35 Burst results for "American Family Physician"

'I Didn't Choose Covid, It Choose Me' Dr Vladimir Zelenko Treats Small Community

The Charlie Kirk Show

01:54 min | 5 months ago

'I Didn't Choose Covid, It Choose Me' Dr Vladimir Zelenko Treats Small Community

"I want to thank Charlie, he's an incredible guy, his spirit his love of this country. He's done an amazing job, building one of the most powerful youth organizations ever created, turning point USA. We will not embrace the ideas that have destroyed countries destroyed lives and we are going to fight for freedom on campuses across the country. That's why we are here. Hey everybody, this episode is brought to you by my friends at ExpressVPN, ExpressVPN dot com slash Charlie, secure your device, anonymize your online activity, protect your action online, express VPN dot com slash Charlie, help our show out by also helping yourself protect yourself ExpressVPN dot com slash Charlie. Hey everybody, welcome to this episode of the Charlie Kirk show. I'm honored to have someone that I've admired for quite some time here on the show. He's someone that has been spreading some needed information around treating the Fauci virus that is doctor zelenko, doctor, welcome to the Charlie Kirk show. Charlie, thanks so much for having me. I'm a big fan. Thank you. First, why don't you take a moment here to introduce yourself? Kind of your work, your credentials and how did you find yourself into this line of work? Well, I didn't choose COVID. It shows me. I'm a family board certified family physician plus 20 years in an upstate New York community. And in March of 2020, my community got hit and I found myself in the epicenter of the largest most concentrated outpatient code outbreak in the country. And at that time, if you recall, there was no treatment. So all we were telling patients that go home take Tylenol when you get sicker, go to the hospital, get on the respirator and New York area, 80% were dying. That didn't seem like a very good treatment approach.

Charlie Kirk Charlie Zelenko Fauci USA New York
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

03:12 min | 8 months ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"Neighbors right down the street. Doctors bryce and boonchai from abrazos. Family medicine right here. In phoenix arizona are at so this looks at fecal cal protection for use in the evaluation of inflammatory bowel disease for review. Cal protected is a protein expressed by neutrophils and can be an indicator of gastrointestinal inflammation. Fecal cal protected. Testing is fda approved to aid in the diagnosis of inflammatory bowel disease. And specifically the thought is that it can be helpful in differentiating ibd from irritable bowel syndrome in people who have gi symptoms. Dave let's talk accuracy. I are right so using a threshold of greater than fifty micrograms per gram fecal cal protecting and appears pretty accurate. Based on a systematic review of nineteen studies about five thousand persons older than sixteen years old the pooled sensitivity was eighty percent and the pooled. Specificity was eighty percent similar. Accuracy was seen in prospective cohort studies of children this highest sensitivity means that. Ib is unlikely in adults and children with the fecal cal protect and less than that fifty micrograms per gram cutoff in children. Using the combination of fecal cow protect in with a cutoff of two hundred fifty micrograms per gram along with c reactive protein of greater than one milligram per deciliter and hemoglobin of less than two standard deviations below. The mean for age and sex has a sensitivity of one hundred percent and specificity of ninety seven percent for diagnosis of inflammatory bowel disease. Heather talked to us about potential benefits and harms of this test. Yeah so like. Dave said normal level could help rule out. Ibd meaning a major benefit of helping someone to avoid endoscopy on the harm side though. False negatives may delay diagnosis so anyone with high clinical suspicion for inflammatory bowel disease based on history and physical should skip this test. There's also concern for false positives based on the lower specificity of the test which would lead to unnecessary endoscopy. And lastly let's hit on cost. It's relatively cheap according to the cms fee schedule. It's about twenty bucks. Of course that is much less than the cost associated with endoscopy. So bottom line fico cow. Protecting is an accurate cost effective tests that can aid in ruling out inflammatory bowel disease. Nice please email us at af. Podcast at afp. Dot org or tweet at af p podcasts. Please rate and comment wherever you got your podcasts. Our podcast team is jake anderson. David by stra steve brown. Sarah coles maggie gergen zuliana ibrahim heather merchant andrew. Ocho and jamie sherman are sound in technical guru. Is tyler coles..

"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

03:33 min | 8 months ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"The case definition for multi-system inflammatory syndrome in children or misc focuses on some of the same symptoms. In fact a recent systematic review found that thirty six percent of patients with had symptoms consistent with kawasaki however the definition does require positive testing for sars. Covy too which is seen in ninety. Five to ninety nine percent of cases. Duration of fever is shorter in. Misc in gi symptoms also tend to be more prominent neuro cognitive and viral. Your eyes symptoms are also reported with but are less common. Both diseases can have. Profound cardiac manifestations coronary artery abnormalities. Such as dilation in aneurysm formation. Are seen in fifteen to twenty five percent of patients with kawasaki if untreated and is seen at a similar rate in misc. I cardiology is an important part of the initial workup. Shock is a rare complication of kawasaki disease however hypertension likely due to cardiac dysfunction and systemic bazo. Dilation is unfortunately seen in most patients with misc and often requires icu. There's some important lab. Findings that can help differentiate between these two diseases. Well in kawasaki we tend to see mild elevation of inflammatory markers and thrombosis whereas in. Misc inflammatory markers tend to be very high anthracite. A pina is common elevated proponent or bnp levels are seen more frequently in misc. Anemia is commonly seen in both and lymphocyte opinion is more typical with misc. Not surprisingly treatment is similar for kawasaki and and focuses on rapidly reducing systemic inflammation. There's obviously a lot of research to be done. Especially for se but by an aspirin are first line treatments for both steroid. Use is a bit more controversial in his definitely an active area of ongoing research. All right heather. Summarize it for us sharing so kawasaki disease and multi. Systemic inflammatory syndrome have many overlapping symptoms and laboratory abnormalities. Fever duration tends to be shorter in misc and gi symptoms or more prominent with misc cardiac complications and or shock are possible. Both but hypertension is more common in. Misc by values can be helpful in differentiating between the two. Finally treatment is similar for both and focuses on ivig and aspirin in addition to careful fluid resuscitation and on tropic support as needed next up a cochran for clinicians pelvic floor muscle training to prevent entry urinary and fecal incontinence in antenatal and postnatal patients in. This comes to us from dr ben. Chalk from lancaster. General hospital family medicine in pennsylvania. The clinical question here is does pelvic floor muscle training. How prevent or treat urinary or fecal incontinence during pregnancy or after delivery. The short answer is based on this cochran review. Our yes no and got it so there's actually a few questions you're right in in that clinical question. So let's break it down. I does pelvic floor. Muscle training during pregnancy. Help prevent urinary incontinence..

inflammatory syndrome kawasaki cardiac manifestations coronar kawasaki disease however hyper cardiac dysfunction aneurysm Systemic inflammatory syndrome fever systemic inflammation thrombosis Anemia dr ben heather General hospital family medici Fever hypertension
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:34 min | 8 months ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"Lucas saito says with white blood cells above ten thousand tack cardio with a heart rate of ninety beats per minute or more an age. Seventy or older. This comes up to a total of max. seven points. zero to two points corresponds to cellulitis. Being unlikely while five to seven means cellulitis was likely and recommended impure treatment a score in the middle of three to four is considered. Indeterminate in recommends dermatology consultation to make the definitive diagnosis. This alt- seventy clinical prediction rule only applies to lower extremity cellulitis. It excludes patients with surgery in the past thirty days. Penetrating trauma in dwelling hardware at the site burns diabetic ulcers abscesses known osteomyelitis and iv antibiotics in the last forty eight hours. And unfortunately this tool has not been validated in the primary care setting plus getting a stat. Cbc is not always feasible. But hopefully this tool can avoid some unnecessary admissions and ibn antibiotics next up a main topic kawasaki disease and multi-system inflammatory syndrome in children an overview and comparison and it comes to us from doctors darby and jackson from wake forest school of medicine in winston salem north carolina. This was definitely a flashback. To impatient pedes rounds for me. I feel like my attendance love to ask about the diagnostic criteria for kawasaki. Disease said dave you probably remember them off the top of your head right totally all right so for everybody except for dave. Maybe don't remember. Let's review all right so for kawasaki. We need first of all just prolonged fever. Five or more days and then with four of the following characteristics oral mucosal inflammation like cracking up the lips classic strawberry tongue bilateral bulwark conjunctiva. Itis diffused macula popular rash often worse in the perennial area extremity changes including era thema and dima of the hands and feet and circle emphatic apathy of one point five centimeters or more classically non tender with overlying skin changes. Incomplete disease is diagnosed when a patient has less than four of these findings but has other suggestive on labs or echocardiographic of note. Forty percent of children with kawasaki test positive for respiratory virus so positive. Viral testing should not exclude the diagnosis..

"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:24 min | 9 months ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"Colorado so drew. I've been thinking during my zuma classes. Socially distance of course can physical activity prevent the development of depression. Yeah heather sure can. Recent meta analysis looked at forty nine different studies included over two hundred sixty thousand individuals to see a physical activity decrease the risk of developing depression. None of the participants had depression at the start of their trials and physical activity was self reported and defined as any bodily movement that required energy expenditure so basically anything like zoom that exactly it was found that patients who had low levels of physical activity were more likely to develop depression than those who had engaged in high levels of physical activity. All the trials lasted at least one year were conducted in multiple different locations and different age groups but regardless of age or the study took place. Physical activity was found to be protective against developing depression. That is great. I got another one for you. A twenty eighteen perspective courts that he with over thirty three thousand adults who were followed for eleven years. That's a long time. I know and it showed a statistically significant increase in the incidence of depression for those who were not physically active compared to those who had just one or two hours of physical activity a week. That's only like to zoom that class. Yeah it sure is. I got another one for you here. It's a twenty eighteen study that looked at sixty one university students to see the effect of exercise intensity and the development of depression subjects were split up into groups of no exercise. Moderate training or six weeks of high intensity interval training both the moderate and high intensity training groups had a significant decrease in depressive symptoms when compared to the control group in fact students in the control group actually had a statistically significant increase in their depressive symptoms which was probably from their university studies. They were probably all pre-med. Yeah probably so in summary yes. Physical activity appears to be associated with a lower risk of developing depression and depressive symptoms with a strength recommendation. Be finally we have a poem. Poems are patient oriented evidence that matters and this is from dr shaughnessy so their question was do. S she l. t. two inhibitors or gop..

depression depressive symptoms heather drew Colorado dr shaughnessy gop
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:28 min | 9 months ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"The only contra indications known allergy to the vaccine and current pregnancy although vaccination is not routinely recommended in people twenty-seven or older since most have been exposed to hp you can use shared decision making to guide vaccinating folks age twenty seven to forty five. The vaccine used in the us is the gardasil nine which effectively protects against nine hp strains shown to be responsible for more than ninety percent of hp related carcinomas super exciting. So in summary vaccinate everybody and then we can forget about all the scary stuff some day. Yeah let's talk about a gram center policy one pager. An editorial in this issue points out that american family physician has been publishing policy. Briefs from the robert graham center for over two decades the graham center based in washington dc creates and curates evidence to inform policies that support primary care and family medicine so a primary care policy think tank. Yes the graham center and the journal one pagers are gold mine for reviewing things that matter most primary care on a policy level our one pager in this issue is entitled state level variation in primary care physician density from doctors merit jobber. Poor peterson and westfall. Sadly the number of primary care. Physicians has been declining for decades. Even though we have evidence that better health outcomes are achieved with higher proportion of primary care there are substantial geographic disparities as shown in this article using data from the american medical association master file and the us census borough these authors calculated the ratio of primary care physicians per one hundred thousand residents in each state. There is substantial variation between states from the lowest forty nine primary care physicians per one hundred thousand population in mississippi to one hundred and thirty one per one hundred thousand in washington. Dc our own home arizona's in the bottom ten with sixty per one hundred thousand. Oh no we need you along with more family. Medicine residents drew and heather. We're working on it. We need policy advances to recruit more medical students to primary care more expansion of residency training programs to engage a rural workforce and we need to retain current primary care..

graham center robert graham center hp Poor peterson allergy westfall washington dc us american medical association mississippi arizona heather drew
How Can Family Physicians Utilize AWS for Health Technology?

Project Voice - Healthcare Summit - 2021

01:52 min | 9 months ago

How Can Family Physicians Utilize AWS for Health Technology?

"What are the greatest opportunities for family physicians to utilize your technology? I think one of the. You know there's many dimensions when I think about it. You know, when we got started, what we see a lot of physicians making direct use of it is in better kind of activity and better connection with their patients. And actually utilizing AWS for a lot of immediate analysis on the populations that they work with. And so, you know, there's some really easy to get started with tools that can be used to do basic informatics work or light population health work where physicians can take a look and try to understand if they're emerging trends or other kinds of maybe disturbing trends emerging in the population that they serve. And then also foster a closer connection between them and that population. You know, getting them connected with a lot of the different digital front door services that we have to help guide patients through their care. Or the different kind of health dashboards and things that connect them to their records and notes and other things. And providing a space for physicians to interact with their patients directly, but without having to see them face to face and crowd them into their schedule. So I think there's a lot of opportunities for individual physicians to even just hop on and utilize these technologies and really jump start help accelerate their practice today.

"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

05:26 min | 9 months ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"Scan to determine the underlying ideology. Yes this is. A green the benefit outweighs the harm. However the generalize ability to family physicians and others performing point of care. Ultrasound is still unclear from this review. Who's ready for a poem me. Let's do it. yes let's talk about. Covert nineteen symptoms after discharge for hospitalize adults. This poem patient oriented evidence that matters is based on a recent perspective court study published in jama and his brought to us by dr henry berry of michigan state university in east lansing michigan. Go green odd to say that. Yeah kind of the take home message from this study. is that more than one. Half of adult survivors of cove in nineteen reported a significant amount of persistent symptoms. Four months after discharge. This was a level of evidence. One be while four months so who is included in the study. This looked at adult patients admitted to a hospital in france between march and may of twenty twenty who had a diagnosis of sars kobe to infection by either pcr or by clinical features associated with typical lung findings on c. t. those who are reporting continued symptoms in all those admitted to the icu. Were also invited for an in-person evaluation which included a cat scan neuro psychometric testing and for any who had been in the icu. A transfer ethic echocardiogram more than half of the patients reported ongoing symptoms at four months. But what symptoms were most common fatigue and around thirty percent and memory difficulties dystopia and persistent para sesia all closer to fifteen percent or the most reported symptoms. Psychometric testing also confirmed cognitive impairment and almost forty percent of patients abnormalities on c. T. an echocardiogram were also commonly noted among these patients as well especially those who had been in the icu well yet another reason to keep encouraging our patients to get vaccinated absolutely. Yes we're going to close out this episode with a message from to special guests american family physician student and resident editorial board members. Hi everyone this is. Go senator from pittsburgh and and risen to representative to a this is priscilla august from arkansas. And i'm a student representative. Afp we are here today to promote the before the contest and share or student and risen repetition in a p. We are super excited to join the podcast. Today let's start with the afc photo contest. This contest is a brand new project and is intended to encourage students and residents to share your stories. About how you use the afc journal all you need to do is take a photo and write a short description then. Email it to us at f. Edits at afp. Dot org and or tweet with the hash tag. Afc journal photo and tag at afdc journal. Precise i saw yours. You're falling asleep while reading a journal. But you're dreaming of reading a few. I suddenly did that before. I also like your photo can't tell because it highlights how great. Afp is as a teaching tool and you know what. I can't wait to see what everyone else comes up with. You can i. Let's talk about our position. E. s. p. definitely the application is now open for joining the afp journal editorial board as the resident and student representative. Prasada can you share what you have done for the past eight months. Sure it's been quite an amazing ride. I submitted a practice. Guideline and a diary of a family physician entry to the afp contributed to social media. Posts helped develop the photo contest and worked on the afc diversity equity and inclusion task force. It's been a great experience and a highly recommended to any student that is interested. Great thing is you don't have to be an expert and the members of the editorial board love to teach that sounds fascinating and he's very true us resident read peer reviewing a p. Papers is editor in chief. Dr sexton was so rich and precious. I highly recommend you to apply for this politician. If you're interesting writing or editing. When is the deadline. The deadline is september eighth. Please for a twitter or facebook account to find information about how apply this is canto this is priscilla. Please email us at afc. Podcast at afp dot org or tweet at afc. Podcast please rate and comment wherever you get your podcast. Our podcast team is jake anderson. David bliss blister steve brown. Sarah coles maggie.

dr henry berry icu afc east lansing jama michigan state university Afc journal afdc journal michigan afp priscilla afp journal france Prasada pittsburgh arkansas Dr sexton
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:33 min | 9 months ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"Next pertussis tests common questions and answers from doctors. Klein smith and zavala from west virginia. Despite universal immunization the incidents of protests in the united states has increased steadily from a thousand and ten reported cases in nineteen seventy six to a peak of forty eight thousand two hundred and seventy seven cases in two thousand twelve. Therefore pertussis remains a public health concern. Yeah that is a disappointing revelation maggie. Why does protesters remain common disease. Despite the high vaccination rates unfortunately certain protests strains have shifted away from displaying the a cellular vaccine antigens we use in our vaccines we're also seeing a waning of immunity. So i guess it's time to review good old pertussis dave jerry call the typical presentation of protests. Yeah the presentation of protest is classically divided into three stages. The first stage is catarrhal which presents similar to a typical viral respiratory infection lasting one. To two weeks the second ages paroxysm uil which presents as a paroxysm uil coughing with apnea whooping on inspiration. After coughing and post husted emphasis that phase last one to six weeks. The last stage is convalescent. Which is characterized by improving but persistent cough and last two to four weeks. Keep in mind though. Patients don't read the tax but not all patients with these three classic stages of presentation and their symptoms and signs or more dependent on their age and immunization status. All right so how can we diagnose a patient with pertussis. The diagnosis of pertussis is made by both clinical features and confirmatory lab results. Although the cdc and who have developed case definitions to assist with diagnosing protests no validated accepted. Clinical decision rule exists a systematic review found individual signs and symptoms were not particularly helpful in diagnosing protests but the clinicians overall impression may be helpful with the positive likelihood of three point. Three which still isn't really all that helpful. No you might need testing. Pcr remains the most accurate test to confirm protests with a positive likelihood ratio. Much better of thirteen and a negative likelihood ratio of zero point zero three..

Klein smith dave jerry zavala west virginia maggie pertussis united states apnea cough cdc
Lindsay Parks: An Osteopathic Family Physician's Perspective on Healthcare

Perspectives on Healthcare

02:57 min | 10 months ago

Lindsay Parks: An Osteopathic Family Physician's Perspective on Healthcare

"What does quality healthcare mean to you. Well that's a great question. and quality initiatives are being studied and enforce by many of the Third party payers They are actually rating their physicians and physicians have to now maintain A number of items of quality or they may not be able to stay with the organization so they base quality mostly on outcomes but along the way towards outcomes. There are many many things that have to be checked. Many boxes that have to be checked To make sure that each patient for each diagnosis is being given the very best medical care that nothing is being missed and that all bases are being covered so quality has taken on a really bigger new meaning over the last ten or fifteen years okay. I'm curious to get your your opinion on this. If quality is based on outcomes sometimes there are. It's not going to be a good outcome. If somebody is diagnosed with a terminal illness the the outcome is obviously going to be there passing on. How can we. What's your opinion on how to judge the quality of healthcare that the person is receiving that when you don't you know when sometimes the outcomes aren't good or that sometimes for example for someone like me who acquired a disability. That's not the desired outcome. You would like to be able to walk into do all those kind of things. How do you judge quality healthcare when it comes to not the most desirable outcomes. That's a great question going into the care of patient There are realistic expectations. That should be set between the physician and the patient and i viewed it that it was always a team. approach that I could never force anything on a patient if they did not want it Certainly in a terminal illness there still are quality of care issues. You wanna make sure that the patient is being cared for socially and emotionally and spiritually as well as physically and in a terminal care case You wanna make sure they get the best care heading into the terminology because every once in a while you have the great joy of seeing it turned around

Third Party
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

01:58 min | 10 months ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"There are a few considerations when it comes to how often to test and which test to use for newborns based on their history and risk newborns should be tested for hiv with nucleic acid amplification testing and pc are testing for hiv dna and arnie as opposed to antibody or combined antigen antibody tests. Be sure to check out table. One in the article for review of the specifics if hiv in the newborn cannot be presumptively excluded. Start backstrom at four to six weeks of age for pj p. prophylaxis and monitor the patients cbc while on art as well as closely monitor for signs of acute hiv infection fever rash and opportunistic infections. Important note thankfully none of this has to delay routine vaccination for the infant the also recommends asking families about pre massification of food and discouraging this practice due to this also leading to transmission. So key points here. Are we have room to improve our ways to prevent and manage. Hiv perinatal transmission efforts should focus on antenatal testing an anti retroviral therapy recommending formula feeding planning for c. actions for patients with high viral loads and frequency of testing and specific art depending on the newborns. And oh don't forget to ask the parents about pre medication please. Email us at. Afp podcast at afp. Dot org or tweet at af podcasts. Please rate and comment wherever you got your podcasts. Our podcast team is jake. Anderson david Steve brown sarah coles maggie gergen zuliana ibrahim heather merchant andrew. Ocho and jamie sherman are sound and technical guru is tyler coles. Our.

hiv infection fever rash backstrom Hiv perinatal cbc Anderson david Steve brown afp sarah coles maggie gergen zuliana ibrahim heather jake jamie sherman Ocho andrew tyler coles
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

03:41 min | 10 months ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"Let's tackle an f. Pin clinical inquiry pharmacologic management of agitation in patients with dementia and. This comes to us from a group out of the university of utah and out of tulsa oklahoma all right so which medications decrease agitation in patients with dementia. You want the short answer or the long answer short answer. Ss rise and revere down and the long answer right okay. So assessor is respected. Own are moderately effective at decreasing agitation in all types of dementia based on a meta analysis. Alanna pene spirit on both reduced dementia related agitation much longer than placebo. Based on one high quality randomized controlled trial and combination dextrathoraphan and quitting may be effective at reducing agitation in patients with dementia based on one high. Quality are t. So what are the other highlights from the studies reviewed for this f pen when looking at the end point of fifty percent reduction in baseline agitation at eight weeks. A twenty eighteen meta analysis found that respite on had a number needed to treat of six and sri's had an nt of twenty five compared to placebo. Also a twenty eleven cochran review looked at safety and found that. Sr is over seventeen days to twelve weeks where no less safe than placebo. The american psychiatric association supports the use of these meds. Non-emergency for agitation in dementia when symptoms are severe dangerous or cause significant distress to the patient and wins non pharmacologic treatments have been exhausted. Started a low dose and even if treatment is effective an attempt to taper should be made at four months. All right guys. We have a poem once weekly semigloss tied. And this one comes to us from dr lawson. That's right apollo him patient oriented evidence that matters. The clinical question is is once weekly. Subcutaneous semigloss tied or olympic and effective adjunct to intensive behavioral therapy for adults without diabetes melodies. Who are overweight or obese. Jake gimme a refresher on how this works. Oh i got you similar. Glue tide is a gop one agonised so it stimulates insulin. Secretion and suppresses glucose gone secretion and it slows gastric emptying. Yes okay now i remember. So what's the deal with the weight loss once weekly subcutaneous semigloss tied. We used with intensive behavioral therapy significantly improves the likelihood that adults without diabetes who are overweight or obese will lose at least five percent of their baseline bodyweight. They found a number needed to treat of two point. Four based on a placebo controlled are c. T. of over six hundred patients. Wow so what's the magic less magic more of a mystery for now. At least this are evaluated adults without type two diabetes with either a bmi of twenty seven or higher and one weight related comber validity or with a bmi of thirty or higher. The population was mostly white and mostly women with an average. Bmi of thirty eight participants in the treatment arm received once weekly subcu- cynically tied and everyone received a low calorie diet and exercise prescription in thirty individual intensive behavioral visits with the dietitian for almost a year and a half ninety three percent of participants completed this trial diet exercise accountability and some igloo tied.

dementia Alanna pene university of utah dr lawson tulsa Jake gimme oklahoma american psychiatric associati cochran diabetes sri olympic gop
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:52 min | 10 months ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"Changes ness skin color. Changes edina my differential is exploding right. You're a true family. Doc zooey we can use the budapest criteria to support our clinical diagnosis here. These criteria are ninety nine percent sensitive and sixty eight percent specific for crp s. Let's walk through them there. Four categories to consider and remember for this criteria sensory. Think pain phase a motor thing temperature and skin. Color sudomo owner. Which is anything that stimulates the sweat glands. So sweat changes 'asymmetry or a dima and lastly motoring trophic symptoms. Pay me a budapest picture i. They must exhibit continuing pain disproportionate to any inciting event. How dr ibrahim. I had a knee surgery one month ago and now my foot is killing me. Report at least one symptom in three of the four categories sensory phase of motor pseudo motor motor and traffic. It's a burning pain. It looks more red than the rest of my leg. And it's really sweaty lately Pain fits the sensory category redness. It's the basil motor category and sweaty. Fits the pseudo motor category During evaluation they must exhibit one. Sign in at least two of the categories and finally no other diagnoses better explain the signs and symptoms other diagnoses to consider include compartment syndrome cellulitis. Dvd nerve impingement peripheral diabetic neuropathy a rheumatological ideology or stress fracture. Guys back to my foot. What can you do to help. We wanna go for functional improvement and pain control as our main goals. So we'll start early and go multi modal. There's evidence that early aggressive treatment may prevent chronic disabling pain we can refer you to pt and ot try a short course of oral steroids with his phosphates lied. Kaine patches and recommend counseling for self management of pain and creating realistic expectations and goals all right. Pt ot steroids is phosphates counselling. I'm feeling better. This fascinates us for the first six months symptoms symptoms and a two to four week course of oral steroids have been shown to significantly approved pain in patients with. Cps finally there's limited evidence for complementary therapies cbd. oil is one that comes up and anecdotally. Some patients report improvement in pain but per the usual more research is needed next..

Family Doctors Want to Come off the Bench for Vaccinations

The Big Story

01:47 min | 11 months ago

Family Doctors Want to Come off the Bench for Vaccinations

"Youth rawlings doctor. Liz mega is the president of the -tario college of family physicians. Hello dr mauka. You're very welcome. This is something that a lot of people we've talked to about vaccines. Sit a conversation that we should have at some point. So i'm really glad we're having it. Yeah yeah me too. You know. I think that We're excited to as family doctors to be participating in the vaccination for covid nineteen. I think there's lots lots to dig into their so. I look forward to our conversation about this. So i may be in general pre covid or just leaving cova decide. How much of vaccinating in. Canada is done by family. Physicians typically so the great majority vaccination is done by family doctors in their offices. So we start vaccinating really When we see patients at who were infants rate from the very beginning through childhood and all the way through to those who are quite elderly So that's Reality right across the country that we're doing that there are some Vaccinations that are share. The responsibility with other parts of the health sector so so school-age vaccines happen often around grades. Seven and eight that something at that public health takes the lead on many provinces including in ontario. So those school based vaccines being exception and the flu shot is one where we share with pharmacy. So in the most recent year pre covid family docs gave about fifty five percent of all flu shots. Ontario in the rest were given Through pharmacy and some public health eunice but overall family ox really are the web's leading vaccination for patients from cradle to grave. So if we

Liz Mega Tario College Of Family Physic Dr Mauka Cova Canada FLU Ontario Eunice
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:36 min | 11 months ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"One of the july twenty twenty one issue. I'm jake jamie and zili in. We are residents and faculty mostly residents of the university of arizona. College of medicine phoenix. Family medicine residency. This time on the podcast. We'll talk about unintentional weight. Loss the top twenty research studies at twenty twenty. Copd exacerbations gene site diagnostic tests. Single dose analgesics. And we'll have a cochran for clinicians looking at antigen and molecular test for stars koby to the opinions expressed in the podcast our own and do not represent the opinions of the american academy of family physicians. The editor of american family physician or banner health. Do not use this podcast for medical advice instead. Sear doctor for medical care that's right listeners. It's season seven which means we're back with a whole new team of amazing residents and were excited to bring you more american family physician. Podcast first up. We have a main topic. Unintentional weight loss in older adults in this comes to us from dr day from grant medical center in california and dr holder from kaiser permanent day in vallejo california. What's the first thing that comes into your head when you think about an older adult with unintentional weight loss. Ooh the c word. Yeah cancers one of the first things i think about to but actually malignancies only responsible for up to a third of cases of unintentional weight loss which must mean that non malignant causes are much more common. Yes that would be a logical conclusion. So what are some non malignant causes weight loss that you guys can think of psychological things like depression anxiety or other mood disorders. Social reasons like not being able to go to the grocery store due to weakness disability or dementia. We're not being able to cook meals for yourself or financial like not being able to afford to go to the grocery store or afford reliable transportation. Even if you're physically able to go yeah. So reasons for weight. Loss also includes physical illness like gi disorders. Such as peptic ulcer disease medication side effects and poly pharmacy can change people's sense of taste and smell and caused decreased appetite dry mouth dysphasia and nausea lots of things to consider your thankfully. There's a nifty mnemonic to help us remember all the reasons why older people can lose weight..

"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:33 min | 11 months ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"This could lead us. To increase rates of multi-drug resistant organisms treatment failure prolonged hospitalizations and overall increased healthcare costs. Some it really sounds like determining when a penicillin allergy is true could be of great benefit. Exactly the preferred test is a former drug challenge which checks for i g e mediated hypersensitivity to penicillin which is type one hypersensitivity. Skin test is also validated tool and is commonly used in certain settings where formal drug challenges aren't possible or timely applying clinical prediction rules based off. A patient's history may be worth considering and so we present to you today. The pen fast rule which was recently studied and validated pen. Fast is short for penicillin allergy. Five or f- fewer years ago a nfl. Access andro dima s severe t treatment which is a clinical prediction rule derived from a prospective cohort of six hundred and twenty two allergy tested patients in australia. And then it was externally validated in other areas of australia. And the us it consists of scoring based on three risk factors and the scores range from zero to five. The first risk factor is if the allergy event occurred five years ago or less which gives the patient two points. They had another two points if the reaction was nfl. Axis and gio dima or a severe cutaneous reaction. Lastly they get one point if they required treatment for the episode. The study caught is a score of three or less since it was determined that these patients had nineteen percent. Risk of true positive penicillin. Allergy at this cutoff score. The sensitivity was seventy point seven percent and the specificity was seventy eight point five percent the extrapolated the likelihood of a true allergy for score of three or less with similar to a negative result on skin testing. It's pretty good and it may be a useful tool to help make decisions about immediate antibiotic treatment and a referral for allergy testing. It's important to note that the limitations included an underrepresentation of non white populations. Children were excluded from the study and mostly involved in patient testing also important to note that of those patients who scored a zero or redeemed. Very low risk still had zero.

australia nineteen percent two points five percent zero seven percent five seventy point today one point three gio dima five years ago seventy eight point first risk factor six hundred and twenty two all three risk factors fewer years ago nfl. Axis
How to Know if Your Pancreas Is Not Functioning Properly

Acupuncture is my Life

02:02 min | 11 months ago

How to Know if Your Pancreas Is Not Functioning Properly

"The pancreas is a very very powerful organ. although it's small it's very powerful and because it produces important digestive insa as well as secrete secretes hormones. That's extremely important for metabolising sugar. Something goes wrong. With this oregon. You have a massive problems on health healthwise now. Some deer are certain signs that you should pay attention to if you happen to experience any li scientists symptoms like i said. Contact your doctor shit with your family physician and then contact your local acupuncture acupunctures my life because you want to address the matter immediately and rule out. The potential pancreatitis or pancreatic cancer. You really porn rule those two disorders acupuncture now. The oncein can be pain in the app. Now domino pain can be a sign of pancreatitis which is inflammation of the pancreas whether it's been short term acute a long term chronic. You want to address this issue. The abdomen can also be sign of pancreatic cancer. Which of course is abnormal. Cell growth in the pancreas

Pancreatitis Oregon Pancreatic Cancer
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

03:32 min | 1 year ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"I don't think anyone would argue with the premise. That blood sugar control is an important component of decreasing post op infection. But this f- pin proves that. I'm not the only one that's pause when reading a note from an orthopedic surgeon with a very specific and often low onc- requirement prior to proceeding with joint replacement. Mri writes the clinical question is in patients with diabetes mellitus who are preparing for total joint replacement. What is the pre-operative a one. C goal to reduce post operative. Perry prosthetic joint infection or any guesses before we dive in lieu. I like it. Great minds think alike clam a bunch of listeners. Just through their a one. C machines at you guys for saying that. But i do love the conservative approach all right so the most direct answer came from two retrospective studies from twenty seventeen. The i included over seven thousand seven hundred patients and affirmed that the risk of infection increases as the peri operative increases. They used seven point five percent as a cutoff and found that of the eight hundred. Seventy seven patients with an a. One c. of seven point five percent or higher twenty one or two point four percent had a post operative perry prosthetic infection compared to sixty nine or one percent of the remaining six thousand eight hundred fifty nine patients with an one c. Less than seven point five for those listeners. That are abm nerds like us. That's an absolute risk reduction of one point. Four percent put another way an a one. C of less than seven point five had an inning t of about seventy two to prevent one infection in the second retrospective study just over sixteen hundred patients with diabetes. Were analyzed only twenty. Two cases of perry prosthetic joint infections occurred but they identified that seven point. Seven percent was a predictive threshold for patients with an agency of less than that seven point. The infection rate was zero. Point eight percent for those with an nc above seven point seven the rate was higher at five point four percent so an unc of less than seven point seven was associated with an absolute risk reduction of four point. Six percent were in an anti of twenty two. Interestingly they weren't able to identify any other complications that were associated with high a onc- levels in that study there has been a meta analysis published in two thousand eighteen. That looked more aggressive. A one c cutoff of seven based on the pool data from six studies there was not a statistically significant association between surgical site infection or prosthetic joint infection. Anyone see over seven. So the authors of this f penn conclude that although there isn't a definitive evidence based a one c goal. The evidence does suggest that had level of less than seven point. Five percent may reduce risk of perry prosthetic joint infections. We were pretty close. Yeah not bad lambert. Yeah you guys. Ready for cochran four clinicians. This one looks at pessaries for managing pelvic organ. Prolapse in comes to us from a team out of penn state university college of medicine in state college pennsylvania. All right you guys. Hold onto your pelvic organs. I guarantee you feel uplifted. After this segment Oh my podcast. They're actually all.

six thousand Seven percent Four percent Six percent eight hundred one percent Five percent five percent four percent Seventy seven patients zero eight hundred fifty nine patie sixty nine two thousand over sixteen hundred patients over seven thousand seven hund one point twenty seventeen two point eight percent
COVID-19 Vaccine: Questions Answered With Dr. Johnson Fatokun, MD

The Unfiltered Real Talk Podcast

02:27 min | 1 year ago

COVID-19 Vaccine: Questions Answered With Dr. Johnson Fatokun, MD

"In today's episode. What talking to bob hawke topic the nineteen vaccine and addressing some of the concerns and worries a face around getting the vaccine and a lot of be concerned about getting the vaccine. And i just a good idea talk about it with medical practitioner would need to the as a medical doctor. Dr johnson photographer who is experience family. Physician practices here not berta so welcomed up. Johnston gets a happy ear only program. Thank you so. We've reached up the johnson today in his office in actually in limit. So how are you doing for staff about. The johnson are crazy busy. Yeah times and very odd certain tumbles love just so. There's a lot of backup false when it comes to these vaccine when it comes to the arrows reside surrounded. He has to put measures in place to mitchell. Everybody is safe. Count your office yasu safety. Those who can't calm you have to do provide catholic though. Sometimes you see some collision myself book late. Making phone calls to crash lot. Mitchell vision gets cab when you do give the house up gracie chugging discounts. So what do you. So i wanna ask you like the like you said. These are very uncertain times challenging times. What are you doing for self care as doctor like. What are you doing to stay motivated. You know into so many things. Well i'm me. Tried to go for walks. I make sure each row physically. No pounding gavin every day. Well it's good food and then rest will any to work. I take any date. It never ends now. Vision context you because of the accents so detects you to call you so you have to find out so downturns and which works and they'll which entity i don't sit in the quiet through soochow everything away

Bob Hawke Dr Johnson Johnson Berta Johnston Mitchell Gavin
Rideshare: Revolutionizing Health Transportation With Josh Komenda, CEO of Veyo

Outcomes Rocket

02:25 min | 1 year ago

Rideshare: Revolutionizing Health Transportation With Josh Komenda, CEO of Veyo

"Today i have the privilege of hosting the fantastic josh commander. He's a co founder and ceo and president of ao. He's just doing an phenomenal job. At the company it's a full-service non emergency medical transportation brokerage designed specifically for healthcare vail uses technology to better manage and emt which is the the non emergency medical transportation and emt benefits for medicaid and medicare programs state governments and managed care organizations today. We're going to be covering this in doing some good learning with josh so suggests such a pleasure to have you here on the podcast with us today. Thank you so much. Beat your soul. Appreciate it absolutely josh. Before we get into baeau near company. Talk to us a little bit about why you're inspired to work. In healthcare. i started. I can walk with cla. Health really healthcare family. My my dad was a family. Physicians now retired out a registered nurse. And that was older brother going into medicine while but definitely was part of it was kind of part of my family's culture going up and you know really part of our core values in to the people that i respect the most roller my parents. My dad's asser never ending cluster desired. Really improve the human condition and show compassion. I personally was drawn to. The clinical aspects of health care is always been more of attack nerd and i love technology and inventing things. When i was a kid ended up going into computer engineering studying software design but always wanted to figure out how to prevent things to make the world a better place and as it happens by career really took me in this direction to really build a better any md at her a healthcare logistics system to really improve the healthcare system or work to improve a part of the healthcare system. Statically and so. I'm just thrilled that this company point my career in thinking about how we make the healthcare system work smarter proved human condition. improve lives. proud comes on. I think also systemically. I'm just excited Run this collision course of healthcare costs in our country. And i think more. I've learned about it and studied it and i think really the only way out of it has to make our system work more efficiently work smarter and i think this is one area in will be called population health or social determinants. That that really inspires me to make the system work better for

Josh Medicaid CLA Medicare
Black Doctors Use Social Media To Share Accurate Information About COVID-19 Vaccine

All Things Considered

04:05 min | 1 year ago

Black Doctors Use Social Media To Share Accurate Information About COVID-19 Vaccine

"The American public is hesitant to get a covert 19 vex. That number goes up to a third of Black Americans, according to the Kaiser Family Foundation poll last month. Hesitancy is rooted in real mistreatment and fanned by myths and misinformation, as NPR's Ping Wang reports some black doctors or finding creative ways to encourage vaccine acceptance. Well, very few vaccine safety problems have been reported. A lot of rumors are still floating online doctor Krista Marie Coleman has been tackling Cove admits on Tic Tac. She's the family physician in Orlando, and she describes one of the recent short video she made to counter misinformation. So yeah, so with the video I I'm using a trending song that people can relate to and as we can here with the song, it says, no, That's not true. So I say the covert vaccine will make you infertile, and I say that's not true. She posted the top second video in early December, and it's been viewed more than half a million times. And then I do a dance at the end, which people can relate to as well. A recent study published in the annals of Internal Medicine, like that public Health Message is geared at communities of color. Learn. It showed that black Americans are more receptive to information. If it comes from black doctors like Coleman. For some people, it means a lot when it comes from someone who looks like them. When it comes from someone who speaks like them. But only 5% of physicians in the U. S are black. Robert Drummond is another black doctor that's turned to social media to share accurate information. More broadly, he's an urgent care physician in Los Angeles, and in a recent Instagram live chat, he noted another big reason why people are wary of covert vaccines. With TV actor Dondre Whitfield's first Let me start by acknowledging the mistrust and acknowledging and understanding that there actually is a very real basis for that mistrust Well, said this deep distrust because that to the history of medical experimentation on slaves. It also goes back to the mid 19 hundreds when black men were deliberately not treated for syphilis. So researchers could see what would happen and it comes up to the present day. Just last week, a black doctor named Susan Moore died from covert 19 after alleging poor treatment at the hospital. When she asked for more pain medication, she said her white doctor made her feel like a drug addict. In the Instagram chat. Drummond pointed to a survey a couple years ago showing that a lot of doctors still wrongly believe that African Americans have a higher tolerance for pain. Everything from the top. We have thicker skin than two. We have a reduced we haven't heightened pain threshold so we don't need as much medication. This thing This is not from 19 hundreds. This is right in the 19 sixties. This is from the lake to thousands right now. As a black man, his part of the medical establishment, Drummond says his job is not to tell people to get vaccines. And said he wants to help people make their own informed decisions. But not everyone lives online. Alison Matthews, a sociologist at Wake Forest University, is researching how to increase trust in covert vaccines. In addition to the Internet, we've used conference wines as well, Azaz Mailed stuff out to people. You have to meet people where they are, in whatever level of communication is the most convenient for them. Matthew says that beyond black doctors, there are other community leaders that are trusted for advice. She works with black church leaders and sororities and civil rights groups. To generating trust in the health system is not a new challenge in the black community, says Dr Lisa Cooper, who directs the Johns Hopkins Center for Health Equity. Even before Cove, it 19 came up. A lot of the work that I did to try to address disparities in health care was focused on Having African Americans and people who are traditionally not given the sense of power and control in their healthcare play a more active role. For Cooper. The challenge is not just about overcoming vaccine hesitancy. It's for the medical community to learn how to build real trust. Ping

Ping Wang Krista Marie Coleman Robert Drummond Dondre Whitfield Kaiser Family Foundation Susan Moore NPR Drummond Orlando Coleman U. Alison Matthews Syphilis Los Angeles Wake Forest University Dr Lisa Cooper Johns Hopkins Center For Healt Matthew Cooper
Health Equity Advocate On Black Doctor's Video Of Treatment For COVID-19

All Things Considered

04:42 min | 1 year ago

Health Equity Advocate On Black Doctor's Video Of Treatment For COVID-19

"Dr Susan Moore has become a hashtag on social media. More of family physician died of covert 19 and an Indiana hospital last week. She was 52 days before she died. She posted a video on Facebook in which she said her doctors treated her as if she were a drug addict. She said they were planning to discharge her from the hospital too soon. People get killed. When you send them home, and they don't know how to affect for themselves. In that video, which has no circulated all over social media doctor more maintained that if she were white, her care for covert 19 would have been very different. Enjoy a career. Perry is president of the National Birth Equity Collaborative. She joins us now. Thanks for speaking with us. Thank you so much for having me. What went through your mind when you first watch that video of Dr Moore speaking from her hospital bed, You know, it was so deeply saddening and very familiar asses. The world watch the murder of George Floyd and it stopped the world in its tracks because, although we'd heard about police violence before, and we knew it existed, and we've seen data and reports That's the same way that I felt watching. Dr Susan Moore described what was happening to her instead of the hospital. It was a glimpse into side of what we all know to be true what we've experienced as members of the black community. Inside of health care is health care providers. There's an O B g Y n And also just knowing that it was not going to end well, knowing that she was begging and pleading and wanting to be seen and valued is fully human, and that wasn't happening. You I know have worked with hospitals on anti racism training. Is there data Do we know how common what Dr Moore described as her experience was? Well, we do know from the data. We work in the black maternal health space, and there's been some studies. That show that medical students believe that black patients don't feel pain the same way that they believe that black patients have thicker skin. There were also a study that was done out of university, North Carolina that showed that if there was a black preacher and white patient asking for a pain treatment toe You have to after having that major abdominal surgery that the black patient got it in a less timely manner and less frequently and with the less amount so every time that we have worked with hospitals, and I've said Okay, well, maybe it's not you. Maybe that's just that hospital that group run your own data Look to see by race. If you're managing your patient's pain equally, if when they come in, they get the same treatment and I've yet to have a hospital come back as a C I told you we're doing it all the same. And so I'm looking forward to that day. You're making a point that Dr Moore herself made in that video. She said she believed she was denied more pain medication or as much as she needed because of her race. I want to mention that the hospital where she was treated Indiana University health Has put out a statement. They say they can't come in on her specific case because of privacy laws. But they say the hospital is committed to equity to reducing racial disparities. They say they're going to do a full investigation. What will you be watching for in that investigation? I'm excited to hear that they want to investigate. It was a little traumatizing for communities. I know that these privacy laws are important. But if you've been a community like the black community, or LGBTQ community or indigenous folks who've been had mistrust from the health care system, because we've been abused by it and lie to and not treated well, when we hear things like we can't comment that doesn't engender trust going forward. Some people listening might be wondering Hang on over prescription of pain. Meds of opioids has been a huge problem. Doctors and hospitals have struggled with how to balance Against overprescribing with obviously the very real need for care and pain relief. Do you think that was at all in play here? Yes, I'm sure that the providers in that hospital or were hypersensitive and very aware of the pain issues and the pain still issues, But unfortunately, when you are from a community that has been that Centered and has been marginalized. There's something is well, you must be pill seeking, like these other people, and we must then count, so the assumption is really real, that I've experienced it by himself, where family members are assumed to be drug seeking pills seeking and never, just looking at the person is individual saying what I want my 52 year old friend as Dr Susan, where could be any of our friend? Be lying here in pain. Don't I want to address her pain? Don't I wanted to be pain free, but I value her, and that's what we're asking for. Dr Joya career, Perry. She heads the National Birth Equity Collaborative. She was speaking about the experience of Dr Susan Moore, who died of covert 19 on December 20th. Dr. Crew, Perry. Thank you. Thank you so much air in patient.

Dr Moore Dr Susan Moore National Birth Equity Collabor George Floyd Perry Indiana Facebook North Carolina Indiana University Dr Susan Dr Joya Dr. Crew
Equipping Frontline Providers in The Fight Against Skin Cancer with Cody Simmons

Outcomes Rocket

05:35 min | 1 year ago

Equipping Frontline Providers in The Fight Against Skin Cancer with Cody Simmons

"Welcome back to the outcomes. Rocket saw marquez. Here and two day. I have the privilege of hosting cody. Simmons is a bio engineer and entrepreneur that has spent his whole career dedicated to bringing new health technologies to physicians and patients prior to his tenure with dermot sensor cody lead commercial efforts for a silicon valley medical device screening startup and also held business development and commercial strategy roles at genetic cody join dermot sensor in may two thousand sixteen as co founder and ceo. He has led the company through raising fifteen million in financing extensive product-development efforts multiple clinical studies and most recently successful regulatory clearances that now allow for the product to be sold commercially. He is an excellent leader in health. Care taken really. You know the advantage of of the advances in digital health to help primary caregivers as well as patience maximize their health cody. I'm really excited to have you on the podcast to learn more about what you guys are up to and more about you. Thanks for joining. I appreciate that and the excitement is shared Thanks for having me today. And like i said very excited to be speaking with you and to have our work featured on your podcast. Absolutely code eight. Now dermot sensor is is. I mean just fascinating evaluating skin cancer in a much simpler way. one on learn more about this as the listeners. Do too but before we dive into that. I love the know more about what inspires your work and healthcare. Sure will i think first and foremost helping patients Is really my inspiration for working in healthcare hands down. I think that everyone faces at least some challenges and frustrations With their job and their day to day work. And i think our company and me personally you know no exception to that would be called work but dinner the day knowing that if you're able to overcome those challenges in your start up and your product is successful knowing that success will benefit hundreds or thousands of patients that is incredibly motivating for me. And i'd say in line with that. I think for entrepreneurs you know. The common expression is that we're supposed to dress unmet needs and as as you've seen obviously from from from all your your work in the podcast. Unfortunately there's no shortage of unmet needs in healthcare and many of them are very large. Ones that fixing not only greatly benefit people's health but depending on the solution also oftentimes i think has a potential to sit health system money and of course patients ultimately pay for parole healthcare whether it's directly or through their employer for private insurance or through taxes that go to medicare and medicaid For sure yeah. And you know we were experiencing so much change and you know. The epidemic has accelerated that change in digital medicine and telemedicine remote care what you guys are doing fascinating and skin. Cancer is a huge problem. It goes unaddressed like undiscovered. It's way too late and so tell us a little about what you guys are doing to add value to the healthcare ecosystem. Sure sure and yet it really is a big problem and you know a clear. Our product is not yet approved by the fda for use in the us but as you mentioned in it is available and certain areas abroad. Who just announced that. Dermot sensor received seamark for sale in europe as well as regulatory clearances australia in a new zealand. So for the u. s. Yeah so that that's been exciting milestone for us and in the us we hope to be approved next year and then after that to start. Adding value to healthcare system in a couple of men was to just address your question so our our company's mission is to improve patients access to effective stink cancer checks as you noted. Writing cancer is very common. It's actually the most common cancer in the united states in melanoma the number one cancer killer of young women fortunately effective effectively skin cancer can be successfully treated if it's detected early enough unfortunately the average wait time in the us dermatologist's appointment once a two months and because of that and other cost access issues. The majority of americans report having never been checked her skin cancer in illness. Small fraction of americans do so annually. Which is direct recognition for many of us So our our main objective to fulfill our mission of improving patients accessed effected skin cancer. Sharks is really empower. America's hundreds of thousands of frontline providers primary care providers like family physicians internists clinicians at retail clinics to more effectively. Catch skin cancer Study showed that primary care providers they're not dermatologists and that that they only correctly decides to refer biopsy a malignant lesion as little as fifty four percent of the time but melanoma fighters survival rates. Go from well under fifty percent for stage. Four melanoma to high nineties for stage. one mellon all not so virtual helps detect nominal. Earlier helps these primary care providers which by definition frontline providers right so the patients often in early. That would be huge. So so detecting melanoma earlier. It's this to help a bad dad. Be a huge benefit for patients. Survival and also treatment costs relate stage. No no law can be over a million dollars whereas stage one mellon on the treatment typically just cost a two thousand dollars

Skin Cancer Marquez Cancer Simmons Cody Dermot Sensor America Melanoma Medicare FDA New Zealand Europe Australia Sharks
How To Deal With Depression

The Emma Guns Show

05:24 min | 1 year ago

How To Deal With Depression

"Hello, Hi and welcome to another bullet points episode where I posed the question. Feeling. Sad and I don't mean sad as in all you feeling a bit blue I'm talking about sad that seasonal affective disorder. In the throes of seasonal change and given how odd the year has been overall for all of us wherever it is that you're listening to this episode wherever you are in the world I thought it would be worth liking this up because it's just a useful thing to watch out for and perhaps more importantly just check in with yourself to see how you doing and if. You're feeling what I like to call funky right now because a few tweaks could actually help you navigate away from that down blue low feeling. Now, before we go any further, it's obviously very important that I say very clearly that I am not a medical professional and any concerns about your health, your mood, your mental health are best discussed with your doctor GP MD or family physician. and. I'm sure we can relate to feeling different and by different I. Mean we may notice a drop in energy feeling a bit lackluster, less enthusiastic all of those things during the cold months and especially. So when eve morning might start looking at summary and then quickly and you get to mid morning and it's definitely winter CEO kind of in this hopeful period of its today going to be Nice Oh actually, no today is going to be really wet and cold. So during the colder months when the days are shorter and the evenings all longer, it can just be a little bit harder to get motivated to feel. To feel that get up and go that just seems to come naturally in the summer, and if you feel a drastic change in your in your mood, your disposition or enthusiasm in the autumn, then you may very well be suffering from a form of seasonal affective disorder and obviously there will be a spectrum it'll be mild, and then they'll be more severe instances. So in the UK, it's on the website and it just being the National Health Service as the seasonal affective disorder is a type of depression that comes and goes in a seasonal patterns. So it makes sense right? So in the wind down in the summer summer you up. And the varying degrees of that down and that will be unique team. It goes on side is sometimes known as winter depression because the symptoms are more parent and tend to be more severe during the winter. The symptoms often begin in the autumn is the day start to get shorter and they're typically most severe during. December. January and February and that's not only when it's dark but also usually when the temperatures really do drop Now I personally can relate to this and I feel as though. When it comes to winter I, have to really fight the urge to hibernate especially in this this time October. November. December I really have to fight that urge and but then I mean I have this instinct to get on the blankets or stay in bed longer will. It sounds really dove preserved my energy like a hibernating bear I have honestly at times had to catch myself and say you're not a bear. You don't need to preserve unity and you don't need to eat all of that. So just don't do it and every time I get that urge to have a D.. Day. I have to remind myself how great it is to go for a long walk on the Crisp win today or even I mean even this weekend I went up for a really long walk and it was budgeting with rain but I had to test out my new rain jacket. So I made into I, made it into something exciting and I tried on the walk to notice how fresh everything smells like when it rains and you go for a long walk in the woods, it just smells incredible and I have to remind myself at that. There is nothing wrong with the DVD I hasten to add we. All benefit them from them. They can be absolutely wonderful but it's just making sure for me personally and I don't know about you that I'm not having too many in a row. So seasonal affective disorder is brought on because the brain is exposed to less natural light and vitamin D during the autumn and winter, and this intern disrupts our production of Melatonin Serotonin and Melatonin is the sleepy hormone and Serotonin is the mood hormone. So if those two are taking a bit of a battering or if they're affected anyway and they get out of balance, you're definitely going to feel in how you sleep and your mood. And you're suffering with sad. Then you may feel quite extreme changes in moods across the season's usually a in autumn winter that'll be characterized by depression. With periods of not feeling depressed throughout. Spring. Summer. The lack of light and exposure to vitamin D and the shorter days mean that the actually pretty prevalent in the northern hemisphere and the instances tend to increase further north you go which makes sense when you think about it let's daylight the signs look out for are things like hypothermia. So that's that feeling of extreme lethargy sleepiness just that feeling that you just want to. Curl up which sometimes valid because you're busy and you really do need to rest but other times if it if it's tipping over the edge and it's just getting all the time, remember what I said about me wanting to be a bad. The other thing to look out for is the urge to an you are overeating or you're craving carbohydrates about some part of it. Also part of it is a notable lack of motivation and energy. You might be irritable and your mood might be noticeably depressed or down. You might also just not enjoy the things that you normally like. He might be withdrawing socially and he might be struggling to do the things that you normally do or even think clearly,

Melatonin UK CEO National Health Service Family Physician. Intern
Canadas Single Payer Prevails Against Privatization Attempt

Medicare for All

05:04 min | 1 year ago

Canadas Single Payer Prevails Against Privatization Attempt

"I, Benjamin. Day. And I'm Stephanie Nakajima. And this is Medicare for all. The podcast for everybody needs healthcare. Today. We have Dr Monica debt who is on the board of Canadian. Doctors for Medicare and Public Health and family physician. Nova Scotia, we're thrilled to have her on today to talk about historic legal challenge to the Medicare program that was just heard by the Supreme Court of British Columbia and spoiler the victory delivered by the court to the country single payer system. I cannot wait to hear about this welcome Dr Dot and I'm just curious before we get into the topic. I mean. You're a family physician, but how did you get involved with? Felt the need to get involved with? Health reform. Protecting the Canadian universal healthcare system, but also trying to expand it and improve upon it. Here Hi. Thanks for having me on your podcast I'm really excited to be here. I've been a family physician about ten years. Now, I've worked in a range of settings from big cities to to mainly though northern. Towns across Canada and I've always been in settings where I've very much appreciated. The fact that my patients have access to healthcare wherever we are whether it's a small town or a big city. You know there's there's variations of cross across the country, but fundamentally, all of my patients do not need to worry about. Physician and hospital care. They do not need to pay when they come see knee or when they get to the hospital they know they can count on that care and that's always been really important to me. I also work in public health in very much care about health policies that. Benefit the health of a community of population and absolutely access to to healthcare is a fundamental determinant of Health I. Think it's something that I wanted to support in a in a everywhere I can in one of those ways has been through involvement with Canadian Doctors for Medicare for about the last ten years. and GM or Canadian for Medicare A as a nonprofit organization we've existed just over ten years and our. Fundamental goal is to maintain an improve our single payer publicly funded healthcare system in. Canada. So we want to maintain that single payer but at the same time know that there's there's always things we can do to make it better, but we can do that with a single payer system. So that it might be a bit confusing for our listeners. To hear that the Canadian single payer healthcare system is also called Medicare since we have a program called Medicare that only. Available for seniors sixty, five and older Whereas Canadian Medicare is of course. Accessible to everybody from to cradle-to-grave. So can you just talk a little bit about how Canadian Medicare works are there are there physician networks? Can you ever lose your coverage? Are you allowed to just out of the system or pay to jump the queue? So we do color our health care system Medicare in Canada at the same time when it actually is it's a series of we have provinces and territories, and so there are thirteen provincial and territorial health insurance programs across the country. So every province and territory is responsible for delivering care. Under the umbrella of what's called the Canada Health Act, which outlines the core principles of of Medicare and Canada and one imposes is universality but really it's a a series of health insurance plans that everyone is covered for primarily for physician and hospital services. So for example, where I work I see patients I build my provincial health insurance program I get paid in that way I cannot bill a private insurance program for for my services. Because it is publicly funded. I'm not allowed to then go in and bill a private insurance program. So for the pieces that are covered publicly through universal system, you cannot buy insurance to go see a physician or go to a hospital privately you need to access it through the public system just as as everyone else does we do have some of our care about thirty percent that is privately paid for either through supplemental insurance or through. Private payment, and that covers pieces like dental care some medications, physiotherapy other allied health professionals, and to be honest it's a gap in that we don't cover some of those pieces, but the vast majority of of care is covered under our public system.

Medicare Medicare And Public Health Canada Family Physician Dr Dot Stephanie Nakajima Canadian Doctors Benjamin Supreme Court Of British Colum Dr Monica Nova Scotia GM
The coronavirus has sparked a boom in digital health

Clark Howard Show

04:35 min | 1 year ago

The coronavirus has sparked a boom in digital health

"I wanNA talk about something that in the midst. Of the misery and the death count's with corona virus in every bad situation. There's always good that emerges at the same time. In an example of that is how the? Health Insurance, industry, and the medical industries have both been. Extremely, hostile through the years to using modern technology such as electric visits telehealth, whatever you WANNA, call it virtual visits. And Corona virus changed all that a raw economics that were affecting the medical industry forced in industry that is always reluctant to change I mean think about. I got a question for you where else in your life name anywhere else in your life ever. That you walk in and you fill out pieces of paper. Seriously like it's nineteen, sixty five. We've got all these electronics today and you fill out paper. At hospitals and doctors offices, you must be kidding me that's how antiquated and backwards medicine is practiced. Okay. Enough about them. But Anyway Corona. Virus. Devastated the revenue models. Of the medical. Industry. People's visits to doctors collapsed. Huge number of people. To great detriment of their own health and potentially life we're not going for things even like their heart care. Or cancer care or chronic illnesses like diabetes not going for their visits they were worried they're going to walk into a doctor's office and they were gonNA come out. With Corona virus and not survive. So medicine finally was like, Hey, maybe that electronic stuff that would work maybe we could try that. Give you an example Humana. According to the Kinsey Business Journal. Nationally has already had a million telehealth visits. Averaging, thirty three thousand visits a day. Just Corona virus. Bay were having virtually zero. Gone from virtually the road a thirty three thousand day. Because doctors wanted their money. But the crazy thing is. It actually dramatically improves. Patients health apparently. because. Big percent of people. Just don't get around going to the doctor even if they have one. And with Corona virus, people just weren't going at all. So, in terms of WHO has a doctor? Anyway a primary care doctor. Only somewhere around sixty percent or so a people even have one. and. Then of those that do. If they try to schedule an appointment, usually, it's really really hard to get one. We'll telemedicine the appointments tend to be shorter they tend to be more focused. And they can eliminate problems that would happen otherwise. But what's even more important? Is. It does improve health outcomes apparently according to the American Academy of Family Physicians Research Save. Done. But. The bigger thing is by having those virtual visits. It creates a relationship. Between doctor patient that right now, even if somebody has a doctor of record, they don't have. something. Goes undetected. So they can get really sick. Who wouldn't have gotten sick somebody could die who wouldn't have died Or. Could have a chronic condition get much worse. So. This is. One of those times where? Something that disrupted all. Pretty much all our lives. is going to have a long-term positive benefit. And it was all about the money.

Corona American Academy Of Family Phy Kinsey Business Journal Humana BAY
Navigating Innovation for Family Medicine with Paul Dow

Outcomes Rocket

05:25 min | 2 years ago

Navigating Innovation for Family Medicine with Paul Dow

"Welcome back to the outcomes. Rocket saw Marquez is here and today have the privilege of hosting Paul Dow? He is the current e-health innovation strategist for the American Academy of Family. Physicians based in Lee would, Kansas with the advent of covid nineteen. The goal is focusing on practice tools that will be robust in the rapid transition that telehealth and virtual patient engagement during the emergency, and beyond policy and innovative thinker and a strategist than the space and I'm excited to be diving into what they're up to at the. American Academy of Family Physicians and for him to share his message around practice viability, and then and his him, and his organizations search for long-term solutions to help with cove in nineteen, and beyond a Paul, such a privilege to have you here if you can give us a little more insight into you and your bio, and and then we could dive into into the the interview. Sure. It's great to be here, Saul, thank you for having me. I. Am a helping petition and have worked for the Academy for about a year prior to that I was at the. Leading Cardiac Society Washington DC for about six years, and then prior to that. Were for medical device vendor for about ten in their clinical education space. Clinical Background is in radiology. Sea Tac X. Ray tech from back in the day but moved were into health it that really kind of seemed like the future and turns out he was so I'll have a variety of other predictions by the end of the podcast, and maybe a few lottery numbers. I love it. I got my plenty handy. Yeah insightful Paul. I definitely was the future, and it is the president now. Health it. The use of technologies like a I digital health. They're here with us and have been accelerated What what is it? That inspires your work in healthcare? I mean you've been in it for for a long time. What keeps you working within the bounds of healthcare? All to me that it's endlessly I guess endless curiosity. He's be interested There's there's so much to learn and file and. It. It feels like there's always a new development into new insights that come out of research or technology. Advancements and trying to apply those into a clinical space you know. How can we make this this thing? This taking care of people more efficient and more effective, not not in the sense of trying to make positions more efficient hamsters. But more, how do you? Leave them off. The monotonous tasks that their their skills are not suited for. Physicians you know floor five stenographers by one then to use their clinical expertise and their deep insight into the diagnostic process as well as also their deep empathy. They got into healthcare because they care about people and if we can have tools. Free up their time then they can focus on hearing for people and You know that that to me is really a huge motivator. A finding solutions that actually work aren't just cool. I'm doing air quotes now But, actually actually are productive and help them on a day to day basis. Love it yeah, it's it's a great great calling, and as as we dive further into into your organ, the organization Europe part of It'd be. It'd be great to to know how you guys see yourselves position to add value to family physicians but also to educate us on on what your community looks like in the breakdown of of physicians that you guys are are helping. Share, so we have about seventy five thousand members of ASAP. if you include residents and medical students that swells to about one hundred, but as far as practicing clinicians in the field, it's about seventy five thousand We have fifty thousand who are employed at a variety of locations, every qualified health centers Medical Centers and the other twenty five thousand are independent practices so basically these are small businesses that are run by clinicians. And we're trying to find solutions to help. Help all of them. You know certainly There is no one perfect technology that's going to fix everyone's issues, but if we are you know patch, some of these technologies together and then provide some insights on workflow your best practices. We share within within the House of Family Medicine. you know then we can start to build some trends and build some some improvements that can be sure to one day.

Paul Dow American Academy Of Family Phy American Academy Of Family Saul Marquez Medical Centers Washington Dc LEE Kansas House Of Family Medicine. President Trump
Trump administration begins process of withdrawing from World Health Organization

Democracy Now! Audio

00:36 sec | 2 years ago

Trump administration begins process of withdrawing from World Health Organization

"The trump administration's begun the process officially withdrawing from the World Health Organization and a move condemned by public health officials across the world, the move cave on the same day, the WHO warned the global peak of the pandemic has still not been reached the American Medical Association American Academy of Pediatrics American. Academy of Family Physicians American College of Physicians Condemn, President Trump's decision. Saying quote puts the health of our country at grave risk. Former vice president. Joe, Biden has vowed to reverse trump's decision on his first day in office if he wins the November election.

American Medical Association A Academy Of Family Physicians A Donald Trump World Health Organization Vice President President Trump Biden JOE
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:25 min | 2 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"For step, we have a poem. Remember poem stands for patient or evidence that matters boom all right, and this poem is titled. Supplemental emery screening women with very dense breasts reduces interval cancer rate, but may cause over diagnosis, and this comes to us from Dr Market Belt, so this poem looked at the dense study from the Netherlands which randomized women identifying having very dense breast tissue. Normal routine digital mammography to receive either a supplemental MRI or routine care. The primary outcome was the likelihood of interval cancer meaning cancers detected in the twenty four months, following a negative index, digital or MRI Mammogram, and before the next scheduled mammogram dependent on the buyer rats, scoring of women were underwent supplemental emery screening one point six five percent had breast cancer detected. Now there's two ways to look at the state of further the per protocol analysis brought the rate of interval cancers, two zero point eight per one thousand women in those who volunteered for supplemental MRI and five per one thousand women in those who did not however only fifty nine percent of the women randomized to supplemental I actually agreed to the screening. Screening so looking at the intention to treat analysis, the rate of interval cancers was actually two point five per one thousand women in the MRI group versus five per one thousand women in the Usual Care Group. This distinction is important as women who ignored the invitation to screen in other migratory trials had worse health outcomes than those who chose to volunteer so intention to treat is the appropriate comparison here, and when thinking of the harms nine and a half percent of women, undergoing supplemental Mery screening were recalled and six point, three percent of all women had a biopsy. The false positive rate was eight percent among women undergoing supplemental emery screening. Also, the characteristics of the interval cancers didn't differ significantly between groups. Although more early stage cancers were detected in the MRI group, which is not surprising so Herbert. Are you going to be recommending supplemental emery screenings for women with dense breast tissue? Might. Not Likely for now at least likely author state, my biggest concern is over diagnosed cancers..

Usual Care Group Dr Market Belt Herbert the Netherlands
How the Pandemic Has Changed the Way We Sleep

Coronavirus Daily Briefing

03:43 min | 2 years ago

How the Pandemic Has Changed the Way We Sleep

"According to preliminary results of a study of sixteen hundred people from sixty countries, forty six percents of people reported poor sleep during the pandemic. That's up from just twenty five percent before the pandemic insomnia and vivid weird dreams, both caused by the increased stress of the time we're living through has been evident anecdotally and as indicated by a fourteen percent uptick in sleep. Medication Prescriptions Melatonin sales in over the counter supplement for the natural hormone that induces sleepiness are up forty four percents. Philip Musket a professor of Psychiatry at Columbia University Medical Center said he's avoiding prescribing medications to patients preferring to offer sleep hygiene tips. He's seen that actually staying asleep is the biggest problem for most people and says some of the primary factors causing that is that people are lacking in structure and exercise. Stain active can help you sleep more soundly and boost your immune system Dr Musk's also advises sticking to a regular sleep schedule and avoiding naps during the day. The good news according to Kathy Goldstein physician at the University of Michigan and an associate professor of neurology at the Schools Sleep Disorders Center is that what most people are experiencing is acute insomnia or quitting the Wall Street Journal having difficulty for or staying asleep a few times a week for three months or less and quotes, the third of people will experience acute insomnia at some point in their lives usually caused by some stressor. stressor in their life like say a pandemic the key doctor. Goldstein says though is not letting the issue. Become a chronic one quote. It's important to avoid associating your bed or bedroom with a place where you were awake. Experts recommend that if you can't fall asleep or wake up in the middle of the night and are unable to go back to sleep after twenty minutes get out of bed and do something, relaxing and quotes. Natasha Bouillon a Phoenix based family physician at one medical, says most people's sleep problems right now either stem from a lack of normal schedule or general anxiety about the pandemic. Some tips she recommends mindfulness through meditation, exercise or cognitive behavioral therapy. To maintain a consistent sleep schedule, turn devices off an hour before going to sleep and make your sleeping space a device free zone, consider even ditching your smartphones alarm and getting an actual alarm clock, as for anyone, experiencing vivid dreams or nightmares Melinda Jackson, a senior lecturer at the Turner Institute for Brain and Mental Health at Monash University in Melbourne, says quote. During Times of stress, there's a release of narrow chemicals that can trigger these vivid dreams and nightmares in some people end quotes. And, Dearly Barrett a dream researcher at Harvard Medical School notes that waking up frequently throughout the night can also cause people to remember their dreams better. Contribute to the sense that your dreams are more vivid than usual. guardless of how? Your sleep has been disrupted. Or why here are a few more sleep? Hygiene tips to leave with quoting the Wall Street Journal eat at regular times than snacking day. Avoid, napping or compensating for poor night of sleep by going to bed, unusually early limit caffeine and avoid alcohol avoid electronic devices one to two hours before going to sleep, but if you do use a blue light filter and try to look at content that is not stressful. Get Bright Light in the morning. Try to find a workspace that isn't in your bedroom and stop working at a specific our and make time for relaxing activities end quote.

Schools Sleep Disorders Center Philip Musket Wall Street Journal Natasha Bouillon Kathy Goldstein Melatonin Columbia University Medical Ce Associate Professor Of Neurolo Professor Of Psychiatry Harvard Medical School Dr Musk University Of Michigan Dearly Barrett Caffeine Phoenix Melinda Jackson Family Physician
Calling Trump: When connections help steer virus supplies

On The Media

06:54 min | 2 years ago

Calling Trump: When connections help steer virus supplies

"President trump who's told states to fend for themselves has had female blocking orders for vital equipment secured by governors some of them anyway so the government can buy them instead this week FEMA see is that in order for five hundred ventilators from a private company obtained by democratic Colorado governor Jared Paul is only to have trump give back a hundred of them at what he called the request of the state's endangered Republican senator Cory Gardner Thursday's Denver post editorial declared trump is playing a disgusting political game with our lives but the trump administration says it's got a plan and that it's working White House adviser Peter Navarro April second these guys up here doing a heck of a job organizing the supply chain well I think that's news to a lot of medical providers no I'm levy is a national health care reporter for the LA times trying to follow the cultic nineteen supply chain I can't say I've talked to many hospitals or doctors offices or clinics around the country who feel that the supply chain is being managed in anything close to a rational way that's for sure and we can't seem to get answers from FEMA or the White House about what system if any is being used to balance the needs a couple weeks ago I was speaking with the head of the Texas academy of family physicians who working with the golfing buddy of his managed to in about a half million masks over the border from Mexico and then spent about seventy two hours getting them to rural hospitals and doctors offices around Texas because the state of Texas didn't have anything to distribute so you've got the system in which everybody's running around trying to get masks and ventilators and everything else and then on top of that is a totally opaque system of what appears to be haphazard intervention by the federal government on some supplies but not all of them everyone is completely perplexed we hear that trump is having no problem directing to Florida whatever Florida seems to need so zero which is the agency that is allegedly responsible for distributing supplies from the strategic national stockpile has claimed that they have some formula for distributing medical supplies that reflects states in large metro areas relative populations and the relative severity of corona virus outbreaks they are actually shipping things across the country however it's impossible to find out what that formula is whether or not allowances are being made in one way or another four criteria that have not been identified president trump hasn't been shy about claiming that he's willing to reward its friends and punish his enemies the conspiracy minded person might think well is there some nefarious methods to how these supplies are getting distributed or not we just don't know what difference does it really make if we know or we don't know what the formula is for distributing this stuff this is taxpayer money that we're talking about private actors in the market of course don't have an obligation to be transparent about what they're doing because there's no expectation under normal circumstances that they're acting in the public interest we hope that the government is acting in the public interest but without transparency who knows who's accountable for this who's in charge is it rear admiral John Paul love check who's at the head of FEMA's coronavirus supply chain task force is it FEMA director Peter Gaynor is it Peter Navarro who is reportedly coordinating private and public sector communication maybe it's the Jared Kushner or the invisible hand isn't really fundamentally the president and no one else you know without clear lines of authority things are not getting done as far as we know in a particularly efficient way nor do we know that however they're being done is being done in a lawful way frankly if for example the president's son in law is dialing up private companies and asking them to give support in one way or another to the supply chain challenges what assurances are being made to those companies about what they can expect I'm talking about promises that are made the company acts that if they help out that they'll be made whole in the end with they'll be reimbursed at a certain level without a process all of that is open to question is there a way to have an informed data driven approach to this as Jared Kushner said the federal government was engaged in if in fact the federal government isn't engaged in an informed data driven approach can big business small business health officials state officials do this on their own so the facts on the ground suggests that this can't happen on its own no that's not to say that there aren't a lot of efforts by individual actors some of them quite influential to play a constructive role I mean we've seen a number of large companies including apple for example say we are going to use our connections to the supply chain to procurer masks and we're going to distribute them the owner of the New England Patriots flew the patriots plane to China to go pick up a shipment of masks and flew back to Boston the problem is when you have this sort of thousand points of light approach to procuring and distributing needed supplies what ends up happening is that well connected medical centers that have relationships with large companies either because they do business with them or because they're located in their backyards are often times at the top of the list so for example sales force made a donation to the university California San Francisco Medical Center because they have a long standing relationship both being based in San Francisco does UCSF knew that equipment more than a hospital in New York City or New Jersey that's a lot to ask of sales force to try to make that determination they don't have any expertise in

Fema President Trump
Calling Trump: When connections help steer virus supplies

On the Media

06:54 min | 2 years ago

Calling Trump: When connections help steer virus supplies

"President trump who's told states to fend for themselves has had female blocking orders for vital equipment secured by governors some of them anyway so the government can buy them instead this week FEMA see is that in order for five hundred ventilators from a private company obtained by democratic Colorado governor Jared Paul is only to have trump give back a hundred of them at what he called the request of the state's endangered Republican senator Cory Gardner Thursday's Denver post editorial declared trump is playing a disgusting political game with our lives but the trump administration says it's got a plan and that it's working White House adviser Peter Navarro April second these guys up here doing a heck of a job organizing the supply chain well I think that's news to a lot of medical providers no I'm levy is a national health care reporter for the LA times trying to follow the cold pick nineteen supply chain I can't say I've talked to many hospitals or doctors offices or clinics around the country who feel that the supply chain is being managed in anything close to a rational way that's for sure and we can't seem to get answers from FEMA or the White House about what system if any is being used to balance the needs a couple weeks ago I was speaking with the head of the Texas academy of family physicians who working with the golfing buddy of his managed to in about a half million masks over the border from Mexico and then spent about seventy two hours getting them to rural hospitals and doctors offices around Texas because the state of Texas didn't have anything to distribute so you've got the system in which everybody's running around trying to get masks and ventilators and everything else and then on top of that is a totally opaque system of what appears to be haphazard intervention by the federal government on some supplies but not all of them everyone is completely perplexed we hear that trump is having no problem directing to Florida whatever Florida seems to need so zero which is the agency that is allegedly responsible for distributing supplies from the strategic national stockpile has claimed that they have some formula for distributing medical supplies that reflects states in large metro areas relative populations and the relative severity of corona virus outbreaks they are actually shipping things across the country however it's impossible to find out what that formula is whether or not allowances are being made in one way or another four criteria that have not been identified president trump hasn't been shy about claiming that he's willing to reward its friends and punish his enemies the conspiracy minded person might think well is there some nefarious method to how these supplies are getting distributed or not we just don't know what difference does it really make if we know or we don't know what the formula is for distributing this stuff this is taxpayer money that we're talking about private actors in the market of course don't have an obligation to be transparent about what they're doing because there's no expectation under normal circumstances that they're acting in the public interest we hope that the government is acting in the public interest but without transparency who knows who's accountable for this who's in charge is it rear admiral John Paul love check who's at the head of FEMA's coronavirus supply chain task force is it FEMA director Peter Gaynor is it Peter Navarro who is reportedly coordinating private and public sector communication maybe it's the Jared Kushner or the invisible hand is it really fundamentally the president and no one else you know without clear lines of authority things are not getting done as far as we know in a particularly efficient way nor do we know that however they're being done is being done in a lawful way frankly if for example the president's son in law is dialing up private companies and asking them to give support in one way or another to the supply chain challenges what assurances are being made to those companies about what they can expect I'm talking about promises that are made the company acts that if they help out that they'll be made whole in the end with they'll be reimbursed at a certain level without a process all of that is open to question is there a way to have an informed data driven approach to this as Jared Kushner said the federal government was engaged in if in fact the federal government isn't engaged in an informed data driven approach can big business small business health officials state officials do this on their own so the facts on the ground suggests that this can't happen on its own no that's not to say that there aren't a lot of efforts by individual actors some of them quite influential to play a constructive role I mean we've seen a number of large companies including apple for example say we are going to use our connections to the supply chain to procurer masks and we're going to distribute them the owner of the New England Patriots flew the patriots plane to China to go pick up a shipment of masks and flew back to Boston the problem is when you have this sort of thousand points of light approach to procuring and distributing needed supplies what ends up happening is that well connected medical centers that have relationships with large companies either because they do business with them or because they're located in their backyards are often times at the top of the list so for example sales force made a donation to the university California San Francisco Medical Center because they have a long standing relationship both being based in San Francisco does UCSF knew that equipment more than a hospital in New York City or New Jersey that's a lot to ask of sales force to try to make that determination they don't have any expertise in

Fema President Trump
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

12:29 min | 2 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"I work get that Contra Costa Family Medicine Residency Program. I'm the ready director there and I'm also the executive producer of the NOCTURNE S and I'm so excited to be on the AF if P fogcast. I've been listening to it for a long time and thank you so much for having me. Thank you so much Dr Block for coming on a podcast we're going to start off right away with clip from the NOCTURNE. Ists so this first cliff that we're going to listen to is from Alana pebbles and she was actually a resident at the UCSF San in just general residency program when she recorded this story and she just finished a fellowship in maternal health and is about to start her first grownup jobs so that's I'm really excited excited for her and this has been one of my favorite stories for a long time. Partly I think your listeners will find that. It's very relatable. She's talking about a woman who who comes into the ER WHO's dying and DNR deny and Milana talks about being really distracted in that moment by the medical record and how that really takes away from the connection that she's trying to have with her patient so I think it's something that resonates with a lot of us and I just love the way that she speaks about that moment. As I'm remembering bring that my job is not to try to save her from what's happening. I decide that we should order the comfort care order set which is like a thing that you can order in the computer and has all of these drugs that you can use to try to treat suffering but I've never done it before so I go to the computer and I'm looking for the order set and I can't find it and so I decided I'm just going to try to order the drugs like one by one just try to come up with it on my own and start earning morphine for pain but I'm ordering ordering it wrong and so I'm getting pizzas from pharmacy star ordering out of an for air hunger and order at like fifteen different times and all of them are wrong and pharmacies paging me and him on the phone and I'm battling with the computer and I look for a second to realize I missing it. The people who aren't missing it are the nurses one by one six nurses walk into the room and they surround her and each put a hand on her and they say it's okay. You don't have to suffer anymore. It took me to let go by and she dies so the second clip that we're going to listen to is part of her interview view with Emily Silverman the host and creator of the NOCTURNE EST and here. She's just talking about again. Sort of the importance of those really monumental moments which I think is why a a lot of US went into family medicine in the first place and the beauty of providing care whether at the beginning of life or the end of life and what's so special and what such an honor about what we get to do every day the greatest privilege of medicine is being able to support people through these incredible the most incredible moments of their lives sometimes the happiest moments when babies are born often some of the saddest and scariest moments when they have a new illness or when they learned that they're going to die and ultimately for everyone when we do die we will we will hopefully be supported by a physician and and when someone is is at the end of their life and is dying to try to fight their death feels like like I am I missing that opportunity to really help them through that by fighting it thank you so much for sharing that first clip. Dr Pepper Benito's story with US Alley. Can you tell us about about the origin of the NOCTURNE Ists. Yeah I'd love to so back in two thousand sixteen a colleague and friend Emily Silverman who was an internal medicine resident at UCSF at the time came up with this idea. I think she had gone to a moth recording or a moth event and she came up with the idea of doing sort of a similar thing for residents. I think she was feeling kind of burnt out at the time and overwhelmed with all of the pain and suffering that she was absorbing from her patients and all of the experiences that she she was going through and so she had this idea of gathering some residents together to share stories and my husband who actually was chief resident at the time went to the event and then came came home and was like Ali mazing. This is totally your thing you really gotta get involved and at that time I was about a year out of residency and just sort live at that point where I was sort of emerging from the post residency Hayes and found myself with all of this time and creative energy that has sort of been laying dormant for all of those years and so emily and I got together at a coffee shop and decided to partner on the project and so then we just kind of took it from and we started producing events we started renting out theaters in San Francisco and the theaters started selling out and we got into bigger and bigger theaters and it just seemed like it was really striking taking a nerve and so what we do is for each event we choose a theme like love or mistakes or death and dying or diversity and then and we put out a call for submissions on the theme. Certainly your listeners are all welcome to submit and then we choose the ones that we think are the most promising and a couple of years ago we brought on ahead of story development a really talented woman named Adelaide Papa Blue Who's actually applying to medical school right now and she's a really talented onto documentarian and she works very closely with the storytellers then to really sort of pull out what's meaningful to them about their stories and find that narrative arc and figure figure out why they're telling the story which isn't usually because it's such an interesting clinical case it's usually because it was something that was really personal and meaningful for the storyteller her and then we put them on stage and we have these beautiful nights where people come together and listen to live music and stories and then what we decided to do was take the most successful stories from the live events and turn them into a podcast for broader consumption. Did you have a background in some kind of creative art well well. I've always loved writing but I had never done any sort of formal storytelling or really creative writing it's always been more from sort of a personal essay in Memoir and opinion writing position and so this just seemed like a really exciting opportunity and I think it tapped into something that I I had been craving of how to share some of these experiences that were having during training and as physicians and also seemed like a really exciting opportunity for advocacy Z. to take our experiences our patient stories and share them in a way that they're not usually shared. Where does the name the NOCTURNES come from. That's such a good question you know. I think that emily come up with it before I came on board and I think she had just batted around a bunch of different ideas and that was kind of the one that stuck I think it has has something a little bit poetic mysterious about it but also people on the inside in medicine definitely know exactly what it means and conservative imagine imagine you know being alone in the hospital late at night and mulling over these stories so I think it kind of the mood that we're looking for. Let's talk a little bit more about your career other than being an executive producer of a hit live show and podcast what drew you to family medicine and what were the major inspirations for your current career path well. I grew up in New York City and so I didn't know that much about family medicine. I know that there is now a thriving family medicine community in New York but I was sort of unaware that I didn't come from a medical family and I think New York oftentimes tends to be a little bit more subspecialize but I think that being family doctor was sort of what I always pictured. Being in a doctor was even if I didn't have a name for it and then I think like a lot of people who ended up going into family medicine. I did my third year rotations and I just liked everything thing I love doing. Ob I loved pediatrics. I love my surgery rotation and I was chugging along in third year getting a little more panicked with every rotation event how I was going to choose shoes and then my very last rotation of the year was my family medicine rotation at San Francisco General and something just totally clicked. I felt like in terms of the clinical fickle side it was exactly what I wanted being able to do women's health and paediatrics and treat chronic conditions and then the ethos of really caring for the whole family and caring community and thinking broadly advocating for our patients with just culturally exactly what I was looking for. You know people always say find your people and it was so clear here to me that those were my people and so then I was lucky to train at UCSF and San Francisco General for Med school and then I went to the Santa Rosa Residency Program for Residency Agency which was such an amazing place. I had fantastic mentors across the board but specifically in women's health and underserved medicine and integrative medicine which are sort of some of the real oh strength of that program and then when I graduated I basically just got really lucky and landed my dream job. At Contra Costa where a woman woman named Sarah Macneil who's now core faculty there was looking for help running the reproductive health curriculum there she since has become a really incredible mentor and advocate for me and so she brought me on and with that job was the option to continue doing et. CETERA and Primary Care Teaching residents and doing this reproductive health work which has always been a big passion of mine and it's just been a great fit. I think I really particularly love working with the residence because they just bring so much passion and so much inspiration. I'm really impressed by them every day so yeah. I feel really lucky. I think I'll probably be there for a good long time so it sounds a not quite totally preplanned. Dan but more sort of like following the the passion or the choice in the moment yeah exactly that's certainly is how my career has been and I think that's what I was always drawn to you. When I met mentors who had really inspiring career pass was they weren't totally linear they just found something and it clicked and they found great mentors and they kind of went with it and so that's what I've been doing and that's how I sort of fell into doing this work but the nocturne s which also has been a really rich part of my life so let's hear your next clip yep so this clip from Michelle Thomas who I believe you actually trained with during your residency in residency at the same time at San Francisco General. That's that's so great so she as you know is an amazing family doctor who's dedicated her career to prison health and specifically end of life care in the prison system and she told a beautiful beautiful story. I really encourage your listeners to go and listen to the whole thing. It's about the compassionate release process and this clip just gives sort of a very small taste of have what that is like practicing within the criminal justice system when I get to the hospice rounding this morning. The nurse gives me an update on our patients and let me know that Mr Turner had died all he wanted to do before he died was to say goodbye to his daughter. She lives in a psychiatric isolation `isolation unit at a women's prison in southern. California and inmates aren't usually allowed to talk to other inmates but our warden is Kinda used to US pushing the boundaries and he got the other one into a great so they took Mr Turner schizophrenic daughter and put her in therapeutic module. That's code for telephone with size cage and allowed them fifteen fifteen minute phone call to say goodbye to their credit. They also pulled together her mental health team to help her processor grief afterwards and one of the officers from the other facility actually sent me an email next day thanking me for allowing him to participate. He said in twenty five years of service. This was one of the most rewarding things exceed done the nurse. I are so happy that Mr Turner got to say goodbye to his daughter and I'm happy that we have one more person in the system who understands that maintaining maintaining safety and security and allowing people their humanity are not mutually exclusive on days like this. I think maybe I'll keep this job.

Emily Silverman San Francisco Contra Costa Family Medicine R US UCSF executive producer Mr Turner UCSF San Alana pebbles Dr Block internal medicine resident director morphine New York New York City Dr Pepper Benito DNR Ali mazing Milana Michelle Thomas
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:13 min | 3 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"Recurring segments in American family physician is the curbside consultation, and this curbside consultation is entitled effective advocacy for patients and communities. The commentary here is from Dr hack and styles from Madison Wisconsin, we as family doctors understand that advocacy is a core component of medical professionalism. We haven't evidence-based background and our training teaches us about a deep understanding that the health of an individual is tied to the health of families and communities. So this curbside consultation offers a framework based on advocacy at four levels of healthcare interpersonal, organizational, health, system and policy advocacy on an interpersonal level starts with listening carefully to hear patients concerns to work for patients, health and social needs family physicians can recognize. Implicit bias teach others and demonstrate understanding of people from all backgrounds. Organizational advocacy involves serving as a leader to help places of employment education professional membership or worship embrace emission of community service to invest in and strengthen local communities S, family physicians. We know many, social and economic factors influence the health of our patients by advocating beyond individual organizational affiliations, we can help create conditions for collective action. This is the health system level of advocacy. We can promote systems that address social determinants of health, affordable and high-quality childcare, healthy foods public education housing and safe recreation, the fourth level of advocacy is on a policy level, we family physicians can express our support for health promoting policies through communications with political leaders in the public. We are credible champions for policies that support robust healthcare systems financing mechanisms and public health infrastructure. We can train the next generation of advocates an influence public opinion through commute. Outreach writing public speaking an editorial 's if you'd like to build your advocacy skills. Check out the American Academy of family physicians and society of teachers of family medicine resources to gain advocacy, experience on a national level..

American family physician American Academy of family Madison Wisconsin
"american family physician" Discussed on AFP: American Family Physician Podcast

AFP: American Family Physician Podcast

02:11 min | 3 years ago

"american family physician" Discussed on AFP: American Family Physician Podcast

"The AFC podcast is supported by the American Academy of family physicians and by the journal FPM, providing practical peer reviewed advice to help primary care providers. Advanced that our practice patient care and career available in prince and online subscription. Formation is available at af dot org slash f PM. Happy new year. And welcome to the American family physician podcast for the January. First twenty nineteen issue. I'm Steve I'm Joe, I'm Jenna, and I'm Sarah. We are residents and faculty from the university of Arizona. College of medicine. Phoenix family medicine residency today on the podcasts. We're going to talk about de prescribing benzodiazepines, migraine prophylaxis advocacy, urine drug tests, HP vaccine N, P H insulin. And we have a new feature. Our lightning round of AFP clinical answers. The opinions expressed in the podcast our own internet represent the opinions of the American Academy of family physicians. The editor of American family physician or banner health do not use this podcast for medical advice. Instead, see our own family, doctor for medical care. We're gonna start things off with our editorial. From this issue de prescribing is an essential part of good prescribing from doctors feral and mansion from on -tario. So paulie pharmacy is something we all encounter frequently and can be challenging to tackle. It's also something that seems to be more common in our aging patient population. Very true nearly one half of our older adults take five or more medications, an older adults prescribed more medications are more likely to be hospitalized due to an adverse drug reaction. So how do we balanced treating our patients medical conditions with managing the benefits and risks of medication therapy?.

American family physician American Academy of family AFP College of medicine university of Arizona HP editor Steve I Jenna Joe