Join(t) us in learning about rheumatoid arthritis care for the internist with Robert McLean MD, rheumatologist, Associate Clinical Professor at Yale, and President Elect of the ACP! We discuss the complexity of rheumatoid arthritis, how to differentiate from other arthritic conditions, and how to have a patient-centered framework for the evaluation and treatment of affected patients. ACP members can claim CME-MOC credit at on ACP's site..

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Writer (Interview & CME questions): Cyrus Askin MD

Show Notes and Infographic by: Elena Gibson MS4

Hosts: Matthew Watto MD, Stuart Brigham MD

Editors: Matthew Watto MD, Emi Okamoto MD

Guest: Robert McLean MD

Time Stamps

• 00:35 Disclaimer, intro and guest bio
• 03:38 Guest onliner; Nudge (book) on behavioral economics
• 08:30 Favorite failure; Stuart’s pick of the week
• 12:24 Key historical features of RA
• 15:30 Differential diagnosis
• 19:20 Physical findings in RA
• 20:58 Initial labs orders for suspected inflammatory arthritis; CRP vs high sensitivity (cardio) CRP assays
• 27:45 Epidemiology of RA; Is there a utility for scoring systems?; A bit more on inflammatory markers
• 32:30 Recap and test interpretation
• 36:22 High yield physical exam in RA
• 40:56 Initial counseling after RA diagnosis
• 46:00 Therapeutic trial with NSAIDS or steroids for inflammatory arthritis
• 50:29 When to reach for the DMARDS
• 52:40 Are steroids considered DMARDS?
• 54:50 Primary care considerations for patients starting steroids or DMARDS (TB, vaccinations)
• 60:34 When and how long to hold DMARDS for surgery or acute illness
• 62:10 Drug-drug interactions and monitoring with methotrexate, hydroxychloroquine, sulfasalazine
• 70:10 Anti-inflammatory diets
• 73:30 Take home points
• 76:00 Outro

Pain management in patients with chronic kidney disease (CKD) often goes something like this: NSAIDs are evil, acetaminophen hardly works, opioids are dangerous, and all the rest (tramadol, gabapentinoids, antidepressants) are messy. But, we tackle the complexities of pain management in patients with chronic kidney disease in this special @NephMadness 2019 episode that, on a scale of 1-10, will leave you feeling very relieved in addressing pain.

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Earn CME and read about each region in NephMadness 2019 at AJKD blog.

Credits

• Written and produced by: Justin Berk MD, Samantha Gelfand MD
• NephMadness Pun Contest produced by: Hannah R Abrams MS3
• Cover art by: Kate Grant MBChB, Dip GUMed
• Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD
• Edited by: Matthew Watto MD, Emi Okamoto MD
• Guests:  Samantha Gelfand MD, Matthew Sparks MD, David Juurlink MD 

Time Stamps

• 00:00 Kidney Pun
• 01:19 Disclaimer, intro and guest bios
• 06:30 Guest one-liners
• 10:42 Books recommendations, staff picks and a patient complaint
• 15:25 Clinical Case and Pain Management Disclaimer
• 16:33 Modalities in pain medicine
• 18:20 Opioids for pain and their metabolites
• 20:44 Dave Juurlink reframes the question, “what is our real goal with pain management?”
• 24:42 Matt Sparks reiterates the dangers of morphine and codeine in patients with advanced CKD
• 27:44 Communicating meds that are contraindicated or relatively contraindicated in CKD
• 30:40 Buprenorphine
• 32:40 What about the WHO Pain Ladder for CKD?; 33:32 Should we use more cannabinoids? Ketamine?
• 37:07 Dave Juurlink rants on Tramadol
• 44:20 How to pick winners in NephMadness
• 46:06 NSAIDS and CKD
• 57:07 Gabapentinoids (gabapentin and pregabalin) for neuropathic pain and driving?!
• 65:57 Estimating eGFR in CKD and AKI. Which equation is best?
• 70:38 How would each of our experts treat this patient with CKD and knee pain
• 75:20 NephMadness 2019 picks for the pain region
• 82:55 Outro

Does your sympathetic nervous system get activated when you notice acute kidney injury in patients with cirrhosis? Ever wonder how to really diagnose hepatorenal syndrome (HRS)? Think you have the bile-acid-stones to start diuretics on a patient requiring pressor support for kidney failure? You have come to the right place! Listen to @kidney_boy Joel Topf, HRS expert Juan Carlos Velez (@veleznephhepato), and self-proclaimed most-handsome-nephrologist Bill Whittier (@TWhittier_RUSH) tackle the complex pathophysiology and treatment of hepatorenal syndrome in this NephMadness 2019 special episode!

Fill out your bracket for NephMadness 2019 today and sign up as part of The Curbsiders! Earn CME and read about each region at AJKD blog.

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Justin Berk MD, Nora Taranto MS4

Infographic by: Alex M @nephroguy

Hosts: Matthew Watto MD

Edited by: Matthew Watto MD, Emi Okamoto MD

Guests: Joel Topf MD, Juan Carlos Velez MD, Bill Whittier MD

Sponsor

Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019.

Time Stamps

• 00:00 NephMadness Kidney Pun Contest
• 01:04 Disclaimer
• 01:38 Sponsor - Become an ACP member today!
• 02:12 Intro, guest bio
• 04:38 Guest one-liners, some career advice and Joel’s pick of the week
• 13:14 Sponsor - Become an ACP member today!
• 14:48 Case of acute kidney injury in a patient with cirrhosis
• 16:37 Initial differential diagnosis and approach to newly elevated creatinine in cirrhosis (urinalysis, FeNa, urine sodium)
• 21:34 History and physical in cirrhosis and AKI
• 24:56 Hepatorenal physiology
• 26:45 Fluid choice
• 30:27 Diuretic therapy in cirrhosis and volume overload
• 34:38 Is a Renal Ultrasound useful in AKI?
• 40:05 Recap: the initial approach to AKI in cirrhosis
• 40:52 Therapeutic trials when volume status is uncertain
• 46:02 Hepatorenal physiology revisited
• 50:03 Vasoconstrictor therapy with octreotide, terlipressin, or norepinephrine
• 62:24 Type 1 versus type 2 hepatorenal syndrome
• 63:55 Large volume paracentesis (LVP) in cirrhosis with AKI; how much fluid to remove; use of diuretics or LVP in patient on norepinephrine?!
• 71:18 Diagnostic criteria or HRS
• 73:00 NephMadness matchups including bile cast nephropathy
• 78:40 Outro

Some precocious policy wonks take a deep dive into the evolving trends and future directions for our primary care workforce. Experts, Dr. Fatima Syed and Dr. Deep Shah return to school us on Physician Supply and Demand, the Access Gap, role of NPs and PAs, Retail Clinics, and Managed Care Clinics. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

Catch up on our previous discussions with Dr. Syed and Dr. Shah: Episode #62: Pod Save Health Care: The Curbsiders Foray into health policy and Episode #120 Health Policy, Patients, Payments, Paperwork for more context. We also did an overview of health care policy essentials with Dr. Sue Bornstein in Episode #64: Stuff You Should Know About Health Policy

Full show notes available at http://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Fatima Syed MD, MSc; Deep Shah MD, MSc

CME questions by: Chris Chiu MD, Beth Garbitelli MS1,

Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD,

Images and infographics: Beth Garbitelli MS1

Edited by: Matthew Watto MD, Chris Chiu MD

Guest: Fatima Syed MD, MSc, Deep Shah MD, MSc

Time Stamps

• 00:00 Disclaimer, intro, guest bios
• 04:40 Picks of the week
• 11:40 Defining physician supply and demand
• 21:30 Why are physicians less productive?
• 28:23 What does the supply demand mismatch mean for patients?
• 30:19 Discussion of various care delivery models (retails health clinics, minutes clinics, urgent care centers)
• 42:15 Physician compensation
• 53:50 Take home points from Fatima and Deep
• 59:39 Outro

Inpatient hypertension is tricky. What’s the best way to answer those overnight nursing phone calls for elevated blood pressures? What’s the role of treating hypertensive urgency in the hospital? Plus, Our nephrology experts put a new issue on the generalist’s radar: are ACE-inhibitors dangerous to give (or hold) during an operation? This NephMadness 2019 episode, features special guests Dr. Pascale Khairallah (@Khairallah_P), Dr. Charlie Wray (@WrayCharles) and Dr. Joel Topf (@kidneyboy) to better understand the role of anti-hypertensives in the inpatient setting and keep your blood pressure down on those overnight calls.

Fill out your bracket for NephMadness 2019 today and sign up as part of The Curbsiders!

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Justin Berk MD, MPH, MBA; Pascale Khairallah MD

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto, MD

Guest:  Pascale Khairallah MD, Charlie Wray DO, Joel Topf MD

Sponsor

Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019.

Time Stamps

• 00:00 Kidney Pun Contest with Hannah Abrams
• 01:16 Disclaimer
• 01:45 Sponsor - Become an ACP Member today!
• 02:14 Intro and guest bios
• 03:50 Picks of the weeks
• 06:00 Sponsor - Become an ACP Member today!
• 07:20 Case of acute severe hypertension; Does hypertensive urgency exist? Should we treat it?
• 26:40 Case of perioperative medicine. Should we hold the ace inhibitor? Is there evidence to guide us?
• 35:02 Take home points
• 36:54 Everyone picks their NephMadness winners for the hospital medicine region
• 43:13 Outro

The battle over the superiority of resuscitation fluids is coming to a boil. Enter the Fluid Wars. Are Lactated Ringers superior to normal saline? Will LR increase a patient’s lactate? What about albumin? The Curbsiders quench the thirst for knowledge by turning to masters Dr. Pascale Khairallah (@Khairallah_P), Dr. Charlie Wray (@WrayCharles) and Dr. Joel Topf (@kidneyboy) for guidance in this special @NephMadness episode that will get your feet wet with the complicated world of fluid resuscitation.

Fill out your bracket for NephMadness 2019 today and sign up as part of The Curbsiders!

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday.

Credits

Written and produced by: Justin Berk MD, Pascale Khairallah MD

NephMadness Pun Contest produced by: Hannah R Abrams MS3

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto MD

Guest:  Pascale Khairallah MD, Charlie Wray DO, Joel Topf MD

Time Stamps

• 00:00 Nephmadness pun contest
• 02:18 Disclaimer
• 02:52 Intro to the show and NephMadness, guest bios
• 08:04 Guest one-liners,
• 10:58 Joel explains NephMadness
• 12:58  Guest book recommendations and career advice
• 17:30 Clinical case; goals of fluid resuscitation; choice of initial IV fluid
• Corporate (TV series) Comedy Central
• 19:41 Complications of normal saline
• 21:29 Colloids versus crystalloids
• LR versus normal saline is not an innocuous decision
• 26:32 Saline versus balance fluids. What’s the makeup?
• 28:19 Does lactated ringers elevate lactate?
• 31:03 Is hyperkalemia a contraindication for LR?
• 32:39 Lactated ringers versus plasma-lyte and cost of fluid
• 34:49 In vitro risks of normal saline
• 40:31 SMART and SALT-ED trial
• 46:08 Stuart finds the IV fluid price list
• 44:37 Each panelist weighs in on saline versus balanced fluids
• 46:45 Why do patients with metabolic alkalosis thrive on saline?
• 49:04 Outro

Cirrhosis TIPS for the decompensated cirrhotic & acute on chronic liver failure from expert hepatologist and keto-practitioner Scott Matherly MD, @liverprof and chief hepatologist at @KashlakHospital. We walk through acute management of variceal bleeds, when to suspect SBP in decompensated cirrhosis (all the time, it turns out), how much fluid to remove in paracentesis, and some definitions about what decompensated cirrhosis and acute on chronic liver failure really mean.

Take our pretest on cirrhosis!

Full show notes available at http://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Nora Taranto MS4, Matthew Watto MD

Pretest by: Cyrus Askin MD

Hosts: Matthew Watto MD, Paul Williams MD,

Images and infographics: Hannah Abrams MS3

Edited by: Matthew Watto MD

Guest: Scott Matherly MD

Sponsor 

Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019.

Time Stamps

• 00:00 NephMadness teaser
• 00:50 Sponsor - Become an ACP Member today!
• 01:25 Intro, guest bio
• 03:45 Guest one-liner, keto diet
• 07:40 Picks of the week from Paul, Matt and Scott
• 11:50 Sponsor - Become an ACP Member today!
• 13:26 Clinical case of bleeding and altered mental status in cirrhosis
• 16:10 Interpretation of our patient’s labs and physical exam
• 18:53 Defining terminology in cirrhosis (decompensated vs compensated vs acute on chronic liver failure)
• 24:48 Initial workup, resuscitation and stabilization in variceal bleeding
• 26:10 Why occult blood and ammonia levels are unhelpful in cirrhosis
• 29:00 Fluid choice for the cirrhotic patient with hypotension; octreotide (or terlipressin); antibiotics prophylaxis
• 33:10 Proton pump inhibitors and ulcers from variceal banding
• 34:00 Mechanism of action for octreotide and terlipressin
• 35:54 Prevention of recurrent bleeding with TIPS, or nonselective beta blockers
• 40:40 Scores for prognostication in the acute setting
• 44:00 Coagulopathy of cirrhosis and should DVT prophylaxis be used
• 48:38 Elevated INR and procedures
• 56:55 Paracentesis in the acute setting and interpretation of fluid studies:cell count, total protein, SAAG, blood culture vial; pathophysiology of ascites
• 67:30 Treatment of SBP: antibiotics, IV albumin; plus, Hepatorenal physiology explained
• 79:04 Hepatic encephalopathy is a shunt phenomen; how to evaluate for causes; treatment of HE
• 87:58 Rifaximin
• 89:10 Take home points
• 91:02 Outro

Listen to our first ever discussion with @kidney_boy, Joel Topf MD. It’s a classic episode with a fresh intro as we prepare for @NephMadness 2019 with our friends from Twitter and @AJKDonline

Dominate leg cramps, diuretic therapy, and resistant hypertension with tips from @kidney_boy, Joel Topf MD @kidney_boy, Chief of Nephrology Kashlak Memorial Hospital, co-creator @NephMadness. We start with basic renal physiology and build up to the treatment of resistant hypertension.

Corrections: Dr Topf posted the following corrections on his blog PBfluids.com 3/22/2017

“I enjoyed the experience immensely, but in an hour of talking off the cuff I made some embarrassing mistakes:

In describing water reabsorption I said it occured in the cortical collecting duct rather than the medullary collecting duct.

In describing my cure for cramps I tell the story of Gitelman’s and say it is like congenital loop diuretics rather than congenital thiazide diuretics

I mucked up the story about the MRFIT story and how it allowed a head to head comparison of HCTZ and chlorthalidone. I really oversold what happened.”

Full show notes at https://thecurbsiders.com/podcast. Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written by: Matthew Watto MD

Produced by: Stuart Brigham MD and Matthew Watto MD

Cohosts: Stuart Brigham MD and Matthew Watto MD

Guest: Joel Topf MD

Sponsor

Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019.

Time Stamps

• 00:00 Sponsor - Become a member of the American College of Physicians
• 00:28 Disclaimer, Intro, Recap of upcoming shows, Corrections and Omissions
• 05:50 Guest one-liner, Discussion of social media in medical education, Joel’s book
• 12:45 Twitter for medical education including NephJC and NephMadness
• 19:50 Sponsor - Become a member of the American College of Physicians
• 21:30 Intro to diuretics, mechanism of action and a brief review of renal physiology
• 28:26 Use of thiazide diuretics
• 30:18 Chlorthalidone versus hydrochlorothiazide
• 34:47 Diuretics and hyponatremia, Monitoring electrolytes and renal function on diuretics
• 39:05 Leg (muscle) cramps and pickle juice
• 42:55 Thiazides, osteoporosis and fracture prevention
• 45:32 Resistant hypertension and  the workup for secondary hypertension
• 53:36 Loop diuretics: how to choose an agent, dosing
• 62:15 Take home points
• 67:00 Outro

Demystify chronic wound care management with high yield pearls from wound care expert Dr. Elizabeth (Foy) White-Chu. She takes us through a simple yet thorough approach to manage complex chronic wounds. We discuss everything from selecting a dressing, to pain management, and what kind of water should you really use when cleansing a wound. Answers to all of these burning questions and more await you, so don’t waste anymore time! Press play and let Dr. White-Chu take you on a journey through evidence based practices for the management of chronic wounds. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written by: Carolyn Chan MD

CME questions by: Justin Berk MD

Produced by: Matthew Watto MD

Hosts: Matthew Watto MD, Paul Williams MD, Carolyn Chan MD

Guest: Dr. Elizabeth (Foy) White-Chu

Sponsor

Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.

Time Stamps

• 00:00 Sponsor - ACPs MKSAP 18
• 00:25 Disclaimer, intro, guest bio
• 03:58 Guest one-liner, movie recommendation, favorite failure, career advice
• 11:40 Picks of the week
• 15:58 Sponsor - ACPs Medical Knowledge Self Assessment 18
• 17:50 Clinical case of lower extremity ulcer; describing a wound
• 21:04 Taking a wound focused history
• 26:28 Differentiating wound types
• 29:04 Edema and compression therapy; Should diuretics be used?
• 36:43 Description of the multi-component wrap
• 38:10 Counseling a patient about wound care and setting expectations for healing
• 41:29 High value options for each wound type
• 44:35 Gardening and wound bed preparation
• 51:32 A bit on silver therapy
• 53:40 Back to the case; Red flags in wound care
• 55:40 Culturing a wound
• 58:17 Instructions on how to write wound care orders
• 62:00 Rundown of topical therapies for wound care
• 65:04 Negative pressure wound therapy aka “wound vac”
• 66:14 How often are dressing changes needed?
• 68:27 Take home points
• 70:20 Outro
• 71:30 Carolyn gives a wound care PUN!

Dive deep into the psychopharmacology of depression with Dr Patrick Finley, PharmD at UCSF. Learn practical tips including how to switch from one antidepressant to another, what to expect with SSRI and SNRI withdrawal, and how to choose a second (or third) antidepressant for refractory depression. We also summarize the safety around antidepressants in the peripartum period. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Molly Heublein, MD

CME questions by: Molly Heublein, MD

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD, Molly Heublein, MD

Edited by: Matthew Watto MD

Guest Presenter: Patrick Finley, PharmD BCPP

Sponsor

Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.

Time Stamps

• 00:00 Sponsor ACP’s MKSAP 18
• 00:25 Disclaimer, intro and guest bio
• 04:33 Guest one-liner, book recommendation, and first patient complaint
• 08:04 Picks of the week
• 12:10 Sponsor ACP’s MKSAP 18
• 14:03 Clinical case of depression; assessing target symtpoms to characterize depression; choice of initial SSRI
• 17:49 Discussion of iron, ferritin, folate and L methylfolate as they relate to treatment refractory depression
• 20:12 Postpartum depression, iron, genetics and environmental factors
• 22:35 How to switch from one SSRI to another; Cross-titration from SNRI to SSRI or from SSRI to SNRI
• 26:05 Withdrawal symptoms from SSRIs or SNRIs and a bit more on switching and cross titration
• 31:33 Is paroxetine ever a good idea?
• 33:03 Ultra-rapid metabolizers of SSRIs and pharmacogenomics
• 34:43 Postpartum depression and treatment with antidepressants during pregnancy and lactation
• 39:25 Monitoring response to therapy with antidepressants ie PHQ-9
• 40:53 Augmentation for partial response; bupropion for augmentation and sexual side effects;
• 43:58 Counseling patients about discontinuation of therapy
• 47:00 How to choose an agent for augmentation of antidepressant therapy
• 51:02 Mirtazapine
• 52:41 Vortioxetine
• 53:24 Atypical antipsychotics for augmentation
• 55:37 Pregabalin and gabapentin for augmentation
• 57:42 Dr Finley’s take home points
• 60:48 Outro

Join us at the forefront as we talk genetic testing in primary care with Dr Dallas Read, esteemed gynecologist and **the only** medical geneticist at Tufts Medical Center. Topics include: what internists should be comfortable testing for in the office, how and when to refer for screening, what tests to order, how to interpret test results, how to handle direct-to-consumer results or requests, and so much more! For years, the medical community has been talking about the immense potential for genetic testing to guide diagnosis and treatment. But has it realized its full potential? The answer to that seems to be a resounding no at the moment--but the days of ubiquitous genetic testing to identify disease and disease risk may not be so far off after all. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

Coming to you from the Curbsiders, we hope you’ll enjoy this latest episode about the genes you wear, whether you want to put them on or not. Genes, Genes, they’re (maybe) good for your heart. But do patients want to know if they are, or if they aren’t?

Full show notes available at http://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and produced by: Nora Taranto MS4
• CME questions by: Nora Taranto MS4
• Hosts: Stuart Brigham MD, Matthew Watto MD, Nora Taranto MS4
• Images and infographics: Beth Garbitelli MS1
• Edited by: Matthew Watto MD, Chris Chiu MD
• Guest: Dr. Dallas Reed MD

Sponsor 

Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.

Time Stamps

• 00:00 Announcement
• 00:37 Sponsor: ACP’s MKSAP 18
• 01:04 Disclaimer, intro, guest bio
• 06:31 Guest one liner, book recommendations, career advice
• 12:23 Cohost picks of the week
• 16:22 Sponsor: ACP’s MKSAP 18
• 18:12 Dr Reed walks us through the genetic machinery from the top down (genome, chromosomes, exons, genes, SNPs, and epigenetics)
• 26:18 A clinical case of Jeanne Sequence; What are the indications for genetic testing?
• 29:54 What is actually being tested?
• 33:57 What is the turnaround time for testing? What resources are available for counseling? Why is this challenging in primary care?
• 38:58 Variant of Uncertain Significance
• 41:22 Direct to consumer genetic testing
• 44:54 Back to our case of Jeanne Sequence; How to take a history for patients with family history of breast cancer.
• 50:41 Guidelines on use of genetic testing; Deciding which family member to test
• 59:49 Laws about genetic testing and discrimination; How does this effect life insurance or disability insurance eligibility
• 63:47 Is routine whole genome testing practical? Will this be commonplace in the future?
• 68:22 What genetics resources are useful for primary care practitioners?
• 72:13 Cost of genetic testing
• 77:32 Take home points
• 82:57 Outro

Learn expert tips for the diagnosis and management of inflammatory bowel disease (IBD) from Dr. Adam Ehrlich, Assistant Professor of Medicine and co-director of the Inflammatory Bowel Disease Program at Temple University Hospital.  In this episode, we learn about the initial work-up, general principles of management, and important primary care considerations for Crohn’s disease and ulcerative colitis (ie endoscopic surveillance, immunizations, bone health/osteoporosis, and more!).

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and produced by: Paul Williams MD
• Edited by: Matthew Watto MD
• Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD
• Guest: Adam Ehrlich MD

Sponsor

Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.

Time Stamps

• 00:00 Sponsor: MKSAP 18
• 00:32 Disclaimer, Intro, guest bio
• 04:05 Guest one-liner, Adam’s movie rec - RBG (documentary), career advice, Paul’s movie rec - Edge of Tomorrow
• 09:25 Sponsor: ACP’s MKSAP 18
• 11:25 Definitions and pathophysiology of inflammatory bowel disease (IBD)

Ulcerative Colitis

• 13:40 A case of ulcerative colitis; Classic symptoms; Initial approach and basic differential diagnosis
• 19:10 Smoking and ulcerative colitis
• 21:17 Initial workup for suspected IBD; Fecal calprotectin
• 25:50 A bit more on CRP and IBD
• 26:55 When to refer for colonoscopy
• 27:58 Back to the case; a typical colonoscopy reports in ulcerative colitis (UC)
• 30:33 Extraintestinal manifestations of UC
• 34:50 Initial counseling for newly diagnosed IBD; natural history of IBD, prognosis
• 39:50 Treatment of ulcerative colitis
• 43:02 Some specifics on steroids, plus topical therapies

Crohn’s disease

• 47:05 A case of Crohn’s disease; initial approach and differential diagnosis
• 50:25 Initial diagnostic testing; colonoscopy findings in Crohn’s; IBD trivia
• 53:58 Treatment of Crohn’s disease
• 58:26 Specifics about biologic therapy for IBD; Endpoints
• 62:25 Steroid sparing agents, immunomodulators like azathioprine, 6-mercaptopurine
• 64:48 Can drug therapy be stopped or tapered in IBD?
• 66:50 Prognosis in Crohn’s and initial patient counseling

Primary Care considerations

• 68:35 Surveillance endoscopy,
• 71:47 Do diet and lifestyle changes for IBD work? What about pregnancy?
• 76:31 Immunizations
• 79:25 Bone health, osteoporosis and IBD, screening for iron and nutritional deficiencies
• 82:27 Take home points
• 86:28 Outro

Master the management of hyperkalemia with tools, tips and tactics from @kidney_boy, Joel Topf MD, Chief of Nephrology @KashlakHospital. We cover: common causes of hyperkalemia; the U-shaped curve of potassium levels and mortality; albuterol nebs; how to safely use insulin; potassium binding resins and colonic necrosis; Does it make sense to give loop diuretics and fluids?; Should we be using fludrocortisone?; Plus, answers to all your questions about a high potassium diet and oral potassium supplements! Join us for Dr Topf’s masterful insights on hyperkalemia and potassium homeostasis.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Sponsor

Join us at ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA . We'll see you there!

Credits

Written and produced by: Matthew Watto, MD

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Infographic: Matthew Watto MD

Edited by: Matthew Watto MD

Guest: Dr Joel Topf MD

Time Stamps

• 00:00 Ad disclaimer, intro and guest bio
• 05:11 Guest one-liner and picks of the week —Peloton indoor cycle, “your local library”, The Nice Guys (film) by Shane Black, and Forgotten Hand (PS4 game)
• 11:17 ACP Internal Medicine Meeting 2019 details
• 12:55 Clinical case of hyperkalemia; discussion of pseudohyperkalemia
• 19:55 Hyperkalemia and the EKG
• 23:38 Threshold for treatment of hyperkalemia
• 27:20 Use of telemetry and the U-shaped curve for potassium and mortality
• 30:11 Choice of therapy for acute hyperkalemia
• 33:13 Albuterol for hyperkalemia
• 34:24 First rule out urinary obstruction and hyperglycemia; Use of IV insulin and dextrose and frequency of monitoring
• 39:44 Loop diuretics plus fluid; Distal sodium delivery and potassium handling in the nephron
• 43:10 Fludrocortisone for hyperkalemia
• 45:05 Calcium for elevated potassium
• 48:43 SPS, potassium binding resin
• 52:43 Risks of SPS (sodium polystyrene sulfonate) and colonic necrosis
• 58:28 Sodium bicarbonate for acute and chronic hyperkalemia
• 61:00 Back to the case; TMP-SMX, ace inhibitors (or ARBs) and hyperkalemia
• 63:05 Threshold for admission; Diet and potassium
• 65:52 Treatment of chronic hyperkalemia and a bit more on high potassium foods
• 68:45 Patiromer and sodium zirconium
• 71:51 Loop diuretics and empiric potassium supplementation
• 74:12 Can diet alone be used to treat HYPOkalemia?
• 75:26 Take home points
• 77:40 NephMadness is coming! March 2019
• 79:53 Outro
• 81:00 More Kidney Boy!

Stuck on sickle cell disease? We hammer out the basics of diagnosis, common sickle cell variants and their manifestations, preventive medicine, acute and chronic pain management, opioid use, and how to recognize and treat common complications like anemia, fever and acute chest syndrome. Sickle cell expert, Sophie Lanzkron MD, Associate Professor of Medicine and Oncology and Director of the Sickle Cell Center for Adults at Johns Hopkins joins!

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Sponsor

ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA. We'll see you there!

Credits

Written (including CME questions) and produced by: Justin Berk MD, Martha Brucato MD PhD, Beth Garbitelli MS1

Hosts: Paul Williams MD, Justin Berk MD, Matthew Watto MD

Edited by: Matthew Watto MD

Guest: Sophie Lanzkron MD MHS

Time Stamps

• 00:00 Announcements, intro
• 02:30 A quick refresher on hemoglobinopathy
• 03:45 Guest bio
• 05:03 Guest one-liner, movie recommendation, career advice, picks of the week
• 10:53 ACP Internal Medicine Meeting 2019 (ad read)
• 12:33 Clinical case; defining sickle cell; pathophysiology
• 16:23 Different types of hemoglobinopathy genotypes and phenotypes
• 20:20 Preventive care for sickle cell disease
• 22:56 Taking a history at the initial visit in patient with sickle disease
• 26:40 Life expectancy in SCD
• 28:30 Hydroxyurea
• 30:40 Chronic red blood cell transfusion therapy; complications; monitoring
• 37:07 Silent cerebral infarcts and mild cognitive impairment in SCD 
• 40:10 Chronic pain management; opioid use disorder in sickle cell disease
• 46:00 Acute pain crisis management; PCAs vs bolus therapy
• 54:08 Reticulocyte count in sickle cell disease
• 55:40 Itching, opioids and naloxone?
• 58:10 Red blood cell transfusion threshold in sickle cell disease (anemia)
• 60:03 Acute fever in SCD
• 61:48 Acute chest syndrome
• 66:45 Transition from pediatrics to adult medicine in sickle cell
• 68:00 Incentive spirometry to prevent acute chest syndrome
• 68:45 Take home points
• 70:00 Outro

Optimize perioperative risk and dominate perioperative medicine. Topics include surgical risk calculators, preoperative labs, stress testing, use of BNP and troponins, postoperative MI, cardiac and pulmonary risk stratification, and more! We’re joined by perioperative medicine expert, Avital O’Glasser MD, Associate Professor of Medicine at Oregon Health & Science University and Assistant Program Director for Scholarship and Social Media. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Matthew Watto MD

CME questions by: Matthew Watto MD

Hosts: Matthew Watto MD, Stuart Brigham MD

Edited by: Matthew Watto MD

Guest: Avital O’Glasser MD

Time Stamps

• 00:00 Disclaimer, intro and guest bio
• 04:20 Guest one-liner, book and movie recommendations, career advice
• 11:20 ACP Internal Medicine Meeting 2019 details
• 14:02 Patient with coronary artery calcifications going for elective hip surgery and wants "clearance"
• 20:50 Functional capacity
• 25:00 Preoperative stress testing and coronary revascularization
• 31:55 Canadian guidelines, BNP and troponin testing
• 36:30 The METS trial and predicting perioperative cardiac events and mortality
• 40:44 Preoperative testing (labs, imaging, urine studies)
• 50:24 Choosing your perioperative cardiac and surgical risk calculator (RCRI, MICA, ACS-NSQIP)
• 59:50 Communicating risk to patient and their surgeon
• 61:30 Pulmonary risk assessment and complications
• 70:35 Perioperative use of opioids
• 75:30 Who needs an echocardiogram prior to surgery?
• 79:00 Canceling a patient's surgery
• 82:55 Take home points
• 83:45 Outro

“Urinary tract infections” (UTIs) are overdiagnosed. Antibiotics are overprescribed. UTIs are inappropriately blamed for geriatric syndromes (eg delirium) despite little supporting evidence. Our guest, Tom Finucane MD, Emeritus Professor of Medicine at Johns Hopkins makes us question everything. Topics: How can we diagnose “UTI”? Who needs treatment? Do urinary tract symptoms matter? Does malodorous urine correlate with infection? Who’s at risk for pyelonephritis and sepsis? Don’t miss this paradigm changing episode. And stop using the term “urinary tract infection” unless it’s prefaced by air quotes!

Sponsor: Join ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA . We'll see you there!

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Matthew Watto MD

Hosts: Matthew Watto MD, Paul Williams MD

Edited by: Matthew Watto MD

Guest: Tom Finucane MD, MACP

Time Stamps

• 00:00 Disclaimer, intro and guest bio
• 04:00 Guest one liner, book recommendation, career advice
• 08:22 The “medical ignorome”
• 13:40 ACP Internal Medicine Meeting 2019 details
• 16:20 Case of malodorous urine; Urine is NOT sterile; Defining terms
• 25:14 Stop saying UTI unless using air quotes
• 28:34 What symptoms or history matters in evaluation for “UTI”? And can we predict who will become systemically ill?
• 34:47 Voltaire and when treatment is warranted for “urinary tract infections”
• 37:15 Delirium in an older adult with possible UTI, how to work it up, and who warrants antibiotics
• 51:55 Take home points
• 53:38 Outro

Take a trip down memory lane with top clinical pearls and favorite moments from The Curbsiders in 2018.

Welcome to our 2018 Recap Extravaganza! Since last year, the Curbsiders team has grown substantially and the podcast has undergone several exciting developments. These include our collaboration with ACP that allows us to provide CME and MOC credit for select episodes, our new partnership with Human Dx as featured in our Kashlak Morning Reports, and the launch of our Women in Medicine series. For our 2017 year-end show, we had listeners vote for their favorite episodes from the past year. This year, we're changing it up a bit and have invited our Curbsider colleagues to share their picks for pearliest pearls and most illuminating episodes of 2018. We hope you’ll enjoy hearing the team’s highlights, and we’ll be back in 2019 with fresh content. Note: No CME-MOC credit for this episode, but stay tuned in 2019 for eligible episodes.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Chris Chiu MD and Sarah Phoebe Roberts, MPH

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD, Chris Chiu MD

Edited by: Chris Chiu MD

Time Stamps

• 00:00 Disclaimer, Intro
• 06:39 Clinical Reasoning Pearls
• 12:35 Pulmonary Hypertension Pearls
• 15:52 Women In Medicine Pearls
• 20:40 Iron Deficiency Pearls
• 24:52 Tick-Borne Illness Pearls
• 28:00 STI Pearls
• 31:00 Physical Exam Pearls
• 32:51 “Things we do for no reason” Pearls
• 36:16 Host Picks
• 42:38 Paul Wraps-up the Year
• 43:38 Outro and Curbsider Team sign-offs

Master the diagnosis and management of Genital Herpes with tips from expert, Robert Bettiker MD . Topics include: the natural history, diagnosis & screening guidelines for genital herpes; cold sores; options for primary and recurrent episodes including prophylaxis; and consideration of specific populations including symptomatic and asymptomatic patients, pregnancy and MSM (men who have sex with men). We also discuss partner notification and treatment.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Kate Grant MBChB DipGUMed, Matthew Watto MD

Images by: Kate Grant MBChB DipGUMed

Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD

Guest: Robert Bettiker MD

Time Stamps

• 00:00 Disclaimer, guest bio, intro
• 01:50 Guest one liner, memorable teaching moment and a few failures
• 10:50 Intro to herpes
• 12:25 Case 1: Genital herpes in a married man
• 15:42 Overview of testing options
• 18:50 Marital counseling in Herpes
• 22:18 Prophylaxis in serodiscordant partners and asymptomatic shedding
• 25:08 Case 2: Severe outbreak of genital herpes in a young woman
• 31:50 Case 3: Young male with recent exposure to herpes
• 38:45 Herpes 1 (HSV1) versus Herpes 2 (HSV2)
• 44:12 Case 4: Herpes in pregnancy
• 50:45 Do topical agents work for herpes
• 55:05 Take home points
• 56:10 Outro
• 57:52 Stuart shares a PUN!

Sharpen your diagnostic schema for abdominal pain and eosinophilia with this mystery case http://hdx.org/Rxg (click link to follow along). Reza Manesh MD, editor of Global Morning Report at The Human Diagnosis Project aka Human Dx attempts to solve this challenging case with the help of The Curbsiders.

Use this link http://hdx.org/Rxg to follow along with the case on the Human Dx app and check out more Global Morning Report cases.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Hannah R Abrams

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto MD

Guest: Reza Manesh MD

Special thanks to: Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing and editing the cases; and to Tyler Brandon for helping to coordinate these wonderful episodes.

Time Stamps

• 00:00 Announcement, disclaimer, intro, guest bio
• 01:20 Picks of the week
• 05:42 How Reza fell in love with clinical reasoning
• 08:58 Case of 50 yo male with abdominal pain
• 21:14 Some unexpected findings
• 43:00 Case conclusion/answer, cognitive autopsy and Reza’s take home points
• 48:35 Outro

Hone your diagnostic skills with this mystery case of cough and dyspnea http://hdx.org/pdp (click link to follow along). The Curbsiders deconstruct the case and discuss their diagnostic schemas for these common problems with the help of returning guest, Reza Manesh MD, editor of Global Morning Report at The Human Diagnosis Project aka Human Dx.

Use this link http://hdx.org/pdp to follow along with the case on the Human Dx app or website and check out more Global Morning Report cases.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Hannah R Abrams

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto MD

Guest: Reza Manesh MD

Special thanks to: Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing and editing the cases; and to Tyler Brandon for helping to coordinate these wonderful episodes.

Time Stamps

• 00:00 Announcement, disclaimer, intro, guest bio
• 03:13 When and how to practice clinical reasoning
• 05:53 Creating diagnostic schemas and Clinical Problem Solvers Podcast
• 09:40 A bit on Human Dx and the show format
• 12:00 Case of a 40 yo male with a cough
• 23:22 Some insights from Reza on “signal versus noise”
• 37:10 Case conclusion/answer, cognitive autopsy and Reza’s take home points
• 45:36 Outro

Create a successful partnership and career withs tips from Wonder Woman, Sue Hingle MD of ACP. 

Work-Life Balance: is it a myth, or attainable if we could just find the right fit? In this episode, we chat with Dr. Susan Hingle about identifying our work-life priorities and re-evaluating these priorities throughout our lives. We strategize about achieving personal and professional goals (pro tip: stop worrying about what others think!). Dr. Hingle is Professor in the Department of Internal Medicine and Vice Chair of Education and Faculty Development and Associate Internal Medicine Residency Program Director at Southern Illinois University. She is also the Immediate Past Chair of the Board of Regents of the American College of Physicians (ACP). She has served at the ACP in a variety of ways, including as a member of the ACP Women’s Task Force. Her clinical expertise is in women’s health, health promotion, and disease prevention. Enjoy the episode!

ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Nora Taranto MS4, Shreya Trivedi MD, Leah Witt MD, Sarah P. Roberts MPH.

CME Questions by: Shreya Trivedi MD

Editors: Matthew Watto MD and Chris Chiu MD

Hosts: Shreya Trivedi MD, Paul Williams MD, Leah Witt MD

Guest: Susan Hingle MD

Time Stamps

• 00:00 Disclaimer, intro and guest bio
• 02:52 Guest one liner, WIM Moment of awakening, advice for her younger self
• 07:45 Picks of the week
• 10:30 Physician with family and caregiver responsibility; How to plan for personal and professional goals
• 18:20 What to look for in a partner, how to work with them to achieve work life fit, and non-traditional roles
• 28:35 Advice on family planning
• 31:40 Residency programs and life events
• 32:55 Should you go part-time?
• 39:43 Work life balance? Or work life fit? And some examples/tips for success
• 49:54 Take home points
• 50:45 Outro
• 52:22 Bonus story

Dr Elisabeth Poorman MD joins us to discuss the natural history of physician depression in residency and beyond. We share some of our own personal stories, and discuss how we can support one another and reach out for help, how to take care of our mental health in an emotionally demanding career, how to deal with licensing questions and worry about stigma, and what systemic changes may be coming (read: we think need to be coming) down the line. The problem of depression and suicide is a particularly real one in medicine, a profession that is, by its very nature traumatic and emotionally draining (both in terms of work demands and also the sick and dying patients we treat).

N.b. This is a sensitive topic. If this is triggering for anyone listening, the national suicide hotline number 1-800-273-8255. Moreover, if anyone needs or wants guidance on available resources, Dr. Elisabeth Poorman has made herself available either via email, private msg on FB or twitter (@DrPoorman), or any of us on twitter. We are happy to talk and see that you get support you need.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Nora Taranto MS4, Shreya Trivedi MD

Hosts: Stuart Brigham MD, Shreya Trivedi MD, Matthew Watto MD

Edited by: Matthew Watto MD

Guest: Elisabeth Poorman, MD

Time Stamps

• 00:00 Disclaimer, Intro, Guest Bio
• 3:25 Wellness Recommendations: Find a Therapist
• 6:12 How to find a therapist in training
• 6:39 Licensing and Mental Health
• 12:14 Disclaimer and Trigger Warning: Stories are Sensitive. National suicide hotline info
• Next, Dr Poorman and each of The Curbsiders share their personal experiences with mental health (see below).
• 12:05 Shreya story
• 21:40 Stuart’s story
• 31:19 Elisabeth’s story
• 36:17 Watto’s story
• 37:41 Passive suicidal ideaiton, a definition  
• 41:10 Suicide and Depression: Do they always coexist? (No)
• 42:20 Life Cycle of Depression and Suicide in the Medical Profession
• 47:15 Depression and Suicide in Primary Care
• 47:59 Mini-Cases
• 54:00 Noticing signs in a colleague: how to help
• 58:00 Specific programs doing things well
• 1:03:08: Questions from Social Media
• 1:03:10: Burnout vs. Depression
• 1:04:27: Will getting treatment affect your board applications
• 1:06:14 Take home points
• 1:08:00 Outro

Aspirin’ to figure out if ASA can help prevent a heart attack? Interpreting all the new trials doesn’t have to cause chest pain! Join Dr. Ambarish Pandey from UT Southwestern as he helps The Curbsiders ASCEND the mountains of the latest studies to ARRIVE at some well-informed conclusions on the role of aspirin in primary prevention for cardiac events. The team also discusses secondary prevention, aspirin and dual (or triple) antiplatelet therapy, and whether it’s okay to stop giving aspirin to older adults without known CAD (Spoiler alert: it’s okay). ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Justin Berk MD, Matthew Watto MD

CME questions by: Justin Berk MD

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto MD and Chris Chiu MD

Guest: Dr. Ambarish Pandey MD

Time Stamps

• 00:00 Disclaimer, intro and guest bio
• 04:15 Guest one liner, book recommendation, career and research advice
• 11:07 Case of aspirin for primary prevention, aspirin’s public persona, and nocebo effects of statins
• 21:40 ARRIVE and ASCEND trials
• 28:14 Aspree trial
• 32:38 Coronary artery calcium; aspirin use for secondary prevention
• 37:42 Dual antiplatelet therapy and the DAPT score
• 41:25 Should we continue aspirin when a patient also needs a DOAC?
• 46:14 Should we continue DAPT in a patient who needs a DOAC (or warfarin)?
• 49:40 Deprescribing aspirin for primary prevention in older adults?
• 50:51 Closing remarks
• 52:33 Outro

Tony Breu MD joins us for some hotcakes, and “cold cakes” including: how aspirin and zodiac sign affect the treatment of acute MI, a recent study on how exercise is probably still good for you, the recently announced REDUCE-IT trial, and the evidence (or lack thereof) for the treatment of hypertensive urgency. Welcome to another edition of Hotcakes and Hot Takes, where we discuss the most interesting articles and news that we have been reading. Special guest is the prolific Dr. Tony Breu (@tony_breu) who is an Assistant Professor of Medicine at Harvard Medical School and a Hospitalist and Director of Internal Medicine Resident Education at the VA Boston Healthcare System. He is known for his series on "Things We Do For No Reason” as well as his thought-provoking “Tweetorials” online. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST on day of release).

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD

CME Questions: Christopher Chiu MD

Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD

Guest Presenter and Content Planning: Anthony Breu MD

Editor: Christopher Chiu MD

Cover-Art: Christopher Chiu MD

Time stamps

• 00:00 Disclaimer, intro, guest bio
• 05:53 Discussion on Tweetorials
• 08:00 Cold Cake: ISIS-2 and the treatment of acute MI with aspirin
• 14:04 ISIS-2 and zodiac subgroup analysis
• 16:19 What is the relationship between cardiorespiratory fitness on mortality?
• 24:40 Discussion of the REDUCE-IT study
• 33:00 Cold Cake: VA Cooperative study and the evidence for treating essential hypertension
• 36:42 TWDFNR and the treatment of hypertensive urgency
• 46:36 Wrap-up and outro

Master the diagnosis and management of common STIs (sexually transmitted infections) with tips from expert, Dana Dunne MD, Associate Professor of Medicine in Infectious Diseases at Yale. Topics include: the stages and many presentations of syphilis, syphilis treatment and counseling, the natural history, diagnosis, and screening guidelines for gonorrhea and chlamydia, treatment options in the age of growing resistance, and a discussion of partner notification and treatment.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Bryan Brown MD

Hosts: Bryan Brown MD, Paul Williams MD, Matthew Watto MD

Guest: Dana Dunne MD

Special thanks to Kate Grant MBChB, Dip GUMed for her contribution of knowledge and artwork.

Time Stamps

• 00:00 Announcement, disclaimer, intro and guest bio
• 04:29 Guest onliner, book recommendation, advice for learners/teacher, and picks of the week
• 11:00 A case of syphilis, clinical manifestations and discussion of the stages
• 26:05 Testing for syphilis
• 39:05 Mandatory reporting and partner tracing
• 42:40 Counseling patients with syphilis
• 44:44 A case of gonorrhea and chlamydia, clinical manifestations, screening guidelines
• 52:30 How to counsel patients to obtain samples from urethra, rectum, vagina, oropharynx; Mycoplasma genitalium
• 59:40 CDC treatment guidelines, Super gonorrhea, test of cure, and treatment of partners
• 72:35 Take home points
• 74:30 Outro

Practice solving diagnostic puzzles with The Curbsiders and Internist / Diagnostician, Reza Manesh MD, Assistant Program Director for Clinical Reasoning of the Osler Medical Training Program at Johns Hopkins! Solve along with us at these links: Case 1 http://hdx.org/I2B and Case 2 http://hdx.org/uM2. Topics include: clinical reasoning terminology, how to use cases to practice diagnostic reasoning, how to build a diagnostic schema, and how to conduct your own cognitive autopsy.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and Produced by: Hannah Abrams

Hosts: Hannah Abrams, Paul Williams MD, Stuart Brigham MD, Matthew Watto MD

Guest: Reza Manesh MD

Special thanks to: Doctors Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing cases

Time Stamps

• 00:00 Disclaimer, intro and guest bio
• 04:02 Guest one liner, book recommendation, favorite failure, advice for learners
• 11:27 Human Dx Project and Global Morning Report
• 15:35 Diagnostic terminology
• 21:25 Case #1, Reza solves
• 33:40 Diagnostic autopsy and teaching points for case #1
• 38:00 Case #2, The Curbsiders solve
• 57:30 Diagnostic autopsy and teaching points for case #2
• 61:33 Take home points and a plug
• 64:30 Outro

Check out this audio treasure map to find the hidden curriculum and learn how it can change your practice. Learn how positive teaching spans not just the classroom or bedside but, how we simply talk about patients. Sanjay Desai MD, coauthor of ACP’s Position Paper on Hidden Curriculum and Internal Medicine program director at Johns Hopkins guides us through several cases that illustrate how our institutional norms can shape the practice of medicine...for better or worse. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Sanjay Desai MD; Justin Berk MD, MPH, MBA; Matthew Watto MD

CME questions by: Justin Berk MD

Editors: Chris Chiu MD & Matthew Watto MD

Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD

Guest: Sanjay Desai MD

Time Stamps

• 00:00 Disclaimer, Intro and guest bio
• 04:00 Guest one liner, book recommendations, career advice
• 10:50 Intro to the hidden curriculum and ACP’s three recommendations
• 22:00 Case #1: A patient with schizophrenia
• 32:10 Case #2: The iPatient
• 38:07 Case #3: Attending forgets to wash their hands
• 41:10 Case #4: A dying patient’s primary care doctor saves the day
• 46:26 Case #5: A case of violating duty hours
• 60:10 Take home points
• 62:00 Outro
  

Shoulder pain made simple. Develop your confidence and skills with tips from sports medicine specialist Dr. Carlin Senter MD. We discuss her simplified approach to the basic shoulder exam, including when and how to do special tests, high yield exam maneuvers, when to refer shoulder pain patients to orthopedic surgery, and who can be managed conservatively.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Molly Heublein MD and Nora Taranto MS4

Editor: Matthew Watto MD

Hosts: Molly Heublein, MD, Paul Williams MD, Matthew Watto MD

Guest: Carlin Senter, MD

Time Stamps

• 00:00 Disclaimer, intro, and guest bio
• 03:15 Guest one liner, book recommendation, career advice, and some picks of the week
• 13:20 Clinical case of shoulder pain; helpful historical features
• 18:54 Differentiating referred pain from c-spine pathology from shoulder pathology
• 21:00 A framework for shoulder pain, HIP-ROT, and using ROM to generate a differential
• 27:40 Frozen shoulder aka adhesive capsulitis
• 31:57 Glenohumeral joint arthritis
• 33:52 Rotator cuff disease
• 40:53 Specific testing for rotator cuff tears
• 51:45 Impingement syndrome versus bursitis
• 56:25 Counseling patient with shoulder pain or injury
• 59:03 Steroid injections, topical therapy, and AC joint arthritis
• 65:18 When to refer to surgery and some take home points

The sleep apnea episode that won’t put you to sleep. Become a sleep apnea guru with incredible insights from Barbara Phillips MD, MSPH, FCCP an expert in pulmonary medicine, critical care and sleep medicine who is also a past president of CHEST! We discuss high-yield topics in the world of obstructive sleep apnea including: home sleep studies vs in-lab polysomnography, the importance of oxygen saturation (the T90 and ODI) when interpreting sleep study results, tricks to improve CPAP adherence, and alternatives therapies for obstructive sleep apnea. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Cyrus Askin MD

CME questions by: Cyrus Askin MD

Editor: Chris Chiu MD & Matthew Watto MD

Hosts: Cyrus Askin MD & Matthew Watto MD

Guest: Barbara Phillips, MD

Cover-Art & Infographic - Beth Garbitelli, MS1

Time Stamps

• 00:00 Disclaimer, intro, guest bio
• 03:00 Guest one liner, book recommendation, advice for trainees
• 08:10 Clinical case of sleep apnea, some basic stats, and key predictors of sleep apnea
• 12:38 Barriers to diagnosis and treatment of OSA
• 15:23 Discussion of T90, hypoxemia and sleep fragmentation
• 17:05 How to read a sleep study report
• 21:55 Home sleep apnea testing
• 24:15 What are the consequences of sleep apnea
• 28:30 What is the efficacy of cpap for lowering blood pressure and mortality
• 31:45 Counseling a patient who is new to cpap
• 33:45 Choice of mask
• 40:10 Do alternatives to cpap work? e.g. surgery, mandibular advancement devices
• 44:17 Modafinil and z-drugs
• 47:15 Driver’s license issues in sleep apnea
• 48:35 Future of sleep medicine and take home points
• 51:15 Outro

We delve into advanced management of headaches, including novel therapies, migraines with aura, migraines in complicated patients, and headaches of short duration with Dr. Rebecca Burch, a headache medicine specialist at the John R. Graham Headache Center at Brigham and Women’s Hospital.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Paul Williams MD

Edited by: Matthew Watto MD

Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD

Guest: Rebecca Burch MD

Time Stamps

• 00:00 Disclaimer, intro and guest bio
• 03:28 Guest one-liner, movie and podcast recommendations, favorite failure and picks of the week from The Curbsiders
• 10:38 Clinical case of migraines; diagnosis and classification
• 14:12 Does medication overuse headache exist?
• 16:16 Chronic daily headache; Conversion from episodic to chronic and vice versa
• 21:43 Approaches to medication overuse headache
• 25:54 Case 2: migraine with aura and other types of migraine (retinal, hemiplegic, etc.)
• 32:09 Pathophysiology of migraine; how triptans work; How should aura effect management?
• 38:44 Migraine cocktails
• 41:15 Comorbid mood disorders; Use of psych meds and triptans
• 45:08 Migraines and oral contraceptives
• 48:42 Botulinum toxin and new CGRP therapies
• 53:36 What does success look like in migraine therapy?
• 55:32 Nonpharmacologic management
• 60:45 Case 3: headaches of short duration
• 66:36 Headache red flags; Imaging for headaches; pathophysiology of high and low pressure headaches
• 72:00 Idiopathic intracranial hypertension
• 75:25 Take home points
• 77:00 Outro

HIV care for the internist with author and HIV expert, Michael Saag MD, Professor of Infectious Diseases at University of Alabama and founder of the 1917 Clinic. We discuss the specifics of screening & diagnostic testing in HIV, monitoring CD4 counts and viral loads, first line antiretroviral therapy, harm reduction, and how to provide excellent HIV care in your primary care clinic.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written & Produced by: Elena Gibson MS4, Justin Berk MD MBA MPH

Artwork by: Elena Gibson MS4

Hosts: Matthew Watto MD, Paul Williams MD, Justin Berk MD MBA MPH

Editor: Matthew Watto MD

Guest: Michael Saag MD

Time Stamps

• 00:00 Disclaimer, intro, and guest bio
• 04:35 Getting to know our guest, a movie recommendation, and words of wisdom
• 08:48 Clinical case, HIV screening, in-depth discussion of HIV testing & diagnosis
• 15:56 New diagnosis of HIV, counseling after diagnosis, confirmation, follow-up testing, the second visit
• 24:20 Treatment - what to start and when; some basic comments on therapy
• 30:05 Primary care after diagnosis, vaccines, cancer screening, cardiovascular disease prevention
• 34:35 Monitoring CD4 counts and viral load; interpreting CD4 count; time course of response for CD4 and viral load
• 42:02 Harm reduction counseling; addressing medication non-adherence
• 47:40 PCP prophylaxis
• 49:43 The 1917 Clinic, Ryan White Clinics, and linking patients to care
• 53:10 Take home points
• 55:40 Plugs
• 57:45 Will a cure or vaccine for HIV emerge?
• 59:16 Outro

Join us in this roundtable discussion of patients before paperwork, administrative burden, the new CMS payment model proposal, and a bit on health insurance with cohost, Fatima Syed MD MSc and guest, Deep Shah MD MSc. Doctors Syed and Shah are both early career physicians with masters degrees in comparative social policy from Oxford University and are active members of the American College of Physicians. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Fatima Syed MD MSc and Matthew Watto MD

CME questions by: Matthew Watto MD

Hosts: Fatima Syed MD MSc, Matthew Watto MD

Guest: Deep Shah MD MSc

Time Stamps

• 00:00 Disclaimer, intro, and guest bios
• 02:18 Guest one liners, book recommendations, picks of the week
• 11:00 Administrative burden
• 16:00 Will the documentation problem get better? Suggestions for improvement
• 25:11 Why do CMS rules spread to the private insurance sector?
• 29:30 What innovations might reduce administrative burden?
• 32:40 The Affordable Care Act, health insurance, price transparency
• 40:20 Take home points
• 43:20 Outro

Nutrition pearls from integrative cardiologist, Steven Devries MD, Associate Professor of Medicine, Northwestern Feinberg School of Medicine, Executive Director of The Gaples Institute. Clinicians receive little formal nutritional training in medical school and residency. It’s time to fill that gap! We discuss the strength of the literature supporting dietary interventions for cardiovascular health and review practical tips to help patients achieve healthy eating patterns. Patients need to hear from us that nutrition matters!

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written & Produced by: Molly Heublein MD

Hosts: Matthew Watto MD, Paul Williams MD, Molly Heublein MD

Guest: Stephen Devries MD

Editor: Matthew Watto MD

Special thanks to Elena Gibson MS4 for writing our show notes

Time Stamps

• 00:00 Disclaimer
• 00:35 Intro and guest bio
• 02:40 Guest one-liner, book recommendation, favorite failure, nontraditional career path
• 10:10 Nutrition and medical education
• 12:45 Evidence for how nutrition can improve health outcomes
• 15:33 How to describe a heart healthy or Mediterranean diet to patients
• 25:16 Discussion of fats and oils
• 31:44 Food deserts, healthy snacking options
• 37:15 Calorie counting and use of healthy eating apps
• 40:55 How to frame the discussion about a healthful eating pattern with patients
• 47:18 Macronutrient content. Does it matter?
• 52:50 Intermittent fasting
• 54:24 A free resource for patients to learn about nutrition

Houston, we have a female sexual dysfunction problem. Female sexual problems, which can affect women of all ages, are underdiagnosed and undertreated--in part because clinicians are not the best at asking about sex in primary care visits. In the course of this episode, learn about how to have that sex talk you’ve (maybe) been avoiding, what to ask when working up sexual problems in women, and find the words to talk to patients about sex. Today, we’re lucky to have the female sexual health expert of experts, Dr. Stacy Lindau, MD, MA, Professor of Obstetrics and Gynecology and Medicine-Geriatrics at the University of Chicago Medicine, on the show to teach us the best “sex talk” language, the differential for female sexual problems, and explore therapies. Sadly, there’s no sildenafil-like magic bullet, but a multidisciplinary team can make real impact on female sexual problems. Don’t forget to check out http://womanlab.org

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Nora Taranto MS4

Hosts: Leah Witt MD and Matthew Watto MD

Infographic: Leah Witt MD

Editor: Matthew Watto MD

Guest: Stacy Lindau MD

Time Stamps

• 00:00 Disclaimer
• 00:35 Intro and guest bio
• 03:30 Guest one liner, book recommendations, favorite failure, career advice and picks of the week
• 12:57 Clinical Case of female sexual dysfunction and some definitions
• 15:08 Are sexual problems a normal part of aging?; How to take a sexual history; Etiology of sexual dysfunction; “Diagnostic sex”; Red flags
• 27:54 Medications that contribute to sexual dysfunction
• 31:00 Labs
• 34:45 Treatment: pelvic PT, medications, counseling, flibanserin, herbal supplements
• 49:05 Screening for female sexual problems
• 51:58 Take home points; WomanLab.org
• 55:19 Outro

Tags

sexual dysfunction, female, gynecologist, ob-gyn, female sexual disorder, libido, sex, hormones, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Summary

Conquer Clostridium difficile (Clostridioides difficile) with this “spore-tacular” episode featuring infectious diseases expert, Dr. Curtis Donskey, Professor at Case Western Reserve University and clinician at the Louis Stokes VA Hospital. We discuss the updates in the 2017 IDSA C. difficile guidelines plus a bunch of random pearls. If you have ever laid awake at night wondering how many pills are needed for a fecal transplant, then this is the episode for you!  We discuss why metronidazole was dropped as the first line therapy for Clostridium difficile infection (CDI) along with other hot topics such as two-step testing, loperamide use, which antibiotics are the least likely to cause CDI, and more. Do not miss this episode!

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written by: Carolyn Chan MD

Produced by: Matthew Watto MD

Hosts: Carolyn Chan MD, Matthew Watto MD, Paul Williams MD

Editor: Matthew Watto MD

Guest: Curtis Donskey, MD

Time Stamps

• 00:00 Intro, disclaimer, guest bio
• 02:19 Getting to know our guest, recommendations for reading, career advice
• 06:40 Clinical case and CDI testing
• 09:30 Testing for CDI: PCR and Two step testing
• 16:30 Testing after treatment
• 20:00 Treatment of initial CDI episodes, metronidazole pharmacokinetics
• 24:15 Classification of CDI severity
• 29:30 Fidaxomicin pearls: when to use, cost, and tapers
• 34:10 Vancomycin tapers
• 36:05 Fecal transplant pearls: freeze dried capsules, c-scopes, treating fulminant CDI
• 44:44 Infection control: counseling homegoing patients, hand washing, and baths
• 47:50 Social media questions: immodium and toxic megacolon, antibiotics less likely to promote CDI, probiotics, and more!
• 59:14 Best CDI joke in the history of time
• 60:00 Take home points
• 62:42 Outro

Tags

Clostridium, difficile, cdi, C.Diff, infectious, diseases, diarrhea, IDSA, guideline, antibiotics, vancomycin, fidaxomicin, fmt, transplant, fecal, stool, toxin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Geriatric psychiatry returns. We tackle sleep problems and behavioral disturbances in patients with dementia with returning guest, and Geriatric Psychiatrist Dennis Popeo MD, Clinical Associate Professor of Psychiatry at NYU Langone Medical Center. Topics include: pharmacologic and nonpharmacologic management of insomnia; treating agitation and irritability; medical management of psychotic symptoms and paranoia; ethical concerns about the treatment of challenging behaviors in dementia; and the shortage of geriatricians and geriatric psychiatrists.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written & Produced by: Jordana Kozupsky NP, Matthew Watto MD

Artwork by: Kate Grant MD

Hosts: Jordana Kozupsky NP, Matthew Watto MD

Editor: Matthew Watto MD

Guest: Dennis Popeo, MD

Time Stamps

• 00:00 Intro and guest bio
• 01:55 Case of sleep disturbance in a patient with dementia; medications for sleep disturbances; nonpharmacologic strategies for sleep
• 11:32 Irritability and agitation versus paranoia, or psychotic symptoms; benzodiazepines in older adults
• 15:40 Antipsychotic medications, the black box warning and ethical concerns
• 23:50 Geriatricians, geriatric psychiatrists in short supply; Behavioral interventions
• 28:16 Outro

Tags

psychiatry, psych, geri, geriatrics, dementia, paranoia, psychosis, sleep, insomnia, agitation, antipsychotics, atypical, black, box, warning, adverse, zolpidem, benzodiazepine, side, effects, therapy, mirtazapine, gabapentin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Summary

Geriatric depression got you down? Boost your spirits with tips and tactics from Geriatric Psychiatrist, Dennis Popeo MD, Clinical Associate Professor of Psychiatry at NYU Langone Medical Center. Topics include: suicide in the older adults; how to diagnosis depression in older adults; how to counsel patients about antidepressants, how to choose an antidepressant, how to monitor and titrate medications, and how long to continue therapy. Stay tuned for part two of our discussion with Dr Popeo on managing sleep and behavioral problems in older adult patients with dementia.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written & Produced by: Jordana Kozupsky NP, Matthew Watto MD

Artwork by: Kate Grant MD

Hosts: Jordana Kozupsky NP, Matthew Watto MD

Editor: Matthew Watto MD

Guest: Dennis Popeo, MD

Time Stamps

• 00:00 A question for you, the listeners
• 01:12 Disclaimer, intro and guest bio
• 05:00 Getting to know our guest, recommendations for reading, and career advice
• 14:13 Case of geriatric depression; effective history taking; recognizing associated symptoms; depression scales
• 19:03 Suicide in older adults; firearm safety
• 24:26 Choice of therapy; Pharmacologic agents; Counseling patients and managing expectations; Dose titration and tracking symptoms
• 34:41 Augmenting therapy versus cross-titration to another agent; When is it okay to stop an antidepressant
• 40:50 Take home points
• 44:40 Outro

Tags: psychiatry, psych, geri, geriatrics, depression, mdd, sleep, insomnia, appetite, agitation, suicide, SSRIs, side, effects, therapy, diagnosis, serotonin, mirtazapine, bupropion, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Kick up the quality of your care with tips and tactics from Caitlin Clancy MD, coauthor of ACP’s High Value Care Curriculum. We learn to define quality and value in healthcare; the most common barriers to high value care; use of probability and likelihood ratios to boost clinical reasoning and combat diagnostic uncertainty; some useful tools to estimate cost; sources of healthcare waste; and some general pearls on how the healthcare system works...or doesn’t. ACP members can claim free CME-MOC at acponline.com/curbsiders (goes live 0900 EST on podcast release date).

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits:

• Written & Produced by: Matthew Watto MD
• Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD
• Guest: Caitlin Clancy MD

Time Stamps

• 00:00 Disclaimer, intro and guest bio
• 03:50 Guest one-liner, some discussion on non traditional paths, and picks of the week
• 12:10 Case 1: Defining value, cost, quality; sources of healthcare waste; and how to avoid the waste of daily labs
• 23:00 Case 2: An uninsured patient who needs major surgery; costs for uninsured versus insured patients
• 28:35 Do insured patients have better outcomes?
• 31:15 How to determine cost and “fair market price”
• 36:29 Case 3: Clinical case of suspected heart failure
• 45:45 Case 4: Clinical case of patient requesting antibiotics; barriers to high value care and how to overcome them
• 57:05 Outro

Tags: high, value, care, quality, cost, diagnostic, uncertainty, likelihood, ratio, testing, treatment, consumer, acp, college, american, insured, uninsured, bill, charge, reimbursement, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Master the management of gout with tips from expert, Tuhina Neogi MD, PhD, Professor of Medicine at Boston University School of Medicine. Topics include: how to initiate and titrate urate lowering therapy, guidelines controversy over uric acid targets, colchicine & NSAIDS for anti-inflammatory prophylaxis, uricosuric agents, febuxostat, HLA B5801, use of uric acid levels in the acute setting and more random gout facts.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits:

• Written and produced by: Matthew Watto MD
• Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD
• Guest: Tuhina Neogi MD, PhD

Time Stamps

• 00:00 Intro and guest bio
• 01:30 Allopurinol initiation and titration
• 07:10 Uricosuric therapy
• 09:10 Controversy over uric acid targets for gout
• 17:40 Parachutes and randomized controlled trials
• 19:15 Colchicine or NSAIDS for prophylaxis
• 23:20 Who needs febuxostat?
• 26:20 When to refer for gout, HLA B5801, and checking uric acid levels in the acute setting  
• 33:29 Take home points
• 36:15 Outro

Tags: allopurinol, uric, urate, acid, level, therapy, management, gout, flare, crystal, arthritis, titration, probenecid, febuxostat, target, acr, acp, guidelines, nsaids, colchicine, hla b5801, septic, rheumatology, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Crystalize your knowledge of gout and stop flares in their tracks with tips from expert, Tuhina Neogi MD, PhD, Professor of Medicine at Boston University School of Medicine. On this first of two gout episodes we learn to diagnose gout with or without arthrocentesis, how to treat flares, and how to counsel patients about gout, which apparently involves fire fighting and bathtubs. Don’t miss next week’s episode on urate lowering therapy, gout guidelines controversy, and answers to your gout questions from social media.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits:

• Written and produced by: Matthew Watto MD
• Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD
• Guest: Tuhina Neogi MD, PhD

Time Stamps

• 00:00 Disclaimer, intro
• 01:40 Guest bio
• 03:20 Guest one liner, music recommendations, advice for researchers, and some comments on failure
• 09:15 Clinical diagnosis of gout
• 12:15 Is taking a diet history useful?
• 14:30 Classification criteria for gout
• 17:35 MSK ultrasound and Physical exam findings in gout
• 21:06 Arthrocentesis and MSU crystals
• 24:45 A recap of how to make the diagnosis of gout
• 26:50 The bathtub analogy and how to counsel a patient with a new diagnosis of gout
• 30:55 Pathophysiology of gout
• 34:55 Treatment for acute gout flares (steroids, colchicine, NSAIDS. And topical NSAIDS?) 
• 45:30 Outro

Tags: gout, crystal, colchicine, steroids, nsaids, joint, flare, acute, chronic, urate, uric, acid, arthritis, acr, exam, diagnosis, rheumatology, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Dr. Neda Frayha (@nedafrayha) of Primary Care RAP (Hippo Education) joins us this month for our thoughts and analysis of some recent (and not so recent) journal articles that interested us this month. Our articles spanned topics that include at cancer survival among patients pursuing treatment with complementary medicine, the effect of body weight on effectiveness of preventive aspirin dosing, strategies to promote physician leadership, respiratory symptoms in those with marijuana use and MRSA risk among patients with penicillin allergies. ACP members can claim free CME-MOC at acponline.com/curbsiders (goes live 0900 EST on podcast release date).

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you!

Thoughts on the Journal Club series? Article or guest nominations? Compliments or complaints? You can reach us at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.  

Credits:

• Written by: Sarah Phoebe Roberts MPH, Neda Frayha MD, Christopher Chiu MD
• Producers: Sarah Phoebe Roberts MPH, Christopher Chiu MD
• Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD
• Editor: Matthew Watto MD 

Time stamps:

• 00:00 Disclaimer, intro, guest bio
• 05:05 Do patients using complementary medicine for cancer therapy have worse outcomes?
• 13:11 Does low dose aspirin work for primary prevention of major adverse cardiac events?
• 19:16 Do physicians make better leaders?
• 24:55 Does marijuana cause respiratory symptoms?
• 30:40 Does penicillin allergy confer increased risk for C Diff and MRSA infection?
• 38:40 Wrap-up and outro

Tags:​ aspirin, cardiac risk, mortality, cancer, complementary, alternative, conventional, therapy, marijuana, cannabis, respiratory, symptoms, leader, leadership, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Get schooled on driver’s safety for older adults by expert, Alice Pomidor MD, Professor of Geriatrics at Florida State University. Whether or not older adults can continue to drive is a huge problem faced by for primary care clinicians, and will remain one until driverless cars become ubiquitous. Topics covered include: how to take a driving history, red flags, physical exam, cognitive exam, and vision assessment for driver’s safety, resources, when to refer, alternate means of transportation, and the legal repercussions of reporting...or not reporting.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits:

• Written and produced by: Matthew Watto MD and Elizabeth Garbitelli MD Candidate 2022
• Editor: Matthew Watto MD
• Cover Image by: Kate Grant MD
• Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD
• Guest: Alice Pomidor MD 

Time Stamps

• 00:00 Disclaimer
• 00:35 Intro and guest bio
• 03:10 Guest onliner, book recommendations, and career advice
• 10:43 Clinical case, and the 5 Rs of clinicians responsibility
• 19:15 Taking a history from older adult drivers
• 26:28 The clinical exam for driver’s safety (cognition, vision, and MSK tests)
• 37:24 How can we avoid patient anger towards clinician and family members?
• 41:10 When and where to refer for driving evaluation
• 47:00 Alternative transportation
• 52:00 What to do if someone refuses or forgets to stop driving
• 59:45 Reporting requirements and legal ramifications
• 69:15 Take home points
• 72:00 Outro 

Tags: driving, elderly, geriatrics, dementia, treatment, prevention, cognition, seniors, drivers, safety, crash, motor, vehicle, car, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Things We Do For No Reason #TWDFNR highlights some widespread practices that are difficult to justify based on lack of proven health benefits, but significant cost (both financial and non-financial harms). Avoid these low value practices and inflated medical bills with tips from expert, Dr Lenny Feldman, MD, FACP, Associate Professor of Medicine Johns Hopkins. Topics include: renal ultrasound and urine electrolytes in acute kidney injury (AKI), folate deficiency and anemia work-up, prealbumin and malnutrition, blood transfusions, shellfish and contrast allergies, monitoring after switch from IV or oral antibiotics, and “against medical advice” discharges.

Don't forget to check out Clinicwiki.org a free, online resource for teaching ambulatory medicine.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. 

Credits:

• Written and produced by: Justin Berk MD, MPH, MBA
• Editor: Matthew Watto, MD
• Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD, FACP
• Guest: Lenny Feldman MD, FACP

Goal: Listeners will recognize things we do for now reason aka low value practices with an unfavorable ratio of benefits to cost and/or harm.

Learning objectives:

After listening to this episode listeners will…

1. Determine if renal ultrasound is indicated in acute kidney injury
2. Recognize the limitations of urine electrolytes in AKI.
3. Identify the shortcomings of folate testing.
4. Explain the significance of low albumin and prealbumin.
5. Identify patients at risk for serious allergic reactions from IV contrast administration
6. Explain the futility in discharge Against Medical Advice (AMA) paperwork
7. Counsel patients on harm reduction in “AMA” discharges
8. Rationalize discharging patients immediately after switching from IV to  oral (PO) antibiotics.

Time Stamps

• 00:00 Announcements
• 00:38 Disclaimer, intro, and guest bio
• 03:53 Guest one liner, some recommendations, and advice
• 08:35 Defining high value care and things we do for no reason (TWDFNR)
• 12:40 Why do clinicians order useless testing?
• 14:58 Urine electrolytes for acute kidney injury
• 20:30 Renal ultrasound for acute kidney injury
• 25:54 Stop ordering folate for anemia workup
• 31:47 How many units should I transfuse?
• 34:40 Prealbumin and albumin for malnourishment.
• 43:24 Iodine, shellfish and contrast allergy
• 50:28 Patient leaving against medical advice
• 56:45 Switching from IV to oral antibiotics
• 63:27 Dr Feldman’s plugs
• 65:36 Outro 

Tags: high, value, choosing, wisely, acute, kidney, injury, renal, ultrasound, transfusion, AKI, malnutrition, folate, prealbumin, albumin contrast, allergy, antibiotics, AMA, TWDFNR, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Point-of-care Ultrasound AKA POCUS ain’t no hocus. Dr. Renee Dversdal (@ReneeDversdal) Director of the Oregon Health & Science University Point of Care Ultrasound and General Medicine Ultrasound Fellowship Director, joins The Curbsiders to discuss her craft. Topics include: Defining POCUS, the value POCUS adds to the physical exam, training pathways and the appropriateness of billing. This episode is sponsored for CME-MOC credit by the American College of Physicians. ACP members can claim free credit at acponline.org/curbsiders (goes live at 9am on release date). Follow this link to read the ACP’s statement in support of POCUS in Internal Medicine.

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits:

• Written by: Christopher Chiu MD and Renee Dversdal MD
• Produced and CME questions by: Christopher Chiu MD
• Edited by: Matthew “Mike” Watto MD
• Hosts: Matthew Watto MD, Stuart Brigham MD, Christopher Chiu MD
• Guest Expert: Renee Dversdal MD

Tags: point-of-care, acp, impocus, ultrasound, bedside, POCUS, CLUE, exam, training, lifestyle, management, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

“Women in medicine, be bold.” Medical World, powerful women are here to stay. Dr. Vineet (Vinny) Arora, Professor of Medicine at University of Chicago, an exemplary Woman in Medicine and Leadership, shares snippets of her own story, valuable career advice to folks at all levels of training, and fascinating data about the gender disparities that exist in training, promotion, and pay.  We hope you’ll learn from this episode, whether you have faced or anticipate facing these struggles as a Woman in Medicine or as a member of another marginalized group, or whether you’re an ally and want to learn more about the issue.

Women are entering medical school now more than ever, and are learning to provide the best possible care to patients (didn’t you see that patients of female physicians have significantly lower mortality rates than patients of male physicians? (Tsugawa et al., 2016)).  The modern medical woman wants to teach, mentor, and lead--and be fairly evaluated, and promoted. That’s where We In Medicine (both women and men) have some work to do.  Because gender disparities (and other disparities hinging on identity) do exist.

N.b. This episode is our inaugural in what we hope will be a Women in Medicine series for the Curbsiders.  We have many more topics with which we’d like to engage, from career trajectory to imposter syndrome to sexual harassment to balancing career and personal lives (as inequity is not only at work (Khullar. Being a Doctor is Hard. It’s Harder for Women. NYT 2017)), to conversations about race, gender, and LGBTQ identity in medicine.  We’re passionate, at The Curbsiders, about all these topics, and we want to dive deep into how to make Medicine a more welcoming and ceiling-less place for all.  We can’t wait to bring this series to you, not to mention to bring some more fabulous female experts on air.

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits:

• Written and produced by: Leah Witt MD, Shreya P. Trivedi MD, Nora Taranto AB, Sarah Phoebe Roberts MPH, Molly Heublein MD, Beth Garbitelli, Hannah R Abrams,
• Images by: Beth Garbitelli and Hannah Abrams
• Editor: Matthew Watto MD
• Hosts: Leah Witt MD, Shreya P. Trivedi MD, Matthew Watto MD
• Guest: Vineet Arora MD

Time Stamps

• 00:00 Disclaimer and intro
• 03:15 Guest bio, and one liner
• 05:55 Dr Arora’s Women in medicine moment of awakening
• 11:05 Advice to young women, “Be bold”
• 13:20 Picks of the week
• 16:45 Mistaken identity. Women not recognized as physicians due to appearance
• 22:05 Gender bias starts early in training and why it's important to shout-out accomplishments
• 31:24 Contracts, promotions and the leaky pipeline
• 38:32 Defining coaches, sponsors, and mentors
• 44:06 How to use your team and shout-out your accomplishments
• 52:04 How to write effective evaluations and letters that avoid gender bias
• 53:55 Take home points
• 57:00 Outro

Tags: women, medicine, wim, LeanIn, leadership, mentorship, doctor, education, family, assistant, career, sponsorship, vineet, arora, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Short on time but hungry for knowledge? Curbsiders’ Journal Club gives you the speedy article analysis you crave. We provide brief summaries of recent research and news items in the field of internal medicine, so you can save time and stay on top of the literature. On this episode, we were joined by Kashlak Memorial’s very own Chair of Medicine, Dr. Robert Centor AKA @medrants on Twitter or “Uncle Bob” to the Curbsider Crew. This month’s topics include: estimating atherosclerotic cardiovascular disease risk, whether CT pulmonary angiography (CTPA) effectively rules out pulmonary embolism, discharging low risk patients with pulmonary embolism from the ED, metformin and risk of acidosis in patients with CKD, treating opioid use disorder after a nonfatal overdose, Canagliflozin and renal protection in type 2 diabetes, screening for diabetes among patients below age 40, and the association between nose-picking and staphylococcus. ACP members can claim free CME-MOC at acponline.com/curbsiders (goes live 0900 EST on podcast release date).

Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you!

Thoughts on the Journal Club series? Article or guest nominations? Compliments or complaints? You can reach us at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.  

Credits:

• Written by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH
• Producers: Christopher J Chiu MD, Sarah Phoebe Roberts MPH
• Editor: Matthew Watto MD
• Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD
• Guest: Robert Centor MD

Time stamps:

• 00:00 Disclaimer and Intro to Curbsiders Journal Club
• 04:00 Dr. Centor's Pick of the Week
• 06:10 Clinical Implications of the Revised Pooled Cohort Equations
• 12:10 Negative Predictive Value in CTPA for VTE
• 18:34 Can low risk patients with PE be discharged from the ED?
• 23:03 Is Metformin associated with Lactic Acidosis in those with low eGFR?
• 28:45 How do medications for opioid use disorder affect mortality after non-fatal overdose?
• 36:44 Canagliflozin and Renal Protection
• 43:00 Performance of USPSTF screening criteria for diabetes
• 46:08 Stuart on Nose picking
• 50:00 Chiu Bites: Infectious ties and physical attire
• 53:50 Outro

Tags: atherosclerotic, cardiovascular, disease, risk, CT, pulmonary, angiography, CTPA, embolism, ED, metformin, acidosis, CKD, treatment, opioid, use, disorder, oud, mat, overdose, canagliflozin, renal, diabetes, screening, nose-picking, staphylococcus, ACP, CME, MOC, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Lyme disease and tick-borne illness deconstructed by Infectious Diseases expert, Paul E. Sax MD, of episode 78 fame. Oh, Summer Nights. The time for romance between Danny Zuko and good girl Sandy, the time to sit in the backyard around the bonfire, the time for sunset hikes in the woods and mountains…..and don’t forget, it’s also the time for those pesky woodland ticks who’ll go for a ride on you and maybe suck your blood (gross!). Dr. Sax takes us through the essentials of tick-borne illness, with a focus on Lyme Disease: diagnosing it, treating it, identifying possible co-infections, and managing Post-Lyme residual symptoms.  

Our (And Dr. Sax’s) Disclaimer about this episode, and the shownotes: Tick-borne illness is a very serious problem in public health in the US, but management is quite a controversial issue. We’ve done our best with this episode to stay as evidence-based as possible. Moreover, given the limited time we have on air, we have tried to focus on what we think is most clinically relevant.

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits:

• Written by: Shreya P. Trivedi MD, Nora Taranto AB
• Produced by: Shreya P. Trivedi MD, Nora Taranto AB
• Editor: Matthew Watto MD
• Images by:  Hannah R. Abrams
• Hosts: Shreya P. Trivedi MD, Matthew Watto MD, Paul Williams MD
• Guest: Paul E. Sax MD

Time Stamps

• 00:00 Intro
• 02:17 Disclaimer
• 03:19 Guest bio
• 05:17 Getting to know Guest
• 08:33 Favorite hiking experiences
• 12:20 Disclaimer of Tick-borne illness
• 12:28 Clinical case of recent hiking in endemic area with a rash
• 20:59 Lyme testing limitations
• 27:38 Patient education to doxycycline
• 30:16 Case of elderly outdoorsy healthy male with flu-like symptoms in the summer
• 32:39 Differentiating anaplasmosis and babesiosis
• 33:17 Workup for patient with possible tick co-infections
• 39:22  Post-lyme disease residual symptoms
• 48:02  Case of tick attached to patient
• 56:19  Outro

Tags: lyme, disease, anaplasmosis, babesiosis, treatment, prevention, coinfection, doxycycline, paul, sax, infectious, diseases, nejm, harvard, pcr, antibody, tick, borne, illness, chronic, post, syndrome, removal, endemic, anatomical, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Renal tubular acidosis aka RTA deconstructed by @Kidney_Boy, Joel Topf MD, Chief of Nephrology at Kashlak Memorial Hospital. We review the three buckets of non gap metabolic acidosis, normal renal physiology & acid base handling, points of failure in RTA, complications and treatment of RTA. Check out Dr Topf’s awesome slides on renal tubular acidosis at http://thecurbsiders.com/podcast .

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits:

• Written by: Matthew Watto MD and Joel Topf MD
• Produced by: Matthew Watto MD
• Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD
• Guest: Joel Topf MD

Time Stamps

• 00:00 Announcements
• 01:02 Disclaimer
• 01:40 Intro and guest bio
• 04:00 Joel’s one liner
• 06:05 Joel’s “favorite failure”
• 11:45 Paul shares a failure
• 13:20 Tweetorials
• 16:39 Clinical case of non gap metabolic acidosis
• 18:06 Three buckets of NAGMA and GI losses
• 21:02 Chloride intoxication and normal saline
• 25:14 Renal tubular acidosis and normal role of kidney in acid base
• 35:03 Proximal (type 2) RTA
• 40:33 Cases of proximal RTA
• 43:38 Distal (type 1) RTA
• 53:15 Bicarbonate dosing and titration
• 55:28 Type 4 RTA (hypoaldosteronism)
• 62:09 Urinary anion gap and ammonium
• 67:26 Replacing GI losses of bicarbonate
• 70:25 Joel reviews quick cases of RTA and NAGMA
• 74:49 Outro 

Tags: renal, tubular, acidosis, non, gap, rta, nagma, metabolic, kidney, diarrhea, sodium, normal, saline, ringer's, lactate, tubule, bicarbonate, physiology, acid, base, ammonia, ammonium, nephrolithiasis, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Expert diagnostician, Dr. Gurpreet Dhaliwal, again joins The Curbsiders to dive deeper into the topic of clinical expertise.  Topics include, and are mainly focused on, Dr. Dhaliwal’s “training regimen:” feedback, simulation, quizzing, learning from consultants, and how to read the medical literature as a clinician.  While we found this episode to be incredibly useful (and entertaining to record), don’t let our bias sway your opinion! In fact, just listen to the episode and listen for practical advise on how to improve your own clinical acumen.  

Dr Brigham’s comment:  Be forewarned, much of what we talk about is seemingly common sense, but, upon listening to the episode many times, I realize that we have, over time, overly complicated the fundamentals of expertise.  I’m just as guilty as the next physician.

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and produced by:  Stuart Brigham MD
• Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD
• Guest: Gurpreet Dhaliwal MD
• Images by: Beth Garbitelli
• Edited by:  Matthew Watto MD

Time Stamps

• 00:00 Disclaimer, Intro
• 02:25 Guest Bio
• 03:57 Pun
• 04:25 Dr. Dhaliwal
• 05:57 Pick of the Week - Move, “Jiro Dreams of Sushi”
• 08:00 Pick of the Week - Podcast, “Unspooled”
• 09:06 Pick of the Week - Water Putty, “Durham’s Rock Hard Water Putty”
• 10:20 “Clinical Case” Introduction
• 12:00 Developing expertise, introduction
• 15:50 Developing a patient log
• 21:30 Asking the wrong question leads to the wrong answer
• 23:35 Telling a colleague they were wrong
• 26:00 Five to one ratio
• 28:58 Understanding the why
• 33:57 Simulation in practice
• 37:35 Quote on learning… Just listen.
• 41:00 Quizzing and consolidating memory
• 44:24 Reading the literature as a clinician
• 50:10 Bottom line
• 57:10 Outro

Tags: clinical, reasoning, diagnosis, diagnostician, accuracy, Osler, misdiagnosis, train, brain, care, test, self, Dhaliwal, Gurpreet, Curbsiders, podcast, patients, cats, funny, educational, inspirational, educator, school, free, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, physician assistant, resident, student

Curbsiders’ Journal Club features rapid summary and critical appraisal of recent articles and news stories in internal medicine by The Curbsiders. This month’s topics include: asthma, maintenance versus as needed inhaler use, procalcitonin, Pneumocystis pneumonia prophylaxis, colon cancer screening, smoking cessation, cannabis and cognitive impairment, LDL cholesterol and mortality, plus some medical podcast recommendations.

Over the last month, we have developed a list of more than 40 interesting articles and news stories that we have been feeding our own brain holes. From this list we have plucked a select few that we really wanted to highlight and share with you.

Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you! We are also on Facebook, Instagram, and Twitter: @thecurbsiders.

Credits:

• Written by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH
• Producers: Christopher J Chiu MD, Sarah Phoebe Roberts MPH
• Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD
• Editor: Matthew Watto MD

Time Stamps:

• 00:00 Announcements
• 00:20 Disclaimer
• 01:00 Intro to Curbsiders Journal Club
• 03:07 Mild asthma and as needed versus maintenance inhaler use
• 09:50 Smoking cessation, e-cigarettes, and financial incentives
• 17:23 Pneumocystis pneumonia prophylaxis
• 22:18 Cannabis and cognitive impairment
• 26:15 Colorectal cancer screening update by American Cancer Society
• 30:37 Procalcitonin for lower respiratory tract infections in the ED
• 37:29 Cholesterol, baseline LDL-C, mortality and cardiovascular events
• 41:01 Incorrect symbology and some podcast recommendations
• 46:22 Outro

Tags: asthma, maintenance, inhaler, procalcitonin, Pneumocystis, pcp, pneumonia, prophylaxis, colon, cancer, screening, crc, smoking, cessation, marijuana, cannabis, cognitive impairment, LDL, cholesterol, mortality, cardiovascular, podcast, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Cirrhosis. Take control of cirrhosis and treat your patients like the pros! In this episode of The Curbsiders, Dr. Scott Matherly, assistant professor in the Dept of Medicine at Virginia Commonwealth University and board certified hepatologist, builds upon his introduction to cirrhosis. You already know what to look out for and how to diagnose these patients, now it’s time to build your knowledge and medical repertoire against this deadly condition! Topics include: high protein diet, ascites, diuretics, hepatic encephalopathy, lactulose vs rifaximin, portal hypertension, esophageal varices, beta blockers, spontaneous bacterial peritonitis prophylaxis and more pathophysiology!

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits:

• Written by: Cyrus Askin MD
• Infographics: Beth Garbitelli
• Produced by: Cyrus Askin MD and Matthew Watto MD
• Hosts: Cyrus Askin MD, Matthew Watto MD, Stuart Brigham MD, Paul Williams MD
• Guest: Scott Matherly MD

Time Stamps

• 00:00 Announcements
• 00:54 Disclaimer
• 01:30 Guest bio
• 02:28 NASH, diet, vitamin E, pioglitazone and prevention of cirrhosis
• 06:56 Clinical case of decompensated cirrhosis
• 09:02 Pathophysiology of circulatory dysfunction in cirrhosis and use of diuretics
• 18:25 Hepatic encephalopathy, ammonia, lactulose and rifaximin
• 25:10 Timing of medical therapy
• 26:39 MAP of 82 mmHg, beta blockers and variceal bleeding
• 31:04 Use of midodrine for hypotension
• 33:45 Prophylaxis of SBP
• 36:05 Take home points
• 38:04 Outro

Tags: cirrhosis, liver, high, protein, diet, sodium, restriction, ascites, diuretics, furosemide, spironolactone, hepatic, encephalopathy, lactulose, rifaximin, portal, hypertension, esophageal, varices, beta, blockers, spontaneous, bacterial, peritonitis, prophylaxis, pathophysiology, sbp, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Cirrhosis. Finally. Take your liver game to the next level with tips from @liverprof, Scott Matherly MD, Assistant Professor of Medicine at Virginia Commonwealth University. Topics include: exam findings in cirrhosis, interpreting liver function tests, incidental cirrhosis on imaging, fatty liver disease, steatohepatitis, hep c, shear wave elastography, screening for varices and hepatocellular carcinoma, pathophysiology, and lifestyle measures for initial management. This episode is sponsored for CME-MOC credit by the American College of Physicians. ACP members can claim free credit at acponline.org/curbsiders (goes live at 9am on release date).

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits:

• Written by: Cyrus Askin MD
• CME questions by: Cyrus Askin MD
• Produced by: Cyrus Askin MD and Matthew Watto MD
• Hosts: Cyrus Askin MD, Matthew Watto MD, Stuart Brigham MD, Paul Williams MD
• Guest: Scott Matherly MD

Time Stamps

• 00:00 Announcements
• 00:45 Disclaimer
• 01:19 Intro to the show and our guest
• 04:15 Guest one liner, books recommendations, and career advice
• 09:04 Cyrus’ pick of the week
• 10:14 Clinical case of abnormal liver functions tests
• 11:12 Seven hand findings of cirrhosis
• 13:28 Should we screen for NASH?
• 15:28 Incidental finding of cirrhosis on imaging
• 17:47 Next steps after diagnosis of cirrhosis
• 20:36 Non-invasive scoring systems to predict cirrhosis
• 23:55 Liver biopsy
• 25:33 Shear wave elastography
• 29:10 Recap of what we learned so far
• 31:58 Three ways cirrhosis can kill you
• 33:56 Counseling patients about cirrhosis
• 36:05 Management of NASH and early  cirrhosis
• 42:55 Screening for varices and hepatocellular carcinoma
• 46:28 Outro

Tags: cirrhosis, liver, function, shear, wave, elastography, fibroscan, imaging, fatty, liver, disease, nash, nafld, steatohepatitis, hepatitis, hep c, hcv, screening, varices, hepatocellular, carcinoma, pathophysiology, lifestyle, management, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Step up your primary care of cancer survivors with tips from Dr Regina Jacob, Assistant Professor of Medicine at Temple University. Care of the cancer patient does not end when their cancer treatment is over, and there is more to a past diagnosis of cancer than surveillance. We discuss cancer survivorship care with Dr. Regina Jacob, including the changing demographics of survivorship, the importance of survivorship care plans, and how survivorship is largely just good primary care.

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits:

• Written by: Paul Williams MD
• Hosts: Stuart Brigham MD, Matthew Watto MD, and Paul Williams MD
• Produced by: Paul Williams MD
• Edited by: Matthew Watto MD
• Guest: Regina Jacob MD 

Time Stamps

• 00:00 Disclaimer
• 00:35 Intro to the topic and guest bio
• 02:15 Guest one liner, book and app recommendations
• 06:58 Paul’s pick of the week.
• 07:40 Clinical case, definitions, and phases survivorship
• 12:36 Survivorship statistics
• 15:04 Co-survivorship
• 17:41 Care models for survivorship
• 20:56 Assigning roles in care of cancer survivors
• 22:59 Sample survivorship care plan
• 27:39 Childhood, adolescent and young adult cancer survivorship
• 34:18 Sexual dysfunction in cancer survivorship
• Turn down Watto and Regina tracks
• 35:56 Stressors in young adult cancer survivors
• 37:33 Fatigue
• 43:28 Guidelines on survivorship
• 45:06 Late cardiac toxicity
• 46:23 Support groups and resources
• 49:04 Take home points
• 50:29 Outro 

Tags: Survivorship, cancer, breast, ovarian, colon, radiation, chemotherapy, side, effect, fatigue, sexual, dysfunction, care, plan, surveillance, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Knee pain is easy with practical tips from Orthopedist, medical educator, car-builder, and inventor extraordinaire Dr. Ted Parks. He teaches us the four buckets of knee pain, how to perform a 30-second knee exam, choose a knee brace, order x-rays, and the red flags to look for in a history and physical that should have you shouting for your closest neighborhood orthopedic surgeon. This episode is brought to you in partnership with the American College of Physicians. ACP members can claim free CME-MOC credit at acponline.org/curbsiders. Check out our video of the Parks-Approved 30-second knee exam!

Credits:

• Written by: Nora Taranto BA, Matthew Watto MD
• Produced by: Chris Chiu MD and Nora Taranto BA
• Edited by: Matthew Watto MD.
• Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD.
• Guest: Ted Parks MD.  

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. 

Time Stamps

• 00:00 Announcement
• 01:00 Disclaimer
• 01:35 Intro and guest bio
• 04:08 Dr Parks’ one-liner, book recommendation, inventions, and career advice
• 10:52 A case of knee pain, and recognizing emergencies
• 14:17 Four buckets of knee pain
• 17:40 Initial approach to treatment of knee pain
• 20:19 Corticosteroid injection controversy
• 22:47 Hyaluronic acid injections
• 24:50 Topical agents
• 27:03 Taking a history about knee pain
• 29:39 Knee locking or giving out
• Practical Office Orthopedics by Ted Parks
• 31:44 How to order knee X-rays
• 36:45 Knee braces
• 41:00 How to perform a 30 second knee exam
• Ms Anita Bones has left knee pain and recent fall.
• 53:00 PRP, stem-cell injections
• 61:00 Glucosamine chondroitin
• 63:09 Take home points
• 64:36 Outro

Tags: orthopedics, knee, pain, ortho, joint, exam, osteoarthritis, arthritis, xray, physical, injection, corticosteroid, hyaluronic, hyaluronate, prp, stem, cell, bracing, nsaids, glucosamine, chondroitin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Keep current with this monthly journal club covering landmark articles through May 2018, plus rapid fire hot takes from the medical literature and health news. We rate each article according to a highly scientific ‘Hotcakes’ scale to highlight what practice-changing knowledge we’ll take to work this month. Topics: Hypertension, blood pressure monitoring, prostate cancer screening, Intimate Partner Violence screening, alcohol is killing you, new diabetes drugs and mortality, DPP-4 inhibitors and IBD risk, NT-proBNP-guided therapy vs usual care, effect of teaching status on mortality, and more! If you’re a listener and have something interesting for us to discuss, please send it our way.

Join our mailing list to receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.

Credits:

• Written and produced by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH
• Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD
• Editor: Matthew Watto MD

Time Stamps: 

• 00:00 The Curbsiders need a web master
• 00:50 Disclaimer
• 01:25 Intro to the format
• 03:25 Ambulatory BP monitoring and mortality
• 09:08 Blood pressure treatment strategies: CVD risk score vs systolic BP targets
• 14:14 Repeated BP measurements important at office visits and future directions of BP management
• 21:25 Hot takes in order of appearance: Prostate cancer screening, intimate partner violence, alcohol, DPP4 inhibitors mortality and IBD, teaching status and mortality in US hospitals, 5 lifestyle factors that may add to life expectancy, NT pro-BNP, BNP and mortality
• 38:12 Outro

Get schooled on hemoglobin a1c targets in type 2 diabetes mellitus by American College of Physicians guidelines coauthor, Devan Kansagara MD MCR, Associate Professor of Medicine, Oregon Health Sciences University. We summarize outcomes from the landmark diabetes trials (ACCORD, ADVANCE, VADT, UKPDS 33 & 34), how a1c targets effect microvascular and macrovascular events, estimating life expectancy, and how to personalize diabetes control for your patients. We’re proud to announce our new partnership with the ACP to provide free CME credit and MOC points on select episodes of The Curbsiders. ACP members can visit acponline.org to redeem free CME/MOC credit.

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list to receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits:

• Written, produced, and edited by: Matthew Watto MD.
• Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD.
• Guest: Devan Kansagara MD, MCR

Time Stamps

• 00:00 Announcement
• 00:48 Disclaimer and intro
• 03:11 Getting to know our guest: one liner, book recommendation, mentorship
• 06:50 How and why did ACP write their guidance statement on diabetes, A1C targets
• 09:18 Landmark trials in type 2 diabetes
• 11:36 Does tight control prevent micro or macrovascular complications
• 13:20 Trials of newer agents like SGLT2i, GLP-1 and DPP4i
• 14:33 How do ACP’s guidelines differ from other published guidelines
• 17:20 Quick recap of landmark trial findings
• 22:24 Personalizing glycemic control
• 24:30 Controversy over an A1C goal of 7-8%
• 28:05 Clinical inertia
• 30:26 Legacy effect and metabolic memory
• 34:00 Deintensifying therapy
• 38:29 Life expectancy and comorbid conditions
• 43:15 Performance measures in diabetes
• 44:42 Take-home points
• 46:30 The Curbsiders recap and give some closing remarks
• 49:13 Outro 

Tags: diabetes, a1c, target, dm, hypoglycemia, glycemic, intensive, tight, glucose, control, cardiovascular, risk, outcome, mortality, death, metformin, insulin, acp, guideline, accord, advance, vadt, ukpds, microvascular, macrovascular, aace, ada, VA, DoD, assistant, care, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Separate the wheat from the chaff when it comes to food allergy, food intolerance, and celiac disease. Featuring renowned gastroenterologist and current president of the American Gastroenterological Association, Dr. Sheila Crowe MD FRCPC FACP FACG AGAF, we discuss how to differentiate a food allergy from an intolerance, what diagnostic testing is appropriate, and why fructans might be the real culprit in patients with ‘gluten sensitivity’.

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits:

• Written by: Sarah P. Roberts, MPH
• Guest: Sheila Crowe, MD
• Hosts: Matthew Watto, MD; Stuart Brigham, MD; Paul Williams, MD
• Producers: Sarah P. Roberts, MPH and Chris Chiu, MD
• Editor: Matthew Watto, MD

Time Stamps:

• 00:00 Disclaimer
• 03:35 Getting to know our guest, book recs, and career advice
• 10:35 Clinical case
• 11:40 Defining allergy, intolerance
• 14:05 Food intolerance and FODMAP
• 18:02 Taking a history in patient with potential food allergy vs intolerance
• 21:34 Dermatitis herpetiformis, gluten ataxia, and extraintestinal manifestations of celiac
• 26:12 Diagnosing celiac disease
• 30:53 Next steps if celiac testing is negative; lactose, fructose intolerance, IBS
• 33:48 Non-celiac gluten sensitivity (NCGS)
• 37:48 Study of NCGS
• 40:41 Olmesartan and drug-induced enteropathy
• 43:38 Dieticians, dietary recs, elimination diets
• 48:10 “Voodoo” testing
• 52:36 Counseling patients on diet
• 54:35 Take home points
• 55:50 Outro

Tags: food, allergy, intolerance, sensitivity, celiac, disease, diarrhea, diet, fodmap, paleolithic, paleo, weight, loss, lactose, olmesartan, refractory, protein, gluten, fructan, wheat, anaphylaxis, tTG, genetic, gene, testing, assistant, care, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

A random serving of knowledge food for your brain hole with returning guest, Dr. Alan Dow, Professor of Internal Medicine at Virginia Commonwealth University School of Medicine. Our final live recap show from ACP 2018 covering: human microbiome, copper deficiency, POTS syndrome, substances of abuse, drugs for delirium and how to be more like Leonardo Da Vinci. Please let us know what you liked, didn’t like and how we can make the show better.

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.

Time stamps:

• 00:00 Disclaimer
• 01:30 Guest bio
• 03:19 Getting to know our guest, podcast, and book recommendations
• 08:55 Human microbiome
• 11:05 A case of anemia and neuropathy
• 13:30 Physiology and treatment of POTS syndrome
• 17:00 Novel substances of abuse
• 20:17 Benzodiazepines for delirium
• 24:00 Leonardo Da Vinci versus the modern physician
• 27:18 Outro

Tags: microbiome, transplant, bupropion, gabapentin, pregabalin, copper, POTS, substance, use, disorder, leonardo, da, vinci, acp, journal, article, literature, news, media, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

A fast moving recap of hot topics and clinical pearls live from Internal Medicine’s largest national conference, ACP 2018 in New Orleans! Dr. Nina Mingioni, Clinical Associate Professor and director of Undergraduate Medical Education in Internal Medicine at Thomas Jefferson University Hospital serves up some knowledge food for our brain holes. Topics: the athlete as a patient, sports physicals, food as medicine, medical marijuana (cannabis), and more! Listeners, please let us know what you liked, didn’t like and how we could make this better. YouTube video of this episode available here: ACP 2018 Recap with Nina Mingioni. 

You can join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders. 

Time stamps:

• 00:00 Music and disclaimer
• 02:48 Getting to know our guest
• 06:07 The athlete as a patient
• 10:20 Relative energy deficiency in sports
• 12:00 Drug interactions
• 15:51 Food as medicine
• 21:56 Marijuana
• 30:24 Outro

Credits: 

Written by: Nina Mingioni MD, Hannah Abrams. Producer/videographer: Chris Chiu MD. Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD. Editor: Matthew Watto MD

Tags: food, microbiome, marijuana, athlete, ekg, ecg, physical, sports, training, energy, relative, deficiency, cannabinoid, entourage, effect, cannabidiol, thc, cannabis, acp, 2018, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Wow the crowd with your knowledge of pulmonary embolism! What are the red flags? What tools are available to guide you? How on Earth do you triage a patient with pulmonary embolism (PE)? What exactly is the RV spiral & how do PEs really cause morbidity and mortality?! Get schooled by pulmonary embolism expert, Dr. Oren Friedman, associate director of the Cardiac-Surgical Intensive care unit at the Cedars-Sinai Heart Institute. Doctors Cyrus Askin and Chris Chiu join as co-hosts. Test Yo’ Self Pulmonary embolism quiz

Written by Cyrus Askin, MD, Justin Berk, MD, MBA, MPH. Figure by Cyrus Askin, MD. Edited by Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. 

Time Stamps

• 5:10 - Start of Interview / Introduction
• 10:00 - Case Presentation - Introduction of DVT / PE Spectrum and Pathophysiology
• 16:18 - How to Triage and Work-Up Pulmonary Embolism (CT, Echo, troponins, “eyeball”)
• 23:30 - Other ways to risk-stratify (Other CT findings, clot burden)
• 28:45 - What does a low-risk patient look like?
• 30:35 - When to consider treatment modalities other than general anticoagulation
• 35:12 - Anticoagulation treatment options
• 36:38 - Next step intensive interventions after anticoagulation
• 42:00 - Evidence behind catheter-directed lysis
• 44:05 - IVC Filter discussion
• 47:22 - Discharge criteria for PE
• 50:00 - Incidental PEs
• 52:40 - Interdisciplinary PERT Team

Tags: pulmonary, embolism, thrombolysis, heparin, anticoagulation, right, ventricle, RV, left ventricle, LV, circulation, hypotension, shock, IVC, vena, cava, filter, catheter, TPA, echocardiogram, CT, scan, computed, tomography, shock, bleed, clot, deep, vein, thrombosis, vte, venous, embolism, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Random clinical pearls from day 2 of ACP 2018 live in New Orleans. Topics include: Perioperative medicine, DOACs, anticoagulation, reversal agents, ACP statements on hidden curriculum, physician well being and burnout, modeling behavior, dermatology pearls, rashes, venous stasis ulcers, pentoxifylline, biotin and Grave's disease, dermatology pearls, Stuart's tips on sports doping, and how chocolate milk improves recovery time. Doctors Chris Chiu and Chris Thrash join us to discuss their favorite teaching points from today's sessions.

Cochrane Review on Venous Ulcers https://bit.ly/2JdQAMu

Joinour mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

The Curbsiders share random clinical pearls from day 1 of ACP 2018 live in New Orleans. Topics covered include: breast density and cancer risk, patients before paperwork, diverticulitis, social determinants of health, migraine prevention, PrEP and thunderclap headaches. Doctors Chris Chiu and Chris Thrash join us on air to discuss their favorite teaching points from today's sessions.

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Keep up-to-date with this fast moving discussion of recent journal articles and thought-provoking headlines in medicine. Welcome to the first-ever Curbsiders journal club covering landmark articles from March to April 2018, plus rapid fire hot takes and the unveiling of our new hotcake based rating system. Please let us know what you liked, didn’t like and how we can make this better next month. Topics: Resident work hours, saline versus balanced IV fluids, barber shops and hypertension, coffee causes cancer, Twitter based medicine, clonidine versus spironolactone, opioids versus nonopioids and aromatherapy for nausea!

Written by: Chris J Chiu, MD; Producer: Sarah Phoebe Roberts MPH; Edited by: Matthew Watto, MD

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders. 

Time stamps:

• 00:00 Disclaimer
• 00:35 Host intros, featuring special guest and correspondent Chris Chiu, MD
• 01:30 Introducing a new Curbsiders segment!
• 03:20 First article: Duty-Hour Flexibility Trial
• 08:55 Second article: Trial of Blood-Pressure Reduction in Black Barbershops
• 14:27 Third article: SALT-ED Trial
• 20:00 Hot takes—intro
• 20:36 Hot take #1, Dr. Milton Packer and Twitter-based medicine
• 24:07 Hot take #2, Coffee and cancer risk
• 26:24 Hot take #3 Aromatherapy for nausea
• 28:10 Hot take #4 Opiates vs. non-opiates for chronic pain
• 29:00 Hot take #5, Surgeon general’s statement on naloxone
• 29:46 Hot take #6, Spironolactone vs clonidine for resistant HTN
• 31:54 Outro & announcements

Become an expert diagnostician like Dr Gurpreet Dhaliwal, Professor of Medicine at UCSF. Join us for this deep dive into clinical reasoning and how doctors think! Topics include: how to improve your own clinical reasoning and diagnostic skills, how to teach these skills, and the initial steps to building your own expertise/mastery in clinical medicine! Dr. Osler once admonished his students to build experiential wisdom and follow-up with their clinical cases (clear cases, doubtful cases, and mistakes), but to do so, one must “...learn to play the game fair, no self-deception, no shrinking from the truth; mercy and consideration for the other man, but none for yourself, upon whom you have to keep an incessant watch.” Test yo’ self: Take our quiz here

Written and produced by:  Stuart Brigham, MD; Images by Hannah Abrams; Edited by:  Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Goal: Listeners will gain an appreciation for the Clinical Reasoning process and the difficulties that underpin building expertise in medicine.

Learning objectives:

After listening to this episode listeners will…

1. Develop an appreciation for clinical reasoning.
2. Recall the importance that the educator plays in role modeling.
3. Learn how to improve diagnostic accuracy by keeping a patient log.
4. Identify the common nomenclature used in clinical reasoning and how teaching this common verbiage could serve to improve diagnostic accuracy
5. Recognize that misdiagnosis is common in clinical practice and every clinician could benefit from deliberate practice.
6. Explain the difference between experience and expertise.

Time Stamps

• 00:00 Disclaimer, Intro
• 02:30 Guest Bio
• 04:50 Dr. Dhaliwal
• 06:45 Book recommendation
• 09:14 App recommendation
• 11:34 Advice for learners and teachers (Pearl #1)
• 12:40 Can a computer out-think a human?
• 15:49 Defining Clinical Reasoning
• 18:38 “Train the Brain” introduced
• 20:30 Knowledge is a precondition
• 21:46 A learner who lacks synthesis
• 24:23 How to provide learner feedback
• 27:04 Defining problem representation, illness scripts, etc.
• 29:20 How to start teaching clinical reasoning
• 31:00 Focus on the “why” and not the “what”
• 32:11 Teaching the nomenclature of clinical reasoning
• 36:07 “You can’t get the right answer if the brain is solving the wrong problem”
• 36:34 Osler and his “Incessant Watch”
• 40:40 Being wrong feels exactly the same as being right
• 42:00 Patient tracking (Dr. Dhaliwal’s recommendation)
• 45:30 Why keeping a patient log is so important
• 47:00 Are heuristics beneficial?
• 48:55 Can you debias yourself?
• 50:00 “Going slow just makes you slow.”
• 52:00 All evidence has flaws, but knowledge is still king.
• 55:13 Clinical reasoning on multi-disciplinary teams
• 59:27 Take-home points

Tags: clinical, reasoning, diagnosis, diagnostician, accuracy, Osler, misdiagnosis, train, brain, care, test, self, Dhaliwal, Gurpreet, Curbsiders, podcast, patients, cats, funny, educational, inspirational, educator, school, free, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, physician assistant, resident, student

Revolutionize your approach to the red eye in pr-eye-mary care! Dr. Glaucomflecken (of GomerBlog/Twitter--fame) teaches us to recognize and manage common eye complaints. You’ll develop an approach to diagnosing and treating your patient with the dreaded red eye. We answer: What presentations should have us running down the hallway for that prized ophtho consult? What on earth does glaucomflecken stand for? Which eye drops are best? What is an eye dentist? Plus, answers to your twitter questions, and so much more! By the end of this episode, you’ll be sure to say “Eye Understand!” Self Assessment Questions: Take the ophtho self-assessment!

Donate at FirstDescents.org to support young cancer survivors like Dr. Glaucomflecken!

Written and produced by: Nora Taranto AB, Carolyn Chan MD; Original art by: Bryan Brown, MD. Edited by: Matthew Watto, MD.

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. 

Times Stamps

• 00:00 Disclaimer
• 02:33 Guest bio
• 04:15 Dr Glaucomflecken
• 05:40 Best advice as a learner
• 06:05 Book recommendation
• 07:33 App recommendation
• 08:32 Clinical case
• 10:02 Corneal ulcers and contact lense hygiene
• 12:10 Indicators of urgent eye problems
• 13:39 The eye exam
• 18:00 Visual acuity exam without an eye chart
• 21:15 Approach to the red eye, blepharitis, allergic conjunctivitis
• 23:45 Approach to vision loss
• 25:52 Angle closure glaucoma, and other emergencies
• 27:37 Bacterial conjunctivitis
• 29:00 Viral conjunctivitis
• 31:26 Return to school or daycare after “pink eye”
• 34:00 Rundown of common eye medications
• 38:35 OTC redness relievers
• 40:30 Breast milk eye drops?!
• 42:07 How to correctly use an eye drop bottle
• 44:16 What does Glaucomflecken mean?
• 45:40 Questions from Twitter: Floaters, diabetic retinopathy treatments, blurry vision from high glucose
• 50:15 Eye dentists?
• 53:10 Take home points
• 54:28 Plug for First Descents charity
• 56:54 Outro

Tags: eye, ophthalmology, eyedrop, GOMER, conjunctivitis, twitter, red, glaucoma, glaucomflecken, acute, angle, closure, glaucoma, bacterial, viral, blepharitis, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Dominate acid-base disturbances with the wisdom of @kidney_boy aka Joel Topf, MD, Chief of Nephrology at Kashlak Memorial Hospital.  Master his 5 key steps for interpreting acid-base disorders and decode any ABG, VBG, and BMP to find the primary disorder, and any other disorders tucked away in the ABG! Plus: Henderson-Hasselbach and pH simplified; the anion gap, should your correct it?; choice of IV fluid; osmolar gaps, methanol, ethylene glycol, isopropyl alcohol; and how metabolic disorders are like a boy band. Be sure to follow along the Dr. Topf’s brilliant acid-base powerpoint.

Written and produced by Joel Topf MD, Shreya Trivedi MD, Xavi Jimenez MD; Images by Hannah Abrams; Edited by Matthew Watto MD

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. 

Time Stamps

• 00:00 Announcement
• 01:00 Disclaimer
• 01:34 Intro
• 02:45 The setup and guest bio
• 03:15 How does Dr Topf compensate for difficulty
• 07:10 What has helped Dr Topf become successful as an educator
• 10:40 With which electrolyte do you most closely identify?
• 14:05 Picks of the week
• 16:05 Nephmadness explained
• 19:50 Joel’s big picture look at acid base
• 22:17 Acid base and logorhythmic scale
• 24:28 A caution about ABGs
• 27:23 Clinical case from Kashlak Memorial Hospital
• 28:05 Misinterpretation of low bicarb on a metabolic panel
• 29:20 Step 1 of acid base
• 32:00 Metabolic disorders and One Direction
• 35:15 Acidemia vs acidosis; alkalemia vs alkalosis
• 37:52 Compensation for acid base disorders
• 40:45 ABG apps and analyzers
• 42:40 Step 2 Is there a second primary disorder? Use equations for determining if compensation is appropriate.
• 51:31 How to determine if respiratory compensation is acute or chronic
• 54:26 Step 3 The anion gap
• 57:21 Correcting the anion gap
• 60:33 What causes a low anion gap?
• 63:58 Anion gap acidosis
• 66:05 GOLDMARK
• 69:15 Step 4 Is there an osmolar gap?
• 71:48 Toxic ingestions: Methanol, ethylene glycol, and isopropyl alcohol
• 76:15 Calculating the osmolar gap
• 79:08 Step 5 Gap-gap calculation aka “the bicarbonate before”
• 85:05 Choice of IV crystalloid fluid and when to use a bicarbonate drip
• 88:15 Bicarbonate in DKA
• 90:18 NephMadness plug
• 91:10 Outro

Tags: acid, base, anion gap, metabolic, respiratory, toxic alcohol, goldmark, mudpiles, albumin, acidosis, alkalosis, compensation, nephrology,  Henderson-Hasselbalch, equation, ABG, VBG, bicarbonate, pCO2, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Want to look cool like a toxicology consultant, sipping coffee on rounds? Ever check a patient for armpit sweat? Learn the secrets of tox from the titans of toxicology podcasting, The Dantastic Mr. Tox & Howard (AKA Dr. Dan Rusyniak and Dr. Howard Greller), as they loquaciously dish on all things tox. Topics include: how to approach the patient with an unknown overdose, are toxidromes clinically useful, clues on physical exam, is GI decontamination still recommended, and why they hate bupropion and tramadol. We recommend cautious ingestion of fluids while listening because this was a seriously funny episode. Try our Self Assessment Questions Toxicology 101 Quiz.

Written and produced by: Christopher Chiu, MD; Graphics by: Beth Garbitelli; Edited by: Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. 

Time Stamps

• 00:00 Disclosures
• 00:35 Intro
• 01:19 Guest bios both real and sarcastic
• 04:38 Getting to know our guests
• 06:33 Multiple choice toxicology
• 09:13 Book recommendations
• 11:30 Advice for learners and teachers
• 15:48 Clinical case from Kashlak Memorial Hospital
• 16:27 Initial approach and some thoughts on toxidromes
• 21:59 Physical exam, a toxicologist’s approach
• 27:09 Review of physiology: anticholinergic, cholinergic, sympathomimetic and how to recognize these findings on exam
• 34:18 Different speech patterns seen in toxicology
• 35:30 History taking and how much detective work is truly necessary
• 40:05 The approach to overdose on multiple substances or in setting of polypharmacy
• 45:52 Seinfeld, ipecac, and the controversy about gastrointestinal decontamination
• 63:10 Antidotes and when to give them
• 67:15 EKGs and overdose. Antidote for long QTc versus wide QRS
• 71:25 Tramadol and Egypt
• 73:45 Bupropion and bath salts
• 78:00 Outro

Tags: antimuscarinic, anticholinergic, cholinergic, sympathomimetic, overdose, tramadol, bupropion, quetiapine, wellbutrin, seroquel, pupil, overdose, naloxone, narcar, toxicology, tox, toxidrome, poisoning, gi, decontamination, charcoal, ipecac, antidote, dantastic, howard, ekg, qrs, qtc, bicarbonate, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Take a deep breath and tune in to this week’s episode full of COPD diagnosis and management pearls, with expert Dr. Denitza Blagev, a pulmonologist, intensivist, and Medical Director for Quality, Speciality Care at Intermountain Healthcare in Utah with a particular interest in physician wellness and issues related to women in medicine. We cover: history taking, interpreting PFTs, patient counseling, inhalers and medications, exacerbations, antibiotics, steroids, and who needs BIPAP...so basically everything you ever wanted to know about chronic obstructive pulmonary disease. Take our self assessment here.

Sponsored by @nephmadness. Registration opens March 15th at AJKDblog.org

Written and produced by: Leah Witt, MD, Cyrus Askin, MD. Edited by Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Time Stamps

• 00:00 NephMadness announcement
• 01:10 Disclaimer
• 01:45 Intro
• 03:50 Guest bio
• 05:03 One liner; What advice would you give our younger self?; Should I do a fellowship?; Book recommendations
• 10:30 Picks of the week
• 15:50 Case of COPD from Kashlak Memorial
• 16:55 Initial approach to a potential case of COPD
• 18:34 Misdiagnosis of COPD
• 20:10 Classic spirometry in COPD and GOLD 0
• 21:30 Diagnosis of emphysema
• 23:18 Diagnosis of chronic bronchitis
• 24:54 Counseling the patient with a new diagnosis of COPD
• 27:00 Spirometry
• 28:45 How to read PFTs
• 33:29 How to order PFTs and get what you want
• 36:00 Why does pre- and post-bronchodilator response matter?
• 38:45 Asthma COPD overlap syndrome
• 40:13 Staging of COPD, does it matter?
• 42:50 Prognosis in COPD
• 45:00 Therapies with mortality benefit
• 48:29 Therapies to improve symptoms and prevent exacerbations
• 52:00 Azithromycin as chronic therapy
• 53:00 Counseling patients on therapy
• 55:00 Short acting inhalers in COPD
• 56:20 Treatment of COPD exacerbations
• 59:18 Antibiotics, who needs them in exacerbation
• 61:52 Nebulized inhaled steroids
• 63:18 Duration of antibiotics and steroids during an exacerbation
• 66:30 Who needs BIPAP chronically?
• 69:22 Who needs BIPAP during an exacerbation?
• 71:33 How often should PFTs be repeated?
• 73:00 When should we suspect PE in COPD exacerbation?
• 74:25 Which labs should be check in the initial COPD workup?
• 76:46 Take home points

Tags: copd, chronic, pulmonary, disease, asthma, emphysema, bronchitis, inhaler, nebulizer, steroids, embolism, exacerbation, bipap, cpap, antibiotics, azithromycin, doxycycline, mortality, oxygen, spirometry, dlco, fev1, fvc, pfts, #nephmadness, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Contraception simplified with clinical pearls from reproductive health and family planning experts, Dr Angeline Ti, and Dr Moira Rashid. We cover it all including: the menstrual cycle, mechanism of action for various methods of birth control, hormonal versus nonhormonal contraceptives (e.g. intrauterine devices, patches, pills, rings, implants), patient counseling, and lots of resources to make your job easier. Women’s health correspondent, Dr Molly Heublein returns as cohost. Take our self-assessment quiz!