Diagnosis, Management, and Social Implications of Attention Deficit Hyperactivity Disorder.  Ever gotten overwhelmed by all the categories of ADHD, or interpreting the scores on a Vanderbilt form? Join us with Dr. Sarah Vinson, a triple-boarded clinician in adult  psychiatry, child psychiatry, and pediatrics who helps us optimize a diagnosis and management process for ADHD. What other conditions can masquerade as ADHD? Which type of stimulant should you use? Listen to find out more! Show notes at: https://thecurbsiders.com/cribsiders/13 Subscribe at: Apple , Google, Spotify Credits Writer, Producer, Infographic: Angela Zhang Cover Art: Chris Chiu Hosts: Justin Berk, Chris Chiu Editor:Justin Berk; Clair Morgan of nodderly.com Guest(s): Dr. Sarah Y. Vinson Time Stamps 5:30 Diagnosis of ADHD 6:53 Considering a differential diagnosis of ADHD 8:43 Categories of ADHD 15:02 Ancillary Supports 18:27 Consequences of Misdiagnosis 19:53 Parent Counseling 22:08 Behavioral Interventions Treatment 25:56 Gender Differences in ADHD 28:00 Anaphylaxis Promo 28:39 Alternative Treatments 30:54 Pharmacotherapy for ADHD 37:29 Side Effects of Medical Treatments 44:33 Monitoring Progress 46:19 Treating concurrent mood disorders 49:21 ADHD in Young Adults 55:29 ADHD and Race 1:08:13 Future of ADHD

Learn about the latest in COVID-19: Do masks prevent infection?, SARS-CoV-2 home testing, vaccine advice, and how to prevent and treat VTE in COVID-19. Join us as our tzar-of-clinical-appraisal Curbsider/internist/epidemiologist Rahul Ganatra MD MPH (@rbganatra) talks us through the controversial DANMASK-19 trial, plus Watto reports back on his conversation with Dr Parth Rali @parthrali (Temple Lung Center) who helped write the CHEST anticoagulation guidelines for COVID-19. Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits Producer: Deb Gorth ScM Show Notes, Cover Art, and CME by: Deb Gorth ScM and Matthew Watto MD Written by: Matthew Watto MD, Paul Williams MD, and Rahul Ganatra MD MPH Hosts: Rahul Ganatra MD MPH, Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Sponsor: ACP’s I Raise the Rates Join with other clinicians in working to raise influenza and other adult vaccination rates. Visit acponline.org/ai to access free tools and learn new strategies to support your efforts. Sponsor: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Time Stamps 00:00 Intro, disclaimer, Picks of the week* and Vaccines 08:00 DANMASK-19 25:00 Anticoagulation in COVID-19 35:06 COVID-19 home PCR testing Outro

Everything you need to know about vulvovaginitis: candidiasis, bacterial vaginosis, and Genitourinary Syndrome of Menopause. Join us on the journey of a lifetime as we learn all about diagnosing, treating and managing vulvovaginal conditions in patients of all ages. Plus, a bit on how to recognize and treat lichen sclerosus. Our brilliant guest for this episode is Dr. Monica Christmas (@drmonicaxmas on Twitter), who is a self-described yoga enthusiast, avid reader, wannabe artist and gynecologist. Dr. Christmas is currently an Assistant Professor at the University of Chicago in the section of Minimally Invasive Gynecologic Surgery where she is the director of the Menopause Program. Monica specializes in gynecologic surgery, abnormal uterine bleeding and menopause management with an interest in sexual dysfunction. Her focus is on helping women live healthy, vibrant, happy lives. Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits Produced by: Kate Grant MD; Sarah Phoebe Roberts MPH Written by: Kate Grant MD Show Notes by: Sarah Phoebe Roberts MPH, Kate Grant MD Cover Art and Infographic: Kate Grant MD Hosts: Kate Grant MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest: Dr. Monica Christmas, MD Sponsor: ACP’s I Raise the Rates Join with other clinicians in working to raise influenza and other adult vaccination rates. Visit acponline.org/ai to access free tools and learn new strategies to support your efforts. Sponsor: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.

Listen in as we recap four of our favorite diabetes episodes to bring you the pearls you need to stay up to date on type 2 diabetes management in the clinic.  We cover pitfalls of A1c testing, guidelines for A1C targets, when and how to use the newer medications SGLT-2 inhibitors and GLP-1 agonists.  We wrap up with a discussion of managing DM2 in patients with kidney disease and in which patients to consider de-intensifying treatment.  Feel confident managing diabetes with the latest data in 2020! Listeners can claim 4 HOURS of Free CE credit for this episode through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | CME! Credits Written and Produced by: Molly Heublein, MD Infographic and Cover Art: Isabel Valdez, PA Show Notes: Isabel Valdez, PA; Molly Heublein, MD Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP, Molly Heublein, MD Editors: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com Sponsors: ACP’s I Raise the Rates Join with other clinicians in working to raise influenza and other adult vaccination rates. Visit acponline.org/ai to access free tools and learn new strategies to support your efforts. VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit. Time Stamps 0:00 Intro, 2:45 Pitfalls of A1c testing, 7:00 Diabetes goals/A1c guidelines; Macrovascular vs Microvascular benefits, 16:20 Choosing between SGLT2 inhibitors vs GLP1 agonists, 19:10 Stuart rants on insulin for symptomatic hyperglycemia, 22:32 Start your patient on an SGLT2i and counsel them about potential adverse events, 30:30 GLP-1 agonists, 36:50 Deintensification; Diabetes Treatment in CKD, Tags Diabetes, hypoglycemia, SGLT2 inhibitors, GLP-1 agonist, metformin, CKD, primary care, assistant, doctor, education, family, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, physician, resident, student

Explore the essentials of Wilderness Medicine and prepare yourself for austere environments as we discuss Altitude Sickness, Frostbite, Animal Bites, Thermoregulation, Wound Care and the proper way to apply a tourniquet.   Thinking about outdoor escapes and vacations now more than ever? Listen as our esteemed guest Dr. Thomas DeLoughery @Bloodman (Oregon Health & Science University) takes us through the fascinating, and at times chilling, world of Wilderness Medicine. This episode will empower you to explore the great outdoors as safely as possible.  We discuss the breadth of wilderness medicine, multiple unique clinical entities encountered in austere environments, and practical ways to protect yourself and others on your adventures.  This episode is truly wild!   Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!   Credits Written, Produced, and Infographic by: Avital O’Glasser MD, FACP, FHM Show Notes: Deborah Gorth ScM and Avital O’Glasser MD, FACP, FHM Cover Art: Kate Grant, MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Avital O’Glasser MD, FACP, FHM Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Thomas DeLoughery MD, MACP, FAWM   Sponsors:   Provider Solutions and Development Provider Solutions & Development is a community of experts dedicated to offering guidance and career coaching to physicians and clinicians throughout their entire career journey. With exclusive access to hundreds of opportunities across the nation, reach out today to begin the search for your perfect practice: www.psdrecruit.org/curbsiders.   VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps Sponsor - Provider Solutions and Development https://curbsiders.vcuhealth.org/ Sponsor - VCU Health CE curbsiders.vcuhealth.org    00:00 Intro, disclaimer, guest bio 03:45 Guest one-liner, advice and Picks of the Week* 08:10 Sponsor - Provider Solutions and Development https://curbsiders.vcuhealth.org/ 09:00 Case of mountaineering; What is Wilderness Medicine?
 12:05 What’s in your first aid kit?
 21:36 Altitude sickness: acute mountain sickness, high altitude cerebral edema and High altitude pulmonary edema
 31:25 Hypothermia   39:36 Frostbite 
 47:25 Hyperthermia: Heat exhaustion and Heat stroke; How much water should you drink?
 51:55 Bat bites and rabies
 58:20 Snake bites
 66:03 Wound care and tourniquets
 75:40 Take Home Points; Outro; Bonus clip Sponsor - VCU Health CE curbsiders.vcuhealth.org      Links* De Gaulle by Julian Jackson  Command and Control by Eric Schlosser Auerbach's Wilderness Medicine, 2-Volume Set  Whatever book Paul said he was reading, sounds nerdy (The First Law Trilogy)  Wilderness Medicine Society Stop The Bleed: Home  Into Thin Air: A Personal Account of the Mt. Everest Disaster by Jon Krakauer National Outdoor Leadership School Advanced Wilderness Life Support  Inside the ER at Mt. Everest  Annapurna by Maurice Herzog  K2, The Savage Mountain: The Classic True Story Of Disaster And Survival On The World's Second-Highest Mountain– by Charles Houston and Robert Bates    *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will learn the basics of wilderness medicine and how to approach a few common conditions.    Learning objectives After listening to this episode listeners will…   Appreciate Wilderness Medicine as a medicine subspeciality and understand why or how someone might pursue this clinical focus area Recognize signs and symptoms of high altitude sickness Develop an approach to treating animal bites and injuries Learn high yield tips for administering first aid in the wilderness including field hemostasis   Disclosures Dr DeLoughery reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation O’Glasser AY, Gorth D, Deloughery T, Williams PN, Watto MF. “#242 Wilderness Medicine: Prfor Disaster”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Original air date November 16, 2020.   Tags Wilderness Medicine, Travel medicine, first aid, first aid kit, altitude sickness, acute mountain sickness, high altitude cerebral edema, high altitude pulmonary edema, acetazolamide, dexamethasone, hypothermia, frostbite, frostnip, heat exposure, heat exhaustion, heat syncope, hyperthermia, hyponatremia, animal bites, bats, rabies, snakes, antivenom, wound care, tourniquet, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Rejoice! as our phenomenal guest Dr. Brad Hayward @bradleyjhayward (Weill Cornell Medicine) demystifies chronic cough for the primary care provider. Dr. Hayward, an internist, pulmonologist, intensivist AND palliative care physician sits down with us to discuss common causes for chronic cough, work up pearls and options for treatment. Follow him on Twitter, @BradleyJHayward. Listeners can claim free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). We hope you enjoy learning from this episode as much as we enjoyed producing it!   Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!   Credits Written (including CME questions) and Produced by: Cyrus Askin MD Infographic by: Cyrus Askin MD Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Stuart Brigham MD; Paul Williams MD, FACP    Editor: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com Guest: Brad Hayward MD   Sponsors: Panacea Financial  This episode is supported by Panacea Financial, digital banking built for doctors, by doctors. At Panacea Financial you can have your own free personal banker and a support team that works around the clock- just like you do. Open your free checking account today at panaceafinancial.com Panacea Financial, a Division of Sonabank, Member FDIC     VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps   Sponsor - Panacea Financial panaceafinancial.comSponsor - VCU Health CE curbsiders.vcuhealth.org 00:00 Intro, disclaimer, guest bio; Guest one-liner and Pick of the Week* 06:23 Sponsor - Panacea Financial panaceafinancial.com 07:30 Case of Post Infectious Cough; Basic definitions for cough Important aspects of the history Empiric therapies for post-viral cough 22:50 Case of idiopathic chronic cough; Physical exam 29:20 Basic testing and empiric therapy for the common causes of chronic cough 41:51 When to refer to pulmonology; Therapy for idiopathic chronic cough; OTC cough meds 54:28 Take home message; Outro Sponsor - VCU Health CE curbsiders.vcuhealth.org   Links* 90 Day Fiancé (show)   Below Deck Mediterranean (show) Mastering Communication with Seriously Ill Patients by  Anthony Back, Robert Arnold & James Tulsky (book)    *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will develop a pragmatic approach to evaluating subacute and chronic cough in adult patients.   Learning objectives After listening to this episode listeners will be able to…   ... define sub-acute vs chronic cough ... build a repertoire of history questions geared towards identifying the etiology of cough in a patient ... build a toolbox of diagnostic studies / tests that can be used in the evaluation of cough ... marry history, physical and diagnostic studies into a coherent approach to diagnosing subacute and chronic cough through a tiered/logical approach ... understand empiric therapies for cough that may have an advantageous risk-reward profile, even in the absence of diagnosis  ... educate patients on common causes for subacute cough and chronic cough, as well as how to appropriately set expectations regarding symptoms severity and duration   Disclosures Dr. Hayward reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Askin CA, Hayward B, Williams PN, Brigham SK, Okamoto E, Watto MF. “241: Chronic Cough”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Original Air Date: November 9, 2020.   Tags Cough, dyspnea, asthma, COPD, eosinophil, IL-5, allergy, ENT, allergist, pulmonary, pulmonologist, PFT, spirometry,  post-nasal drip, GERD, reflux, eczema, rash, atopy, mucus, bronchiectasis, lung, antihistamine, CT, X-Ray,  smoking, vaping, birds, dust, cockroaches, steroids, ICS, inhaled, gabapentin,  primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Returning guest expert Dr Ted Parks helps us get the elbow straight with a simple approach to common causes of elbow pain for primary care.  Listen as he guides Stuart through physical exam techniques (or watch them on YouTube) for epicondylitis and learn what the bursa is there for anyways. Find out what fracture you can treat in your office, why you shouldn’t stab straight into the olecranon bursa and when elbow pain should be referred.  Feel confident when your patient comes in with elbow pain! Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] Credits Written and Produced by: Molly Heublein, MD Cover Art and Infographic: Edison Jyang Hosts: Stuart Brigham MD, Matthew Watto MD, FACP; Molly Heublein, MD Editor: Emi Okamoto, MD (written materials); Clair Morgan of Nodderly.com (audio/video) Guest: Ted Parks, MD     Sponsors   Provider Solutions and Development Provider Solutions & Development is a community of experts dedicated to offering guidance and career coaching to physicians and clinicians throughout their entire career journey. With exclusive access to hundreds of opportunities across the nation, reach out today to begin the search for your perfect practice: www.psdrecruit.org/curbsiders.     VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps Sponsor - Provider Solutions and Development https://curbsiders.vcuhealth.org/ Sponsor - VCU Health CE curbsiders.vcuhealth.org    00:00 Intro, disclaimer, guest bio 04:00 Picks of the Week* Sponsor - Provider Solutions and Development https://curbsiders.vcuhealth.org/ 09:50 Medial and lateral epicondylitis case, Elbow anatomy 13:00 Pathophysiology of epicondylitis, Epicondylitis exam, Epicondylitis treatment 34:11 Olecranon bursitis, Bursitis diagnosis and aspiration 46:12 Radial head fracture diagnosis, Radial head fracture treatment 55:30 Cubital tunnel nerve entrapment 57:45 Platelet rich plasma 60:39 Take home points, Plug and Outro 64:00 Bonus Pick of the Week Sponsor - VCU Health CE curbsiders.vcuhealth.org      Goals Listeners will have a working differential of elbow complaints that commonly present in primary care, and understand how to diagnose these and initiate treatment.   Learning objectives After listening to this episode listeners will... Perform an exam for medial and lateral epicondylitis. Describe treatment options for medial and lateral epicondylitis Identify when further evaluation for clinical olecranon bursitis beyond clinical exam is needed Explain how radial head fractures differ from most other fractures, and why casting or surgery is generally not needed.   Links* Molly’s Pick: The Warmth of Other Suns (book) by Isabel Wilkerson  Stuart’s Pick: The Fringe (TV show), JJ Abrams Practical Office Orthopedics (textbook) by Ted Parks, MD   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   References Johnson GW, Cadwallader K, Scheffel SB, Epperly TD. Treatment of lateral epicondylitis. Am Fam Physician. 2007 Sep 15;76(6):843-8. PMID: 17910298. Simental-Mendía M, et al. Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized placebo-controlled clinical trials. Clin Rheumatol. 2020 Aug;39(8):2255-2265. doi: 10.1007/s10067-020-05000-y. Epub 2020 Feb 26. PMID: 32103373. Parks, Ted.  Practical Office Orthopedics.   McGraw-Hill Education / Medical; 1st Edition (December 29, 2017).   Khodaee M. Common Superficial Bursitis. Am Fam Physician. 2017 Feb 15;95(4):224-231. PMID: 28290630. Liow RY, Cregan A, Nanda R, Montgomery RJ. Early mobilisation for minimally displaced radial head fractures is desirable. A prospective randomised study of two protocols. Injury. 2002 Nov;33(9):801-6. doi: 10.1016/s0020-1383(02)00164-x. PMID: 12379391. Boone S, Gelberman RH, Calfee RP. The Management of Cubital Tunnel Syndrome. J Hand Surg Am. 2015 Sep;40(9):1897-904; quiz 1904. doi: 10.1016/j.jhsa.2015.03.011. Epub 2015 Aug 1. PMID: 26243318.   Tags Elbow, orthopedics, olecranon bursitis, bursa, aspiration, septic joint, medial epicondylitis, lateral epicondylitis, radial head fracture, PRP, platelet rich plasma, humerus, olecranon, radius, tendonitis, primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student   Disclosures Dr Parks reports is the author of Practical Office Orthopedics (McGraw-Hill 2017) . The Curbsiders report no relevant financial disclosures.    Citation Heublein M, Parks T, Jyang E, Brigham SK, Okamoto E, Watto MF. “#240 Elbow Pain: Straighten it out. A dabble into elbow care  with Dr Ted Parks”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list November 02, 2020.

A runny nose won’t have you running in circles this cold season with our fantastic overview of rhinosinusitis in all its forms! We discuss etiology and presentation of viral versus bacterial rhinosinusitis, practical counseling tips for guiding patients on nasal irrigation, and working up chronic rhinosinusitis! Our guest is the fabulous Dr. Dink Jardine, a general otolaryngologist, Commander in the US Navy, and Director for Professional Education (DPE) and Designated Institutional Official (DIO) at Naval Medical Center Camp Lejeune (NMCCL).    Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!   Credits Written and Produced by: Paul Williams MD, FACP, Beth Garbitelli Cover Art: Kate Grant MBChb, MRCGP  Infographic by:  Beth Garbitelli Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Molly Heublein MD (written materials); Clair Morgan of nodderly.com (audio) Guest: Dink Jardine, MD   Sponsors:   National Internal Medicine Day Help ACP celebrate National Internal Medicine Day on October 28th. Visit https://www.acponline.org/NIMD20 to learn how you can show your internal medicine pride. Be sure to tag @ACPInternists and use the hashtags #NationalInternalMedicineDay, #IMProud, and #IMEssential.     VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps Sponsor – National Internal Medicine Day, The American College of Physicians Sponsor - VCU Health Continuing Education 00:30 Intro, disclaimer, guest bio 03:00 Guest one-liner, Favorite failure, Pick of the Week*:  Still Life by Louise Penny Sponsor – National Internal Medicine Day, The American College of Physicians 09:30 Case 1 - Acute Viral Rhinosinusitis  10:40 Rhinosinusitis vs. Sinusitis  14:20 Physical exam in rhinosinusitis 20:40 Counseling patients about viral vs. bacterial infection 22:56  Sinus regimen/nasal irrigation - “Is there a sinus toilet” 27:10 Intranasal fluticasone and other intranasal medications  29:40 Rhinitis medicamentosa 30:40 Nasal spray positioning 33:50 Case 1 - Double Sickening 37:40 Worst case scenarios from rhinosinusitis 40:40 Antibiotic treatment for bacterial rhinosinusitis 43:20 Failed improvement on antibiotics? Second-line options 49:30 Case 2 - Chronic rhinosinusitis  52:28 Etiology of chronic rhinosinusitis 53:33 Making a diagnosis of chronic rhinosinusitis 55:25 Treating chronic rhinosinusitis  58:40 Vasomotor rhinitis  60:40 Sinus irrigation counseling and tips (YouTube) 65:30 Case 3 - Allergic Rhinitis  70:13 Oral medications for allergic rhinitis; Chronic allergic/non-allergic rhinitis  73:51 Take-home points   Links* Still Life: A Chief Inspector Gamache Novel by Louise Penny,  Chief Inspector Gamache series “Dr. Adappa and Dr. Palmer teach you How to do Nasal Irrigation” https://www.youtube.com/watch?v=Br928VfiC1M   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goals Listeners will develop an approach to the diagnosis and management of rhinosinusitis.   Learning objectives After listening to this episode listeners will... Classify rhinosinusitis, including acute, chronic, bacterial, and viral. Discuss the microbiology and pathophysiology underpinning rhinitis and sinusitis. Differentiate the presentation and management of acute bacterial and acute viral rhinosinusitis. Develop an approach to the diagnosis and management of allergic rhinosinusitis. Recognize and manage patients with non-allergic rhinitis. Discuss the role of antibiotic therapy and surgery in the management of rhinosinusitis.   Disclosures Dr. Jardine reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Williams PN, Garbitelli B, Jardine D, Heublein M, Watto MF.. “#239 Sinusitis: It’s not that tricky.” The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date October 26, 2020.   Tags sinus, sinusitis, rhinitis, acute bacterial, rhinosinusitis, bacterial, viral, virus, nose, chronic sinusitis, ENT, primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

DVT / PE Triple Distilled! Our favorite VTE pearls summarized in this fast paced recap gleaned from our discussions with Dr Oren Friedman #92 Pulmonary Embolism for the Internist and hematologist, heavy metal enthusiast, Dr Michael Streiff #154 DVT and PE Master Class. Introducing our new Triple Distilled sub-series offering shorter episodes that reinforce and refresh key concepts from past shows along with any pertinent updates.    Listeners can claim 2 hours of Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!   Credits Written and Produced by: Matthew Watto MD, FACP Cover Art by: Matthew Watto MD, FACP Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com   Sponsor:  VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps 00:00 Intro, disclaimer 01:40 Making the diagnosis of VTE 09:07 Triage and risk stratify Pulmonary Embolism 14:00 Anticoagulant choice; Duration of therapy after unprovoked DVT / PE 21:00 Workup for unprovoked DVT / PE; DOACs in special populations: at extremes of weight,  advanced CKD and in antiphospholipid syndrome 28:22 IVC filters  30:20 Outro   Links Check out the full show notes from previous Curbsiders’ shows covering VTE.  Dr Oren Friedman #92 Pulmonary Embolism for the Internist  Dr Michael Streiff #154 DVT and PE Master Class   Goals Listeners will feel confident in the diagnosis and management of VTE   Learning objectives After listening to this episode listeners will...   Diagnose (VTE) DVT and PE using imaging, risk scores and clinical gestalt Risk stratify patients with pulmonary embolism Choose the appropriate initial anticoagulant for VTE Decide duration of anticoagulation for VTE Recall real risks and questionable benefits of IVC filters in DVT / PE Determine need for cancer or thrombophilia workup in unprovoked DVT / PE     Disclosures The Curbsiders report no relevant financial disclosures.    Citation Watto MF, Williams PN, Brigham SK, Watto MF. “#238 DVT / PE Triple Distilled”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date October 22, 2020.   Tags Pulmonary embolism, vte, dvt, pe, heparin, anticoagulation, right ventricle, RV, left ventricle, LV, circulation, hypotension, shock, IVC filter, TPA, echocardiogram, CT scan, bleed, clot, deep, vein, thrombosis, DOAC, NOAC, anticoagulation, d-dimer, Wells, primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Fun, fluorescein, and fundoscopy unite as our esteemed guest, Dr. Nisha Chadha @iEducatorMD (Mount Sinai School of Medicine) brings us ophthalmology for primary care! Dr. Chadha is a medical educator and the content creator of the med-ed simulation website 20/20 Sim. She teaches us the 3-vital signs of ophthalmology, how to recognize common diabetic eye diseases, how to explain diabetic retinopathy to our patients, how to optimize a patient for cataract surgery and so much more. This episode is truly vision-ary!   Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!   Credits Written, Produced, and Infographic by: Carolyn Chan, MD Cover Art: Kate Grant Hosts: Matthew Watto MD, FACP; Carolyn Chan, MD Editor: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com Guest: Dr. Nisha Chadha   Sponsors:   National Internal Medicine Day Help ACP celebrate National Internal Medicine Day on October 28th. Visit https://www.acponline.org/NIMD20 to learn how you can show your internal medicine pride. Be sure to tag @ACPInternists and use the hashtags #NationalInternalMedicineDay, #IMProud, and #IMEssential. VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps Sponsor – National Internal Medicine Day, The American College of Physicians Sponsor – VCU Health Continuing Education 00:30 Intro, disclaimer, guest bio   03:21 Guest one-liner, Carolyn’s Pick of the Week  09:05  Picks of the Week* 10:13 Case from Kashlak, 3 - Vital Signs of Ophthalmology  17:09  Ocular complications of diabetes 20:22 Screening for diabetic retinopathy; Reports and Abbreviations 26:07 Counseling Patients: The eye is a camera; Clinical symptoms of ocular complications  32:07 Fluorescein Stain; Treatment Options for Diabetic Eye Disease: NPDR, PDR, VH, and RD  41:16 Eye Vitamins for Macular Edema 43:35 Cataracts  47:22 Missing Glaucoma Drops  50:50 Periop Optimization for Cataract Surgery, Anticoagulation and Other Medical Management  58:14 Take Home Points, Plug: 20/20 Sim; Outro Sponsor – VCU Health Continuing Education     Links* Mindset: The New Psychology of Success by Carol S.  Dwek  Crackdown Podcast 20/20 Sim Site   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will discuss screening, counseling, and management of common ocular diseases seen within primary care.    Learning objectives After listening to this episode listeners will…   Define and assess the three vital signs of ophthalmology.  List ocular complications of diabetes. Counsel a patient on a new diagnosis of  diabetic retinopathy. Describe treatments for diabetic retinopathy. Define proliferative retinopathy, non-proliferative retinopathy, and macular edema. Compose a perioperative medication management plan for cataract surgery   Disclosures Dr. Chadha reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Chan C., Chadha N., Okamoto E., Watto MF. “#237 Ophthalmology for Primary Care”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Original air date October 19, 2020.   Tags Eye, ophthalmology, ophtho, optometry, glaucoma, diabetes, diabetic retinopathy, macular edema, cataracts, cataract surgery, perioperative management, physical exam,  primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student  

Learn which exam maneuvers are worthwhile and which ones are worthless in your approach to shortness of breath. In our evidence based series on the physical exam, we discuss the approach to the dyspneic patient with Dr. Brian Garibaldi (Hopkins, SBM), associate professor of pulmonary and critical care medicine at Johns Hopkins, and co-president of the Society of Bedside Medicine. We discuss the physical exam’s effect on our differential diagnosis, maneuvers that are commonly taught, and some simple tests with great data that may go overlooked. Be prepared, this episode may take your breath away!   Credits Written and Produced by: Justin Berk, MD, MPH, MBA and Sam Masur, MD  Infographic: Sam Masur, MD, Beth Garbitelli Cover Art: Beth Garbitelli Hosts: Stuart Brigham, MD; Matthew Watto, MD, FACP; and Paul Williams, MD, FACP Editor:Justin Berk MD; Clair Morgan of nodderly.com Guest(s): Brian Garibaldi, MD   Sponsors:   National Internal Medicine Day Help ACP celebrate National Internal Medicine Day on October 28th. Visit https://www.acponline.org/NIMD20 to learn how you can show your internal medicine pride. Be sure to tag @ACPInternists and use the hashtags #NationalInternalMedicineDay, #IMProud, and #IMEssential.   VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps Sponsor – National Internal Medicine Day, The American College of Physicians Sponsor – VCU Health Continuing Education 00:00 Intro, disclaimer, guest bio Sponsor – National Internal Medicine Day, The American College of Physicians 03:47 Introduction to evidence-based exam, pre-test probability, and likelihood ratios 05:29 Case from Kashlak Memorial  06:51 Dr. Garibaldi’s initial maneuvers for the dyspneic patient 11:33 Recapping the exam maneuvers 14:05 Likelihood ratios for common maneuvers 18:25 Over 6/Under 6 maneuvers 25:30 Recap of Dr. Garibaldi’s go-to maneuvers 28:19 Role of labs and diagnostic imaging 31:03 Role of point-of-care ultrasound (POCUS) 34:10 Friday at 5pm 36:31 Take home points 39:25 Outro Sponsor – VCU Health Continuing Education   Links* Stanford 25: Teaching and promoting bedside exam skills to students, residents and healthcare professionals both in person and online The 5 Minute Moment at the Society of Bedside Medicine The POCUS Atlas: Evidence Based Point of Care Ultrasound   Goal Listeners will feel confident how to optimally use the physical exam to guide clinical decision-making in patients presenting with dyspnea.   Learning objectives After listening to this episode listeners will…   Describe the effectiveness of the exam when it comes to aiding diagnosis in a patient with dyspnea Identify specific exam maneuvers that can aid clinical decision-making  Identify exam maneuvers that may not offer more information compared to imaging such as POCUS   Disclosures This episode was made with assistance from the Society of Bedside Medicine and funding from the New York Academy Medicine.  Dr Garibaldi reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Masur S, Garibaldi BT, Watto M, Williams P, Brigham S, Berk J.  #236 Physical Exam Series: Approach to Shortness of Breath. The Curbsiders Internal Medicine Podcast. https:/www.thecurbsiders.com/episode-list. Original Air Date October 12,  2020.   References Mochizuki K et al. Importance of respiratory rate for the prediction of clinical deterioration after emergency department discharge: a single-center, case-control study. Acute Med Surg. Nov 2016. doi:10.1002/ams2.252 Sarkar M et al. Physical signs in patients with chronic obstructive pulmonary disease. Lung India. 2019. doi:10.4103/lungindia.lungindia_145_18 Fagan TJ. Letter: Nomogram for Bayes theorem. N Engl J Med. 1975;293(5):257. doi:10.1056/NEJM197507312930513 Simel, David, et al. Rational Clinical Examination, McGraw-Hill Professional Publishing, 2009. ProQuest Ebook Central  McGee, Steven. Evidence-based physical diagnosis [4th edition] Elsevier, 2018. Clinical Key Benbassat, J., Baumal, R. Narrative Review: Should Teaching of the Respiratory Physical Examination Be Restricted Only to Signs with Proven Reliability and Validity?. J GEN INTERN MED 25, 865–872 (2010). https://doi.org/10.1007/s11606-010-1327-8 Al Deeb M et al. Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: a systematic review and meta-analysis. Acad Emerg Med. 2014;21(8):843-852. doi:10.1111/acem.12435 Yousefifard et al. Screening Performance Characteristic of Ultrasonography and Radiography in Detection of Pleural Effusion; a Meta-Analysis. Emerg (Tehran). 2016;4(1):1-10. Martindale et al. Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med. 2016;23(3):223-242. doi:10.1111/acem.12878 Caldentey et al. Prognostic value of the physical examination in patients with heart failure and atrial fibrillation: insights from the AF-CHF trial (atrial fibrillation and chronic heart failure). JACC Heart Fail 2014.. doi:10.1016/j.jchf.2013.10.004   Tags Physical exam, dyspnea, shortness of breath, auscultation, PMI, percussion, heart failure, wheeze, POCUS, COPD, JVD, hepatojugular reflux, observation, asymmetry, Brian Garibaldi, practice, pallor, lung, heart, hands.

Time for spooky cakes with a side of candy corn. We discuss Dapagliflozin (SGLT2i) for CKD, Turmeric for knee pain and Honey for URTI (cough) on this halloween themed hotcakes with Rahul Ganatra MD, MPH @rbganatra   Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (Note: CME for this episode won’t be available until 10/12/20. We apologize for the inconvenience).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!   Credits Producer: Sarah Phoebe Roberts Written by: Rahul Ganatra MD, MPH, Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP, Sarah Phoebe Roberts MPH    Cover Art: Matthew Watto MD, FACP Hosts: Rahul Ganatra MD, MPH, Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP, Sarah Phoebe Roberts MPH    Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com   Sponsors   National Internal Medicine Day Help ACP celebrate National Internal Medicine Day on October 28th. Visit https://www.acponline.org/NIMD20 to learn how you can show your internal medicine pride. Be sure to tag @ACPInternists and use the hashtags #NationalInternalMedicineDay, #IMProud, and #IMEssential.   VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps 00:00 Sponsor – National Internal Medicine Day, The American College of Physicians 00:25 Sponsor – VCU Health Continuing Education 00:40 Intro, disclaimer, Picks of the Week 07:38 Sponsor – National Internal Medicine Day, The American College of Physicians 08:40 Dapa-CKD 20:00 Turmeric for Knee Osteoarthritis 32:10 Honey for URTI and Cough 46:32 Shout out to @votehealth2020 and PatientVoting.com  48:25 Outro Sponsor – VCU Health Continuing Education   Links* Candy Corn (autumn mix) and (classic) Paul’s Halloween movie marathon: Cabin in the Woods, The Descent, The Witch, Ghostbusters   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will review and perform critical appraisal of recent articles with the potential to change internal medicine practice   Learning objectives After listening to this episode listeners will…   Review the potential benefits of dapagliflozin for prevent of CKD progression and death Evaluate the utility of turmeric for osteoarthritis with inflammatory synovitis Discuss the efficacy of honey for the treatment of acute upper respiratory tract infection and persistent post-infectious cough   Disclosures The Curbsiders report no relevant financial disclosures.    Citation Watto M, Ganatra R, Williams PN, Brigham SK, Roberts SP. “235 Spooky Cakes”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date October 5, 2020.   Tags Dapagliflozin, slgt2i, sglt2 inhibitors, ckd, turmeric, curcumin, knee osteoarthritis, knee pain, synovitis, honey, urti, respiratory tract infection, cough, primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Master your breast cancer screening spiel, cultivate your approach to the breast mass, and empower your patients with empathetic shared decision-making (which we know you’re all already fabulous at)!  On this fantastic episode, we are joined by Dr. Nancy Keating @NancyKeatingMD, policy wonk and primary care doc extraordinaire at Brigham and Women’s Hospital. This episode is rife with drama, as the ACS butts heads with the USPTF and the ACR, and you have to figure out  what’s right for the patient by talking with them--almost as exciting as that moment on Grey’s when Izzie cuts the...anyway, I won’t ruin a key plot point in the most excellent medical show of all time, all in a day’s work, here at The Curbsiders. Enjoy!    Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!   Credits Producer and Writer: Nora Taranto MD Show Notes: Nora Taranto MD, Isabel Valdez PA  Infographic: Nora Taranto MD Cover Art: Kate Grant, MD  Hosts: Stuart Brigham MD, FACP; Matthew Watto MD, FACP; Paul Williams MD, FACP, Nora Taranto MD    Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Reviewer: Arielle Medford MD  Guest: Nancy Keating MD, MPH   Sponsors   Provider Solutions & Development Provider Solutions & Development is a community of experts dedicated to offering guidance and career coaching to physicians and clinicians throughout their entire career journey. With exclusive access to hundreds of opportunities across the nation, reach out today to begin the search for your perfect practice: www.psdrecruit.org/curbsiders.     VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.     Time Stamps Sponsor - Provider Solutions & Development www.psdrecruit.org/curbsiders. Sponsor - VCU Health Continuing Education 00:30   Intro & Guest Bio 03:27   Guest one-liner 05:27   Best Advice for Women in Medicine 07:34   Picks of the Week Sponsor - Provider Solutions & Development www.psdrecruit.org/curbsiders. 10:00   Case 1: Brenda Cantwell and Breast Lump DDx 13:39   Clinical Breast Exam vs Self Breast Exam 17:26   Practical Tips for the Clinical Breast Exam 21:50   Imaging to Evaluate the Breast Lump 26:36   Demystifying BIRADS 28:36   Epidemiology Potpourri 33:02   Breast Pain without a Mass 34:30   Case 2: Mammie Gram and Breast Screening 46:03   Average Risk vs High Risk Screening 47:18   Breast Risk Prediction Tools 48:51   Breast Density 53:16   Imaging Modalities 61:28     Shared Decision Making in Screening   68:04    Case 3: Ms Britta Lumpworth and When to Stop Screening Mammograms 74:42    Take Home Points and Outro Sponsor - VCU Health Continuing Education     Links* Evicted: Poverty and Profit in the American City by Matthew Desmond Run The List podcast  ACOG Practice Bulletin 179, 2017 Elmore et al, Ten Year Risk of False Positive Screening Mammograms and Clinical Breast Examinations, N Engl J Med, 1998.  Thomas, et al, Randomized trial of breast self-exam in Shanghai: final results. JNCI, 2002. Semagliazov et al, Results of a prospective randomized investigation [Russia] to evaluate the significance of self-examination for the early detection of breast cancer, Vopr Onkol, 2003.  Fuller, M. S., Lee, C. I., & Elmore, J. G. Breast cancer screening: an evidence-based update. The Medical clinics of North America, 2015. Chan et al, False-negative rate of combined mammography and ultrasound for women with palpable breast masses. Breast Cancer Res Treat, 2015.  ACS Recommendations for the Early Detection of Breast Cancer, 2020. USPTF Breast Cancer Screening Recommendations, 2016.  Henderson et al, Breast Examination Techniques, 2020.  Kolb et al. Comparison of the performance of screening mammography, physical exam, and breast ultrasound and evaluation of factors that influence them: an analysis of 27.825 patient evaluations, Radiology, 2002.  Mammogram Interpretation, Chapter 2. Radiology Key.Com.  Flobbe et al, The Additional Diagnostic Value of Ultrasonography in the Diagnosis of Breast Cancer. Arch Intern Med, 2003.  ACS Understanding Mammogram Readings, 2019.  Bittner, Guide to mammography reports: BIRADS terminology, Am Fam Physician, 2010.  Seer cancer statistics review, 1975-2017. 2020.  Anders CK et al, Breast carcinomas arising at a young age: unique biology or a surrogate for aggressive intrinsic subtypes?. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011  ACS How Common is Breast Cancer?  SEER Lifetime Risk (%) of Dying from Cancer by Site and Race/Ethnicity: Females, Total US, 2014-2016 Garcia et al, Cardiovascular disease in women: clinical perspectives, Circ res, 2017.  Cancer Statistics Center: Breast Statistics.  Independent UK Panel on Breast Cancer Screening, The Benefits and harms of breast cancer screening: an independent review, Lancet, 2012.  CDC Breast Cancer Screening Guidelines 2020  ACS Breast Cancer Screening Guidelines, 2015 USPTF Breast Cancer Screening Recommendations, 2016.  ACR Breast Cancer Screening Update, 2018.  Canadian Task Force Breast Cancer Screening Recommendations  UK-NHS Breast Cancer Screening Recommendations  Biller-Andorno et al. Perspective: Abolishing Mammography Screening Programs? A View from the Swiss Medical Board, N Eng J Med, 2014.  Nelson et al, Effectiveness of Breast Cancer Screening: Systematic Review and Meta-analysis to Update the 2009 US PTF Recommendation, Ann Intern Med, 2016.  Miller et al, Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial, BMJ, 2014.  Breast Cancer Risk Assessment Tool (NCI)   BCSC Breast Cancer Risk Assessment Tool  Health Decision/University of Wisconsin Decision Tool Harding Center for Risk Literacy Fact Box   Keating et al, Breast Cancer Screening in 2018: Time for Shared Decision Making, Jama Insights, 2018.  ePrognosis life expectancy calculator      *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will learn how to evaluate a breast lump in the primary care clinic, what the guidelines recommend for asymptomatic breast cancer screening, and how to engage a patient in shared-decision making given the data available on mammograms.    Learning objectives After listening to this episode listeners will…   Triage and evaluate the Breast Lump  Perform breast cancer risk assessment  Recall the Guideline Recommendations for Breast Cancer Screening and how they vary  Engage patients in conversation about b...

Listen to our medical education heroes, Dr. Abby Spencer, @abbyCCim (Cleveland Clinic), and Dr. Alia Chisty, @aliachisty (Penn State Health), school us on how to give effective and meaningful feedback! Topics include: the ADAPT framework, how to give difficult feedback, keywords and phrases when giving feedback, how to avoid gender and racial bias when giving feedback, giving feedback to your peers and how to solicit effective feedback as a team leader.     Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!   Credits Written and Produced by Paul Williams MD, FACP Cover Art: Paul Williams, MD, FACP Infographic: Edison Jyang Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guests: Abby Spencer MD and Alia Chisty MD   Sponsors   Provider Solutions & Development   Provider Solutions & Development is a community of experts dedicated to offering guidance and career coaching to physicians and clinicians throughout their entire career journey. With exclusive access to hundreds of opportunities across the nation, reach out today to begin the search for your perfect practice: www.psdrecruit.org/curbsiders. VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.    Time Stamps Sponsor - Provider Solutions & Development www.psdrecruit.org/curbsiders. Sponsor - VCU Health Continuing Education 00:30 Intro, disclaimer, guest bio, pun 04:00 Guest one-liners, Picks of the Week* (see links below) 10:25 Sponsor - Provider Solutions & Development www.psdrecruit.org/curbsiders. 11:00 Case from Kashlak, Feedback definitions 15:00 Addressing perceived barriers to feedback 31:45 ADAPT model of feedback 38:10 Addressing potentially gendered feedback;  42:45 Giving feedback to those who lack insight 48:29 Feedback and racial bias 52:25 Giving peer feedback 58:10 Tips for soliciting feedback as a supervisor 69:05 Does giving difficult feedback mean people won’t like you? 75:10 Take home points and Outro Sponsor - VCU Health Continuing Education   Links* Radical Candor (book) Host (film) Percy Jackson & The Olympians: The Lightning Thief movie  Hamilton on Disney Plus Her (film)    *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will demonstrate effective techniques to deliver and solicit meaningful feedback.   Learning objectives After listening to this episode listeners will…   Discuss the definitions and terms used to discuss feedback. Deliver effective feedback that is concordant with the learning goals of their trainees. Address potential perceived barriers to feedback. Utilize the ADAPT framework to partner with their learners and develop shared goals. Develop strategies to mitigate against using gender- or racially-biased narrative language. Deliver feedback to learners with limited insight by leveraging the impact of perception on achieving goals. Solicit effective and meaningful feedback despite being in a position of authority   Disclosures Drs. Spencer and Chisty report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Williams PN, Spencer A, Chisty A, Brigham SK, Jyang E, Watto MF. “#233 Giving effective feedback with Abby Spencer and Alia Chisty”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date September 21, 2020.   References  Ende J. Feedback in Clinical Medical Education.  JAMA.  1983. . [https://pubmed.ncbi.nlm.nih.gov/6876333/]  Brown B.  2018.  Dare to Lead.  Random House. Stone D and Heen S.  2014.  Thanks for the Feedback.  Penguin Books. Scott K.  2019.  Radical Candor.  St. Martin’s Press. Fainstad T et al.  Feedback can be less stressful: Medical trainee perceptions of using the Prepare to ADAPT (Ask-Discuss-Ask-Plan Together) framework.  Cureus.  2018. [https://pubmed.ncbi.nlm.nih.gov/30906679/]  Rojek AE et al.  Differences in narrative language in evaluations of medical students by gender and under-represented minority status.  J Gen Int Med.  2019.  [https://pubmed.ncbi.nlm.nih.gov/30993609/]  Mueller AS et al.  Gender differences in attending physicians’ feedback to residents.  JGME.  2017.  [https://pubmed.ncbi.nlm.nih.gov/29075375/]  Ross, DA et al.  Differences in words used to describe racial and gender groups in Medical Student Performance Evaluations.  PLoS ONE.  2017.  [https://pubmed.ncbi.nlm.nih.gov/28792940/] 

Dive deep into common dermatological conditions of the scalp and face including alopecia, seborrheic dermatitis, rosacea, acne, and even the scourge of health professionals, ‘maskne’! We are joined by our Kashlak Chief of Dermatology and resident Skinternist Dr. Helena Pasieka (of @MedStarWHC). After listening to this episode, your dermatology knowledge will be head and shoulders above the rest! Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).  Note: The full slide deck with images for this episode is not available at this time. We will post it to this show notes page as soon as we clear the image rights.  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!   Credits Written and Produced by: Beth Garbitelli, Matthew Watto MD, FACP,  Cover Art and Infographic by:  Beth Garbitelli Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Beth Garbitelli   Editor:  Cyrus Askin MD (written materials); Clair Morgan of nodderly.com Guest: Helena Pasieka MD, MS   Sponsors   Provider Solutions & Development Provider Solutions & Development is a community of experts dedicated to offering guidance and career coaching to physicians and clinicians throughout their entire career journey. With exclusive access to hundreds of opportunities across the nation, reach out today to begin the search for your perfect practice: www.psdrecruit.org/curbsiders.   VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps Sponsor - Provider Solutions & Development www.psdrecruit.org/curbsiders. Sponsor - VCU Health Continuing Education 00:30 Intro, disclaimer, guest bio 04:35 Guest one-liner, Picks of the Week*: Hamilton and Alexander Hamilton by Ron Chernow, Ultra-Gooey Stovetop Mac and Cheese Recipe, The Food Lab: Better Home Cooking Through Science by J. Kenji Lopez-Alt Sponsor - Provider Solutions & Development www.psdrecruit.org/curbsiders 08:30 Case 1: Alopecia  12:05 Assessing scalp for inflammatory changes and follicular drop-out 13:10 Central Centrifugal Cicatricial Alopecia (CCCA) 14:00 Alopecia/hair loss non-scarring subtypes 25:00 Alopecia Treatments 28:55 Case 2:  Psoriasis vs. Seborrheic Dermatitis  31:45 Looking for psoriatic plaques 32:11 Seborrheic dermatitis hallmarks  35:19 Treatment for Seborrheic Dermatitis 42:10 Case 3: Rosacea vs. Acne  50:40 Differentiating rosacea rash from SLE 52:40 Rosacea management & treatment 55:00 Identifying rosacea in Black skin 56:50 Acne management &  treatment 59:10 Retinoid dermatitis 1:00:30 Maskne 1:02:29 Antibiotics for acne 1:03:38 Retinoids and pregnancy 1:04:09 Doxycycline for rosacea 1:06:15 Take home points Sponsor - VCU Health Continuing Education   Links* Hamilton and Alexander Hamilton by Ron Chernow,  Serious Eats/The Food Lab's Ultra-Gooey Stovetop Mac and Cheese Recipe (Beth’s Cheese Blend: 8oz American cheese, 8 oz Fontina, 8 oz cheddar- not Seriously Sharp!! Also, you may be able to get away with not using 1.5lb of cheese, mix in and see how it goes, feel free to DM @VermontKitchen on Instagram for cooking guidance)  The Food Lab: Better Home Cooking Through Science by J. Kenji Lopez-Alt  Mineral sunscreens: suggestions include Neutrogena Sensitive Skin Sunscreen or Elta MD UV Physical Broad-Spectrum Tinted Facial Sunscreen (Formulations with Zinc Oxide only tend to be very heavy and will not blend well in all skin tones)  Brown Skin Matters on Twitter and Instagram Skin of Color Society American Academy of Dermatology Society for Dermatology Hospitalists Black Skin Directory Learning Journal Mind the Gap (2020) by Malone Mukwende  Ethnic Dermatology: Principles and Practice (2013) Skin of Color: A Practical Guide to Dermatologic Diagnosis and Treatment (2012) An Atlas of African Dermatology (2001)   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goals Listeners will appropriately recognize, diagnose and treat common dermatological complaints of the scalp and face seen in the primary care clinic.   Learning objectives After listening to this episode listeners will... Recognize and treat common skin complaints of the scalp and face in primary care. Become familiar with the basic therapeutic arsenal to treat scalp and face complaints in primary care. Be able to differentiate non-scarring versus scarring hair loss on physical exam. Comprehend nuances in total body presentations of psoriasis as a means to differentiate from seborrheic dermatitis.  Review when referral to dermatology for hair loss or skin changes of the face/scalp  is necessary. Recognize the extreme lack of diversity in dermatology and disparities in outcomes for various diagnoses.   Disclosures Dr. Pasieka reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Pasieka HB, Williams PN, Watto MF, Garbitelli EC. “#232 Skinternship: Scalp & Face”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date September 14, 2020.

Take your salt game to the next-next level. We brushed off this fan favorite episode and rebooted #48 hyponatremia deconstructed with our Chief of Nephrology, Dr. Joel Topf aka @kidney_boy aka The Salt Whisperer for your CME earning pleasure. Learn the correct steps to diagnose and manage this common and dangerous condition. Topics covered include: true versus false hyponatremia, SIADH, tea and toast hyponatremia, beer potomania, safe rates of sodium correction, IV fluid choice, vaptans and more. Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!   Credits Original episode written and produced by: Matthew Watto MD, FACP  Show Notes and CME questions by: Deb Gorth ScM Cover Art and Infographic by: Edison Jyang Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Molly Heublein (written materials); Matthew Watto MD (audio)  Guest: Joel Topf MD Sponsors   POCUS Fellowship at University of Pennsylvania A novel, collaborative, POCUS fellowship training is available at the University of Pennsylvania for IM and FM graduates!  In 2016 they leveraged the robust EM ultrasound fellowship training infrastructure with UPenn’s progressive Department of Medicine to create the 1st multi-specialty clinical ultrasound fellowship.  Their graduating fellows have made them proud by accepting leadership positions, and if you want to be on the cutting edge, you should join their team.   Interview season is in full swing and they’re actively accepting applications.  Please go to pennultrasound.org or contact [email protected] for information.  You can apply for fellowship using the eusfellowships.com portal.   VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps 00:00 Intro 03:30 Guest interview 07:15 Pick of the week w/Dr. Topf 16:20 Clinical case of hyponatremia 17:48 False hyponatremia normal osmolality 19:34 False hyponatremia high osmolality 20:36 Understanding why osmolality matters 23:28 Workup false hyponatremia 24:45 Recap of discussion so far 25:40 ADH dependent vs independent hyponatremia 27:00 Psychogenic polydipsia 289:15 Renal failure and hyponatremia 30:03 Tea and toast, and Beer Drinker’s potomania 35:22 ADH dependent hyponatremia 38:15 Volume versus osmolality 40:00 Volume status exam 45:14 Additional testing with urine lytes and uric acid 47:30 Treatment for SIADH  52:42 Discussion of the vaptans 58:21 Additional testing in SIADH 62:50 When to admit patient for hyponatremia 63:59 Clinical case of hyponatremia complications 68:56 Fluids and rate of correction 73:36 DDAVP clamp 76:30 Moderate hyponatremia 78:35 Diuretic dosing DOES matter! 81:59 Loop diuretics for SIADH 84:25 Take home points 87:25 Outro Links* Dr. Joel Topf’s Textbook Dr. Joel Topf’s Blog Dungeons and Dragons Tartine (cookbook) by Elizabeth M. Prueitt I Hate You, Don’t Leave Me by Hall Strauss Intentional Parenting by Sissy Goff Mindset by Carol Dweck Nintendo Switch 8.0 Bit Techno- The Curbsiders Theme Song by Stuart Kent Brigham Ure-Na  European Society of Endocrinology Clinical Practice Guidelines.  Don’t miss Dr. Topf on twitter aka @kidney_boy.   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.     Goal Listeners will recall the pathophysiology of hyponatremia and develop a systematized approach to identifying the type and cause of hyponatremia, as well as how to safely manage hyponatremia.    Learning objectives After listening to this episode listeners will…   Differentiate true and false hyponatremia Recall the pathophysiology of true and false hyponatremia  Interpret blood and urine tests to identify the cause of hyponatremia Recall the limitations of the volume status exam List ADH dependent causes of hyponatremia List ADH independent causes of hyponatremia  Explain the pathophysiology of beer drinker’s potomania and “tea and toast” hyponatremia Use uric acid to differentiate SIADH from other causes of hyponatremia Basic therapy for SIADH Recall safe rates of correction for hyponatremia   Disclosures Dr. Topf has received honoraria from AstraZeneca and Cara Therapeutics. He is joint venture partner in Davita Dialysis centers receiving dividends. The Curbsiders report no relevant financial disclosures.    Citation Topf J, Gorth DJ, Williams PN, Brigham SK, Heublein M, Jyang E, Watto MF. “REBOOT #48 Hyponatremia Deconstructed”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Original air date: July 17, 2017; Updated September 7, 2020.

Type 1 Diabetes - this episode is definitely a sweet one! Join us for a conversation with our guest Dr. Hussein Abdullatif (UAB), covering the diagnosis, workup, and management of Type 1 Diabetes Mellitus. We discuss the initial lab work-up, approach to treatment, atypical presentation, and how it’s okay to eat donuts around the time of an insulin shot!    NOTE: The show notes and CME for this episode will not be available until Wednesday September 2, 2020 at https://thecribsiders.com/ and cribsiders.vcuhealth.org respectively.   Credits Written and Produced by: Shannon Snellgrove Infographic: Shannon Snellgrove Cover Art: Christopher Chiu MD (Cribsiders); Shannon Snellgrove (Curbsiders) Hosts: Justin Berk MD and Christopher Chiu MD Editor:Justin Berk MD; Clair Morgan of nodderly.com Guest(s): Hussein Abdullatif MD   *Sponsors*   POCUS Fellowship at University of Pennsylvania A novel, collaborative, POCUS fellowship training is available at the University of Pennsylvania for IM and FM graduates!  In 2016 we leveraged the robust EM ultrasound fellowship training infrastructure with UPenn’s progressive Department of Medicine to create the 1st multi-specialty clinical ultrasound fellowship.  Our graduating fellows have made us proud by accepting leadership positions, and if you want to be on the cutting edge, you should join our team.   Interview season is in full swing and we’re actively accepting applications.  Please go to pennultrasound.org or contact [email protected] for information.  You can apply for fellowship using the eusfellowships.com portal.     VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps Diagnosis of T1DM 6:50 Presentation of T1DM 10:10 Explaining T1DM to a parent 12:00 Genetic Predisposition to Diabetes 15:20 T1DM Antibodies 17:10 Initial work-up for concomitant autoimmune disease 21:10 Atypical Presentation of T1DM 22:44 Treatment of T1DM 29:10 Dietary Modifications in T1DM 33:10 Checking blood sugars 39:50 Honeymoon Period 42:25 Hypoglycemia 44:00 Sports, Sickness, Alcohol and Glucose levels 48:25 Periop glucose management 51:10 Long-term complications of T1DM 53:50 Closed Loop System and Future Treatments 56:10   Goal Listeners will feel confident in the presentation, diagnostic workup, and management of Type 1 Diabetes.   Learning objectives After listening to this episode listeners will…   Identify the signs and symptoms of type 1 diabetes  Practice appropriate work-up in the diagnosis of type 1 diabetes Manage type 1 diabetes with evidence-based therapies Identify the appropriate insulin analogues in daily diabetes management using basal/bolus concepts Educate patients and have meaningful discussions about effective self-management of type 1 diabetes (including diet and lifestyle changes)   Disclosures Dr Abdul-Latif reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures.    Citation Abdullatif H, Snellgrove S, Chiu C, Berk J. “Type 1 Diabetes”. The Cribsiders Pediatrics Podcast. https:/www.thecribsiders.com/ September 2, 2020 (link goes live on 9/2/2020)

Are U Talkin’ UTIs Re: Me? Infectious Diseases expert, Dr Boghuma Titanji MD, PhD  @boghuma (Emory; TED) schools us on the diagnosis and management of urinary tract infections: updated definitions of complicated and uncomplicated UTI, pitfalls of the urinalysis, first line antibiotics, duration of therapy and which agents to use for complicated UTI. This episode is liquid gold!  Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!   Credits Written and Produced by: Matthew Watto MD, FACP  Cover Art and Infographic by: Edison Jyang Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Molly Heublein MD (written materials); Clair Morgan of nodderly.com Guest: Boghuma Kabisen Titanji MD, PhD Sponsor - VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps Sponsor - VCU Health Continuing Education 00:30 Intro, disclaimer, guest bio 02:50 Guest one-liner, Picks of the Week*: Urban gardening, Behave (book) by Robert Sapolsky 08:54 Defining UTI; Framework for UTI 16:35 Case 1 - Cath Foley; Acute uncomplicated cystitis; Interpreting the Urinalysis 28:00 Women with recurrent UTIs 38:55 Case 2 - UTI in a man 47:15 Treatment of complicated infections; Duration of therapy 52:27 Case 3 - Catheter associated UTI; MRSA UTI 61:25 Duration of therapy for bacteremia from UTI 64:40 Take home points, plugs and outro Sponsor - VCU Health Continuing Education   Links* Behave (book) by Robert Sapolsky Boghuma’s blog theiddoc.net Boghuma’s TED Talk  Emory’s ID fellowship program   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goals Listeners will appropriately recognize, diagnose and treat the various presentations of urinary tract infection.   Learning objectives After listening to this episode listeners will... Define UTI and feel confident making the diagnosis of UTI based on lab tests, history and exam findings Differentiate between complicated and uncomplicated UTI Recognize how UTI may presents differently in differ groups (paraplegic, chronic foley catheter, men and women) Choose the appropriate antibiotic and duration with an eye towards antibiotic stewardship Determine an approach to the patient with recurrent UTIs, including who may benefit from long term antibiotic prophylaxis.    Disclosures Dr Titanji reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Titanji BK, Williams PN, Watto MF. “#231 U Talkin’ UTIs Re: Me”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date August 24, 2020.

Does the thought of managing acute decompensated heart failure (ADHF) give you paroxysmal nocturnal dyspnea?  Recline for a bit while Dr. Michelle Kittleson MD, PhD @MKittlesonMD (Cedars Sinai) takes us through the Zen of jugular venous pressure (JVP) exams, how to approach diuresis, and the fine points of hospital discharge. This knowledge food is easier to swallow than an oral potassium replacement. Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits Written and Produced by: Deborah Gorth ScM Cover Art and Infographic by: Edison Jyang Hosts: Matthew Watto MD, FACP and Paul Williams MD, FACP Editor: Cyrus Askin MD (written materials); Clair Morgan of nodderly.com Guest: Michelle Kittleson MD, PhD Sponsor - VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Time Stamps 00:00 Intro 02:40 Guest one-liner; Picks of the Week 08:33 Case from Kashlak part 1, Definition of acute decompensated heart failure (ADHF), Factors that lead to ADHF (FAILURE mnemonic) 13:39 Historical clues for ADHF; Is salt restriction needed? Fluid restriction? 20:42 More on History and Physical exam for ADHF; JVP exam in detail; Crackles are worthless?! 28:36 Labs to trend during an ADHF admission 33:15 Recap of history, physical exam, and initial approach; Initiating diuresis; Goal urine output; Diuresis in HFrEF vs HFpEF phenotypes 45:32 Diuretic resistance and when to use a drip, metolazone; Do K and Mg need to be 4 and 2? 49:05 When to hold guideline directed medical therapy (Beta blockers, ARNI, ACEI/ARB) 56:05 Who needs a right heart cath? 59:30 Endpoints for discharge; Switch to PO diuretics; Approach to discharge and transitions of care 64:04 SGLT2i in heart failure 68:15 Take home points and outro

Join us for an extra-hot summer episode featuring our critical appraisal expert, Rahul Ganatra MD, MPH @rbganatra. Prepare to marvel as he breaks down his recent tweetorial on the RECOVERY trial of dexamethasone for COVID-19; to gasp as Paul Williams updates us on statins and ASCVD prevention and to be enthralled by the dulcet tones of Matt Watto explaining the latest research on DAPT vs. monotherapy with ticagrelor. Bonus: a new hotcakes rating scale has arrived! Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits Producer: Sarah Phoebe Roberts Show Notes by: Sarah Phoebe Roberts Writer: Rahul Ganatra MD, Sarah Phoebe Roberts, Matthew Watto MD, Paul Williams MD Cover Art: Matthew Watto MD Hosts: Rahul Ganatra MD, Matthew Watto MD, Paul Williams MD Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Sponsor: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Time Stamps 00:00 Intro 02:15 Picks of the Week 06:15 New Hotcakes rating scale 09:20 RECOVERY trial 17:30 Rapid home-testing for COVID 20:15 Statins and ASCVD prevention 32:30 Ticagrelor monotherapy after ACS 41:30 Outro Picks of the week Paul: U Talkin' Talking Heads 2 My Talking Head podcast Sarah: New hotcakes scale! Rahul: Chromeo’s new Quarantine Casanova album Watto: 30 Rock season 1, episode 3 “Blind Date”

Blazing hot tips to diagnose and treat hyperthyroidism with Dr Eve Bloomgarden, @evebmd (Northwestern). We cover a ton of ground including how to: interpret thyroid function tests, use your thumbs (or an ultrasound) to examine the thyroid, become an expert on Graves’ orbitopathy, prescribe methimazole and decide who needs surgery or radioactive iodine therapy. Plus, a bit on subclinical hyperthyroidism. This episode is on fire! Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits Written and Produced by: Tima Karginov and Matthew Watto MD, FACP Infographic by: Tima Karginov Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Eve Bloomgarden MD Sponsors: Pediatrics On Call podcast by the American Academy of Pediatrics If you provide medical care to children, Pediatrics On Call — the new podcast from the American Academy of Pediatrics — will help you do it better. Each week, hear the latest news and research on children's health, on topics from obesity and mental health to keeping the kiddos safe when they’re stuck at home. Subscribe from your favorite podcast provider or find the latest episodes here. VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Time Stamps 00:00 Intro 03:15 Guest one-liner, favorite failure, Picks of the Week* 08:50 Sponsor 10:37 Background, Definition of Hyperthyroidism, thyrotoxicosis; Basic labs 14:20  Case from Kashlak, Symptoms of Hyperthyroidism 25:00 Grave’s eye disease: exam, therapy and counseling 32:35 Thyroid exam and ultrasound 38:55 Thyroid Stimulating Immunoglobulin 41:00 Biotin 44:30 Thyroid Scintigraphy 49:00 Causes of Thyrotoxicosis 52:00 Treatment & Adherence to antithyroid medication (methimazole) 56:20 Beta Blockers in thyrotoxicosis 64:50 Subclinical Hyperthyroidism 67:00 Take Home Points, Outro

The American Academy of Pediatrics (AAP) recommends that schools strive to reopen in the Fall, but there is hesitation from families and teachers alike. We speak with Dr. Sharfstein, a public health expert and pediatrician, regarding the importance of reopening schools for children, what criteria need to be met prior to opening, and how to keep children and teachers safe. Tune in to learn transmission amongst children, how other countries have reopened, why to cohort children, and how the primary care pediatrician can assist in the coming school year! Credits Producers & Writers: Edward Corty, Nicholas Lee MD Infographic: Nicholas Lee MD Cover Art: Chris Chiu MD Hosts: Justin Berk MD, Chris Chiu MD, Edward Corty Editor:Justin Berk MD; Chris Chiu MD Guest(s): Joshua Sharfstein MD Sponsors: Pediatrics On Call Sponsor: VCU Health Continuing Education - to offer FREE continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org or cribsiders.vcuhealth.org Time Stamps Introduction 1:00 How to answer “What do you think about school openings?” 11:30 Risk Assessment of School Re-openings 14:40 Evidence of Transmission among Children 17:10 What Other Countries Have Done 19:40 Community Threshold for Re-Opening and Using Protocols 20:30 The Reasons to Cohort 22:45 How to Address Scenarios 24:20 Health Disparities and Return to School 27:00 Existing Inequities and Children’s Sacrifice of Education 29:00 “Opting Out” of School Return and Feeling Safe 31:30 How Can Governments Help Support the Return 35:50 Guidance to give as PCP 37:50 School Alternatives / Innovations to Going Back 40:10 The Difference Between Equity and Equality 42:50 Testing in Schools 43:45 Resources to Follow For More Information 46:00 Take-Away Points 47:10 Optimism 48:25 Picks of the Week 53:50

Swim through the sea of acronyms as Dr Scott Matherly (@liverprof) helps us become a little less baffled by the thought of NAFLD. We discuss the initial diagnosis of fatty liver disease, indications for additional evaluation with imaging and/or biopsy, and potential treatment options. With a quarter of the world affected, it’s crucial to understand the various forms of disease and how to counsel patients about this all-too-common condition! Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits Written and Produced by: Elena Gibson MD Infographic and Cover Art: Elena Gibson MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com Guest: Scott Matherly MD Sponsor: Pediatrics On Call Sponsor:  VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account! Time Stamps 00:00 Intro 03:15 Guest one-liner; Picks of the Week*
: 08:15 Sponsor 08:50 Case from Kashlak part 1; What is hepatic steatosis? 11:43 NAFLD acronyms and definitions 18:20 Alcohol and Fatty Liver 23:15 Initial Evaluation of NAFLD 35:12 Dr Matherly’s piel to patients with fatty 41:11 NASH/Fibrosis Risk Assessment 48:54 Outcomes in NASH with Fibrosis 51:20 Statins are safe in liver disease 56:15 Treatment Options (surgery, Vitamin E, Pioglitazone, SLGT2 inhibitors and GLP1 agonists; Coffee?!) 71:42 Take home points and Outro

Get a grip on acute kidney injury (AKI) with Dr. Joel Topf (AKA @kidney_boy), Kashlak’s Chief of Nephrology! We’ve put together an AKI highlight reel - focusing on practical tips and tricks to help you identify, diagnose and manage AKI, plus how to recognize AIN and random myths and musings on vancomycin, NSAIDS, contrast nephropathy, and the risk of NSF from gadolinium.  Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits Written (including CME questions) and Produced by: Cyrus Askin, MD Infographic by: Cyrus Askin, MD Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Joel Topf, MD Sponsor: Pediatrics On Call  Sponsor: VCU Health CE - Check out curbsiders.vcuhealth.org and create your FREE account! Time Stamps 00:00 Intro 03:00 Guest one-liner, Picks of the Week*: Zoe Keating albums (Cellist); Mrs. America (TV series) on FX; The Last of Us (Videogame); 08:45 Sponsor 09:15 Definition of acute kidney injury (AKI) and fundamentals 11:00 Cardiorenal syndrome 12:24 Schema for AKI 17:30 Establish an etiology, determine urine output and address electrolyte abnormalities 21:22 AKI in the otherwise-healthy patient; 32:20 Rhabdomyolysis
38:21 Vancomycin 41:43 Acute interstitial nephritis (AIN) 44:52 Contrast induced nephropathy (CIN) 50:37 Gadolinium in AKI and/or CKD 52:53 Timing of dialysis 56:37 AKI in the out-patient setting and how to handle home meds e.g. TMP-SMX, RAAS inhibitors; 62:01 Is Ultrasound necessary in AKI 64:58 Dr. Topf’s take home points and Plug for Seminars in Nephrology

Listen as our expert guests, Kelly Graham, MD, MPH (@KellyGrahamMD) and Lekshmi Santhosh, MD MAEd (@LekshmiMD), detail the professional and personal challenges faced by women in medicine during the COVID-19 pandemic. Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME!   Credits Produced by: Leah Witt MD & Shreya Trivedi MD  Written by: Molly Heublein MD, Isabel Valdez PA-C, Leah Witt MD & Shreya Trivedi MD Infographic & Cover Art: Edison Jyang Hosts: Leah Witt MD & Shreya Trivedi MD, Justin Berk MD, MPH, MBA Editor: Molly Heublein MD and Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guests: Kelly Graham, MD, MPH; Lekshmi Santhosh, MD MAEd    Sponsor: VCU Health CE - Check out curbsiders.vcuhealth.org and create your FREE account!   Episode Breakdown Intro, disclaimer Introduction and bio for Kelly Graham, MD, MPH Introduction and bio for Lekshmi Santhosh, MD MAEd One-liner for Kelly Graham, MD, MPH One-liner for Lekshmi Santhosh, MD MAEd Gender Awakening Moments Picks of the Week* Case from Kashlak Difficulty with lack of childcare while working Hippocratic Oath paradox Dr. Santhosh’s 3 Ps Motherhood penalty-fatherhood bonus Two Pandemics, One Response Breadwinner-homemaker bias Female physician burnout Minority Tax Silver Linings Take home points and Outro

Jump into an episode dedicated to hospital based addiction medicine, as we cover common scenarios hospitalists encounter.  In this episode we talk to addiction medicine expert, Dr. Melissa Weimer @DrMelissaWeimer (Yale) about inpatient management of patients with substance use disorders. Topics include: the management of polysubstance withdrawal,  approaching acute pain management for a person with opioid use disorder, and inpatient harm reduction strategies. After this episode listeners will gain new tools to help them best care for hospitalized patients with substance use disorders. Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | CME! Credits Writers and Producers: Carolyn Chan MD, Deb Gorth, and Nora Taranto MD Cover Art and Infographics by: Carolyn Chan, MD Hosts: Stuart Brigham MD; Paul Williams MD, FACP; Carolyn Chan MD Editor: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com Guest: Dr. Melissa Weimer Sponsor: VCU Health CE - Check out curbsiders.vcuhealth.org and create your FREE account! Time Stamps Intro, disclaimer, guest bio : 00:00 Guest one-liner:    03:00 Picks of the Week*:   08:20 Case from Kashlak:  10:30 Urine Toxicology Screens 11:30 Discussing Urine Toxicology Screens with Patients  13:20 Management of Polysubstance Withdrawal 16:16 Tapering Benzodiazepines   19:56 Acute Pain Management and Opioid Use Disorder 30:35 Active Drug Use in the Hospital 38:52 Harm Reduction 40:00 Discharges - Planned 43:43 Perioperative Buprenorphine and Methadone: 46:50 QT Prolongation and Methadone - 52:53 Outro 56:21

Our very first Cribsiders/Curbsiders crossover episode! Learn about cystic fibrosis care across the lifespan. We dive into the diagnosis of CF (don’t lick your patients!), management of pulmonary and extrapulmonary complications, and the future of CF. You’ll also get tips on CF in adolescents and young adults, as well as recognizing undiagnosed CF in older patients. Our guest, Dr. Whittney Warren, is a pulmonary critical care doctor and the medical director of the Adult Cystic Fibrosis clinic in an academic hospital in Texas. Show notes: https:/www.thecribsiders.com/.   Credits Writer, Producer, Infographic, CME Questions: Clara Mao  Cover Art: Christopher Chiu MD Hosts: Justin Berk MD, Christopher Chiu MD, and Matthew Watto MD Editor: Justin Berk MD; Clair Morgan of nodderly.com Guest: Whittney Warren DO    Time Stamps Intro / Disclaimer 0:00 Guest bio 2:25 Guest one-liner, picks of the week 3:15 Explaining CF to patients, life expectancy  7:00 Types of CF mutations and phenotypes 11:50 Presentation of CF in older patients 15:20 Screening and diagnosis 16:40 PFTs and airway clearance 25:20 Nutrition and the “CF diet” 29:10 CF exacerbations and antibiotic selection 32:25 Extrapulmonary manifestations 39:35 Transition of care for CF adolescents (alcohol, exercise, sex) 43:50 CFTR modulator therapy 51:35 Lung transplantation 54:45   Goal Listeners will develop a systematic approach towards long-term management and acute exacerbations of cystic fibrosis.   Learning objectives After listening to this episode listeners will…   Explain the pathophysiology underlying cystic fibrosis. Identify maintenance therapies that optimize pulmonary function and nutritional status in patients with cystic fibrosis. Choose evidence-based practices in the management of cystic fibrosis-associated pulmonary exacerbations.

This episode is Half COVID Cakes, Half Hotcakes, and entirely enlightening.  Our guest Dr. Utibe Essien MD, MPH @UREssien and Curbsider/epidemiologist, Dr. Rahul Ganatra MD, MPH @rbganatra discuss some Hot COVID Cakes including: racial differences in COVID-19 outcomes, why dogs and dexamethasone may hold the key to defeating COVID-19, how hormonal adjunctive therapies might be key for depression, and when to poo-poo probiotics versus when a side of Lactobacillus may be beneficial. Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | CME! Credits Written and Produced by: Rahul Ganatra MD, MPHl Emi Okamoto MD; Sarah P. Roberts MPH; and Matthew Watto MD Show Notes and CME questions by: Deborah J. Gorth ScM Cover Art: Deborah J. Gorth ScM Hosts: Matthew Watto MD; Rahul Ganatra MD, MPH, Emi Okamoto MD, and Sarah P. Roberts MPH Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest: Utibe Essien MD, MPH Sponsor: VCU Health CE - Check out curbsiders.vcuhealth.org and create your FREE account! Time Stamps 00:00 Intro, disclaimer, guest bio 02:20 Silver Linings / Picks of the Week: Chicken Run (2000) and Chicken Run 2 on Netflix; Philly Inquirer story on COVID sniffing dogs; Buy some peaches! And check out their Wikipedia page! 07:33 Hospitalizations and Mortality Among Black and White patients with COVID-19 26:10 Dexamethasone for COVID-19 28:55 Hormonal therapy for depression 38:16 Probiotics 45:00 Outro

Listen as our esteemed guest Dr. Utibe Essien @UREssien walks us through key terminology and evidence necessary to understand anti-Black racism in medicine. Dr. Essien provides insights into ways that racism impacts our work in the clinical and academic settings and offers approaches for addressing anti-Black racism in these settings. Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | CME! Credits Producer and Writer: Joniqua Ceasar MD, Hannah Abrams MD Cover Art: Hannah Abrams MD Infographic: Beth Garbitelli Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Joniqua Ceasar MD Editor: Paul Williams MD, Chris Chiu MD (written materials); Clair Morgan of nodderly.com Guest: Utibe Essien MD Sponsor: VCU Health CE - Check out curbsiders.vcuhealth.org and create your FREE account! Time Stamps 00:00 Intro, disclaimer, guest bio 02:40 Guest one-liner, Picks of the Week*: Just Mercy 09:20 Statement from the show; Importance of discussing racism in medicine 14:11 Definitions 18:06 Identifying how racism manifests in the clinical setting 37:46 Ideas for advocacy 49:50 Take points and Outro

Throw out your down pillows and join The Curbsiders for this lively discussion on interstitial lung disease. While the hundreds of interstitial lung disease types make this topic a bit overwhelming, breathe easy knowing that pulmonologist, Dr. Erin Narewski @erinnarewski (Temple), can boil things down to an easy to approach framework in less time than it takes to complete a few 6-minute walk tests. In this episode, we walk through the classification, relevant patient history, workup, and management of interstitial lung disease. Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | CME! Credits Written and Produced by: Paul Williams, MD, FACP; Nicole Kus, David Madnick, and Peter Wikoff Infographic and Cover Art: Edison Jyang Show Notes: Deborah Gorth Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Paul Williams MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Erin Narewski DO, FCCP Sponsor: ACP membership acponline.org/member Sponsor: VCU Health CE - Check out curbsiders.vcuhealth.org and create your FREE account! Time Stamps 0:00  Intro 03:14 Guest one-liner, career advice, favorite failure, Picks of the Week*: The Strain, FX Horror TV Show; One Hundred Years of Solitude (book) by Gabriel Garcia Marquez; Hypoallergenic pillows; Peanut butter whiskey 10:02 Sponsor - Join the ACP community! Be IM Proud Visit acponline.org/member and use the code ACPDISCOUNT 11:00 Case from Kashlak, Definitions 16:40 Buckets of ILD 32:06 Discussion of testing ILD: Labs and Imaging 44:20 Imaging findings in ILD 49:44 Basic Management of ILD 61:00 Take home points and Outro

We’re going upstream! Dr. Karen DeSalvo (@KBDeSalvo) talks social determinants of health, arming us with a framework to consider this very challenging aspect of patient care. As Society for General Internal Medicine President and Chief Health Officer at Google Health, she shares her clinical and public health experience, including weathering Katrina in New Orleans. While our clinical care largely focuses on the downstream medical consequences, we must recognize the upstream social context to address the barriers to health and wellbeing. Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | CME! Credits Written and Produced by: Emi Okamoto MD Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Emi Okamoto MD Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest: Karen DeSalvo MD, MPH, MSc Sponsor: VCU Health CE - Check out curbsiders.vcuhealth.org for and create your FREE account! Time Stamps Intro, disclaimer, guest bio 0:44 Dr Desalvo’s one-liner 3:34 Picks of the Week*- The Great Influenza book by John M Barry  5:01 Dr Desalvo’s advice and past experience 6:10 Case from Kashlak 10:30 What about the evidence for social determinants? 13:40 What to do about this in the clinic, and is it worth screening? 16:06 Approaching as a team and with the community 19:40 How do we affect the upstream, before the downstream consequences? 22:40 NAM recommendations and framework 26:00 The role of technology 30:00 What are Social Determinants of Health (SDOH), and who they affect 34:00 Start paying attention to SDOH 37:00 Outro 38:49

Answers to common questions in post-op care with our Kashlak Chief of Perioperative Medicine Dr. Avital O’Glasser. She provides updates in delirium prevention, perioperative medication management, pain control, and even clarifies a lesson from Meredith Grey about causes of post-op fever. Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | CME! Credits Written: Hannah Abrams MD, Avital O’Glasser MD Produced by, Infographic and Cover Art by: Hannah Abrams MD Hosts: Hannah Abrams MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Avital O’Glasser MD (written materials); Clair Morgan of nodderly.com Guest: Avital O’Glasser MD Sponsor: ACP - acponline.org/member Sponsor: VCU Health CE -Check out curbsiders.vcuhealth.org and create your FREE account! Time Stamps 00:00 Intro 02:53 Guest one-liner, Picks of the Week*: 12 Angry Men 1957 Movie; Hedwig and the Angry Inch Cast Recording; PCSSNow Buprenorphine Waiver Training for Medical Students 09:28 Sponsor 10:17 Kashlak case; How to collaborate with our surgical colleagues 13:45 Questions to ask at the time of transfer 23:00 Routine Post-Op Care: Bowel regimen, pain control, delirium prevention, glucose, antihypertensives, and nausea 44:25 Co-managing Complications and Fever/Tachycardia; Brief discussion of VTE prophylaxis 57:55 Outro

Join us as we delve into the paradigm-shifting ethos of trauma-informed care with renowned expert Dr. Megan Gerber, Associate Professor of Medicine at Boston University School of Medicine, Medical Director of Women’s Health for VA Boston where she directs the Women’s Health Fellowship, editor of “Trauma-informed Health Care Approaches: A Guide for Primary Care.”  We discuss the framework for trauma-informed universal precautions, as well as basics about the prevalence of trauma, strategies for integrating a trauma-sensitive approach into primary care, practical changes for the office environment,  modifications for physical exam methods, and more. We recognize this topic may be triggering. If you are struggling with thoughts of harming yourself, the national suicide prevention lifeline number is 1-800-273-8255. Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits Producer/Writer/Graphics: Beth Garbitelli Co-Producer: Paul Williams MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Beth Garbitelli Editor: Molly Heublein MD (written materials); Clair Morgan of nodderly.com Guest: Megan Gerber MD, MPH, FACP Sponsor: ACP - Visit acponline.org/member Sponsor: VCU Health CE - Check out curbsiders.vcuhealth.org and create your FREE account! Time Stamps Intro, disclaimer, guest bio (0:00 - 3:15) Guest one-liner (3:30) Kashlak Cases (13:45) Epidemiology of trauma (15:18) Trauma and #MeToo (18:10) Defining Trauma-Informed Care (TIC) (19:00) Integrating TIC into primary care (22:48) Screening in TIC (25:00) Containment and retraumatization (29:00) Inquiring about trauma (30:45) Recap and Office Visit Mechanics (35:30) Building the Relationship (38:00) Common Inquiry Mishaps (38:52) TIC Physical Exam (40:20) Resources for Patients (44:30) Office Environment (48:00) Provider Burnout (50:00) TIC in Covid-19 (52:30) Take-home Points (56:20)

Introducing our friends, The Curious Clinicians: Why do human bodies work how they do? Why do medications work, or not work? Do you miss digging into the “why” behind what we do every day? Join Hannah Abrams (@hannarabrams), Tony (@tony_breu), and Avi (@AvrahamCooperMD) in the Curious Clinicians podcast as they delve into these questions & more, starting with episode 1: Why does fingernail clubbing happen in so many different diseases? https://curiousclinicians.com/ Check out their website and subscribe on your favorite podcast player.

Stay current with the emerging COVID-19 research including: ACTT-1 (remdesivir), triple therapy with interferon, and conundrums  about SARS-CoV-2 PCR and serologic testing. We’re led by the one and only Curbsider/internist/epidemiologist, Rahul Ganatra MD MPH (@rbganatr). And...just in case you live outside of the habitat for murder hornets and your anxiety about the pandemic had begun to abate, we touch on the CDCs guidance to beware of hungry aggressive rats. Gross!   Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | CME!     Credits Written and Produced by: Rahul Ganatra MD, MPH, Deborah J. Gorth ScM, Emi Okamoto MD, Sarah P. Roberts MPH, and Matthew Watto MD Cover Art: Deborah J. Gorth ScM Hosts: Matthew Watto MD, Rahul Ganatra MD MPH, Emi Okamoto MD, and Sarah P. Roberts MPH Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com   Sponsors: ACP and VCU Health CE   Time Stamps 00:00 Sponsors 00:30 Intro, disclaimer 02:40 Fomites, groceries and killer rats 08:22 Sponsor 09:22 ACTT-1 trial of remdesivir 18:22 Triple therapy with lopinavir/ritonavir, ribavarin and interferon 33:10 Background on PCR testing for SARS-CoV-2; How common are false negative PCR tests? 44:25 Serologic testing for SARS-CoV-2; Utility of antibody testing; Test characteristics 50:30 Outro

Learn the nuances of caring for and building relationships with patients experiencing homelessness from expert internal medicine and addiction physician Stefan Kertesz, return guest from Episode 74 on Opioids and Health Policy (highly recommend a re-listen, y’all!).  Topics: the challenge of creating a welcoming and useful space for individuals experiencing homelessness, how to meet patients where they’re at--both physically and mentally--the challenge of managing diuretics for those without stable access to a bathroom (avoid, if possible), and how absolutely essential the foot exam is. Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits Written and Produced by Nora Taranto MD Infographics by Nora Taranto MD Cover Art by Kate Grant MBChB, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Nora Taranto MD Editor: Carolyn Chan (written materials); Clair Morgan of nodderly.com Guest: Stefan Kertesz MD Sponsor: VCU Health CE Time Stamps 00:00 Intro, disclaimer, guest bio 3:17 Guest one-liner 8:55 Picks of the Week*: Dr. Kertesz’s Book Recommendation: Saul Weiner’s On Becoming A Healer; Nora’s Pick of the week: BackStory (especially their episode on dynamite!) https://www.backstoryradio.org/ 10:07 Case from Kashlak 10:56 Language: How to ask where a patient lives? 13:25 Terminology: Persons Experiencing Homelessness: 14:35 The stats on prevalence of health and illness in the homeless population, and the importance of both medical and environmental factors 20:44 How to start the visit, and how to establish trust early on? 27:40 Why is the mortality rate higher? 35:15 Special conditions and Medication Considerations: Hypertension, Diuretics, Insulin and Food Insecurity, Substance Use Disorders, Feet, and Hepatitis C 54:15 COVID and homeless healthcare 57:00 Care Models 62:30 Take Home Points and Outro

Chase that metronidazole with a beer! Pop some 30 year old pills! Retrain your brain as our esteemed guest Dr. Douglas Paauw goes over his popular annual ACP presentation on Medical Myths. Learn about how some common medical myths originate and continue in our practice. We discuss why it’s okay to drink on metronidazole, take expired medications, inject epinephrine into extremities and why recurrent sinusitis may not really exist. Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | CME! Credits Written and Produced by: Justin Berk, MD MPH MBA Infographic and Cover Art: Beth Garbitelli Hosts: Justin Berk, MD, MPH, MBA; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com Guest: Douglas Paauw, MD Sponsor: VCU Health CE Time Stamps 00:00 Intro, disclaimer, guest bio 02:22 Guest one-liner; Career Advice, Picks of the Week*: Being Mortal, book by Atul Gawande; The Band Played On, book by Randy Shilts; Lagunitas Hoppy Refresher: zero alcohol, zero calories! 06:15 Medical Myth Definitions 10:20 Dogma: Metronidazole and Alcohol; Healthy RCT Metronidazole and Alcohol 19:09 Expired Medications; Military Stockpiling Study 24:22 Aspirin and Nitroglycerin; Unopened eye drops; Epi-Pens; Expired Med Recap 31:13 Sinus Headaches; Trigeminal Nerve; Pearl: Recurrent headaches; Study showing Effectiveness of treatment (92%) 41:07 Epinephrine in extremity; RCT of Epi in Extremities Study showing Experts use it; Podiatry journal 48:39 Take home points and Outro

Elevate your critical appraisal skills as we review the first RCT of remdesivir and share the latest and greatest COVID-19 stories including: Llama antibodies, Stroke statistics, Future Waves, Exit Strategies and Awake Proning. We’re joined by everyone’s favorite Curbsider/internist/epidemiologist, Rahul Ganatra MD MPH (@rbganatra). Rahul provides critical appraisal of the newest randomized control trial (RCT) on remdesivir from the Lancet, and gives us a lesson on why statistical power is so important to consider. We also share updates on strokes, awake proning, pandemic predictions, and we reveal another reason to love llamas (besides those luscious lashes). Llama mia, here we go again! Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | CME! Credits Written and Produced by: Sarah P. Roberts MPH, Rahul Ganatra MD, MPH, Emi Okamoto MD, Paul Williams MD and Matthew Watto MD Cover Art: Beth Garbitelli Hosts: Matthew Watto MD, Paul Williams MD, Rahul Ganatra MD MPH, Emi Okamoto MD , Sarah P. Roberts MPH, Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Sponsor: VCU Health CE Time Stamps 00:00 Intro 02:10 Fun animal facts: Llama antibodies 09:10 Remdesivir RCT by Wang et al 12:40 Power and Sample Size 16:32 Baseline Characteristics, Results and Author’s conclusions 19:15 Rahul’s conclusions: How chance and bias affected the results 24:00 Right censoring; Viral load and timing of antivirals 30:30 Final thoughts on Remdesivir RCT by Wang et al; Looking ahead to the NIAID (ACTT) trial 33:53 Are patients really having fewer strokes and heart attacks? 38:20 Awake proning 43:30 Paul teaches us not to use the term “happy hypoxemic” 45:00 CIDRAP viewpoint on future waves and exit strategies 50:22 Outro

Listen as our esteemed guest Dr. Nina Mingioni (Jefferson) walks us through her approach to fatigue, from differential diagnosis, to the evidence behind physical exam, laboratory workup, and beyond! Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits Writer, Producer, Infographic, and Cover Art: Hannah R. Abrams Hosts: Hannah R Abrams, Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Nina Mingioni MD, FACP Sponsor: VCU Health CE Time Stamps 00:00 Intro, disclaimer, guest bio and a bad pun 03:00 Guest one-liner 07:10 Case from Kashlak, Defining fatigue; Taking a general history 11:36 Most common causes of fatigue and how to elicit them from the history 20:39 Physical exam for fatigue; Medications that cause fatigue; 25:25 Exam findings and LRs for anemia; Sleep apnea 30:55 Lab workup for fatigue; Expanded testing: Ferritin, Vitamins, EBV, Rheumatologic diseases, Celiac disease, Lyme 47:55 Spiel to the patient when no answer is found 51:14 Other diagnoses to consider: Fibromyalgia, Myalgic Encephalomyelitis 55:09 Take home points and Outro

Crush those 11 pm “STAT: Patient agitated” pages with this expert guide to assessing for and treating alcohol withdrawal!  Dr. Joji Suzuki MD, addiction psychiatrist extraordinaire at the Brigham and Women’s Hospital, walks us through how to think about the risk of severe withdrawal, the different ways to manage it, and how to engage with patients as they’re leaving the hospital. In the course of this Car-Talk (well, not exactly the same as the critically acclaimed radio show, but he did record in his car….), Dr. Suzuki demystifies withdrawal and debunks some common myths: that we must manage withdrawal inpatient, that banana bags are the cure to a hangover and alcoholic malnutrition, and that we tend to under-medicate with benzos (actually, it’s the opposite!). Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | CME Credits Written and Produced by Nora Taranto MD Infographic and Cover Art by: Nora Taranto MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Cyrus Askin MD, Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest: Joji Suzuki MD Sponsor: VCU Health CE Time Stamps 00:00 Intro, disclaimer, guest bio 02:52 Guest one-liner; Career advice; Picks of the Week*: Why We Do What We Do (book); Fargo (film) 08:10 A Case from Kashlak and Screening for Alcohol Use and Severe Withdrawal Risk 17:32 Outpatient Versus Inpatient Treatment 25:27 Gabapentin for alcohol withdrawal 27:10 Indicators for ICU level Care 31:53 Symptom-Driven versus Fixed-Dose Protocols , Benzos vs. Barbs 36:55 And which benzo? 39:47 A Natural History of Withdrawal 44:10 Banana Bags and Thiamine Deficiency 48:17 The Transition Home: Naltrexone, Bridge Clinics, and Motivational Interviewing 56:36 Outro and Bonus clip

In this episode we tackle treatment with remdesivir, management with anticoagulation, and presymptomatic transmission. Welcome back to COVID Cakes, a rundown of recent COVID articles and news stories. What does the latest Gilead medication have to offer? Why should we wear masks? And if you thought 6 feet was THE safe distance…we’ve got some bad news about running. But it’s not all bad! We’re joined by everyone’s favorite Curbsider/Internist/Epidemiologist, Rahul Ganatra MD MPH (@rbganatra), who provides critical appraisal of the newest COVID-19 treatment article. Pull up a chair, bring your own syrup, and join us! Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | CME! Credits Producer: Sarah P. Roberts MPH, Rahul Ganatra MD MPH, Emi Okamoto MD Writer: Emi Okamoto MD, Rahul Ganatra MD MPH, Cover Art: Chris Chiu MD Hosts: Chris Chiu MD, Rahul Ganatra MD MPH, Emi Okamoto MD Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Sponsors: Apollohct.com and VCU Health CE Time Stamps 00:30 Intro, disclaimer 02:30 Picks of the Week 6:36 Remdesivir trial rundown 21:52 Thrombosis in COVID-19 29:50 Asymptomatic/Presymptomatic transmission 41:42 Quick takes 49:00 Outro

It’s NephMadness! Get inside the black box of transplant medicine as we discuss: Kidney transplant for the internist. Join Dr. Cyrus Askin, @askins_razor, one of our Curbsiders Correspondents, as he teams up with the fine folks from the Freely Filtered Podcast led by Dr. Samira Farouq, @ssfarouk, a Mount Sinai transplant nephrologist. Topics: indications for kidney transplant, immunosuppressive agents, what to watch out for in your post-transplant patients and so much more! Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | CME Credits Written and Produced by: Cyrus Askin MD, Matthew Watto MD and the Freely Filtered Crew Infographic: Cyrus Askin MD Cover Art: Kate Grant MBChB DipGUMed Hosts: Cyrus Askin MD, Joel Topf MD, Samira Farouk MD, Swapnil Hiremath MD, Jennie Lin MD & Matt Sparks MD Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Sponsor: VCU Health CE Time Stamps 00:00 Announcement, Intro to Freely Filtered and NephMadness 04:00 Case of advanced CKD; Who/when to refer for transplant 12:05 Benefits of renal transplant 16:22 Counseling patients with advanced CKD about transplant and a bit on living donors 20:40 Medications after transplant; Drug-drug interactions 25:50 Dr. Sparks’ 30 second exam for the transplant patient; Diarrheal illness 32:07 Calcineurin inhibitor levels 36:42 Prophylaxis for long term complications 40:21 Allograft rejection; BAMF criteria 50:40 Cardiovascular risk; Statins 56:11 Malignancy after kidney transplant 60:00 NephMadness Transplant Region: Biomarkers vs Biopsy 72:23 Outro

LIVE! from VCU, we discuss why and how to use Twitter and other Social Media platforms as a clinician educator. Guest Michelle Brooks MD (@michellebrooksMD, VCU) shares her Twitter origin story along with pearls on how to use Twitter for digital scholarship #meded, networking and how to stay out of trouble on social media.  Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits Written and Produced by: Matthew Watto MD, FACP Infographic: Michelle Brooks MD Cover Art: Matthew Watto MD, FACP Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Clair Morgan of nodderly.com Guest: Michelle Brooks MD Sponsor: VCU Health CE Time Stamps 00:00 Guest one liner, favorite failure, career advice, 08:08 Picks of the week*: Culture Code (book) by Daniel Coyle; Crucial Conversations (book); Teaching Naked (book); Dark Crystal (Netflix series); The Outsider (HBO series) 11:23 Case of Sosh Al Media; Landscape of social media; Control your digital footprint; Public vs Private profiles 23:04 Negative aspects of social media 26:44 How to utilize Twitter for medical education; Twitter basics; Milton Packer 37:14 Pros and Cons of #medtwitter 42:02 Tweetorials 44:28 Audience questions: Repercussions from posting on social media; Social Media fellowships; Advocacy on social media 51:34 Outro

Fall in love with the thyroid all over again, as we deconstruct hypothyroidism with thyroid expert, Susan Mandel MD, MPH (PENN). We review common causes, symptoms, diagnosis and treatment and how these may differ for those who are Pregnant, over age 65, or have existing Heart disease. Plus, Dr Mandel schools us on her approach to treatment with levothyroxine (T4), and even explains when she trials liothyronine (T3) replacement! Warm up those thumbs for the thyroid exam...it’s on! Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] | Free CME! Credits Written and Produced by: Elena Gibson MD Cover art and Infographic by: Dr Kate Grant MBChb MRCGP Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Emi Okamoto (written materials); Clair Morgan of nodderly.com Guest: Susan Mandel MD, MPH Sponsor: VCU Health CE Time Stamps 00:00 Intro, disclaimer, guest bio 02:43 Guest one-liner; Pick of the week: Waiting for Godot (Play); Favorite Failure; Career Advice 09:40 Case from Kashlak Part one; Hypothyroidism signs and symptoms 13:20 When to Test for Hypothyroidism 17:43 Biotin interaction 19:49 Which thyroid tests should we order? 26:15 Subclinical hypothyroidism 29:00 Etiology/Types of hypothyroidism 33:30 Case from Kashlak Part two; Initial Medication dosing; Physical Exam 37:10 Levothyroxine replacement time of administration 42:10 TSH goal 46:00 Levothyroxine manufacturers 48:33 Dosing in older adults 50:27 T3 treatment 56:52 Pregnancy 59:42 Dose adjustments 61:43 Estrogen and thyroid binding protein 63:33 Who needs a referral? 65:40 Plugs, Outro

Welcome to The Curbsiders tutorial on how to create your own medical podcast. @doctorwatto and @paulnwilliamz walk you through how to conceptualize your podcast, build your team, choose your equipment and the basics of how to setup hardware and software recording. Be sure to browse the accompanying show notes for a true step-by-step guide complete with links to videos, web pages, and blog posts that we found helpful when starting our show. If it’s not in this document, then it can easily be found on YouTube, or via a Google search. Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected]   Credits Written and produced by: Matthew Watto MD Cover art and Infographic by Matthew Watto MD Hosts: Matthew Watto MD and Paul Williams MD Editor: Clair Morgan of Nodderly.com   Time Stamps 00:00 Announcement, Intro, Disclaimer 02:53 Our top podcasting pearls 07:01 Find your niche 09:46 Logistics 13:25 Business, finances and legal matters 14:40 Equipment 21:48 Recording and editing 24:56 Website, web and media hosting 28:53 How to setup and record your podcast 35:08 Editing software 35:58 Search engine optimization 37:45 Post-processing 39:49 Take home points and outro  

Breathe easy with these airway management principles and expert tips for managing the patient with COVID-19 related lung disease (i.e. pneumonia, hypoxemia, ARDS). In the COVID-19 era, non-intensivists are being called upon to care for critically ill patients across the globe. At the Curbsiders, we understand that this can be a stressful proposition! Therefore, we’ve enlisted the help of the renowned medical intensivist & USUHS Chair of Medicine, Dr. Kevin Chung (@chungk1031) to teach us what we need to know about airway management  in these challenging times. Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] Credits Written and Produced by: Cyrus Askin MD, Michael Rose MD, Kathleen Hiltz MD Show Notes: Cyrus Askin MD Infographic: Elena Gibson, MD Cover Art: Dr. Kate Grant MBChB DipGUMed Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Cyrus Askin, MD Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: COL Kevin Chung, MD, FACP Sponsors: McGraw Hill Time Stamps 00:00 Intro 03:15 Guest one liner, chicken wings (Miller Lite marinade), career advice 07:40 Sponsor 08:20 Case of hypoxemic respiratory failure; Rapid evaluation, initial labs 16:03 Initial assessment of a COVID-PUI; HFNC and non-invasive ventilation 23:40 Proning patients for hypoxemia 29:15 ARDS basics: diagnostic criteria, Brief Recap 33:22 Mechanical ventilation: Initial settings, following the blood gas 40:55 Peak and plateau pressure, Lung compliance and  Troubleshooting a high pressures 51:30 Ventilator dyssynchrony; Lung compliance and traditional ARDS vs COVID-19 lungs 62:55 Advanced ARDS - The 5 Ps of therapy and differences with COVID-19 68:10 Take home points; Plugs; Outro

Rundown of recent COVID articles and news stories including: Hydroxychloroquine and azithromycin, serologic testing, use of convalescent plasma, economic inequality / health disparities... and COVID in cats?! We’re joined by Curbsider/Internist/Epidemiologist, Rahul Ganatra MD, @rbganatra (VA Boston). Plus, @Paulnwilliamz and @cjchiu give us  some telehealth along with the usual antics. Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | [email protected] Credits Written, Produced, Hosted by: Rahul Ganatra MD, Chris Chiu MD, FACP, FAAP; Matthew Watto MD, FACP; Paul Williams MD, FACP Cover Art and Show Notes by: Matthew Watto MD, FACP Editor: Matthew Watto MD Guest: Rahul Ganatra MD Time Stamps 00:00 Intro, COVID-19 and cats by Shi J Science Apr 2020; Picks of the week 07:08 Telehealth (Greenhalgh BMJ 2020), Breathlessness (Roth score calculator), ACP COVID-19 resource site 11:50 Telehealth best practices 16:42 Convalescent plasma and Serology 21:45 Chris discusses the decontamination of N95 masks using CCDS (CCDS, Battele news Report) 23:45 Inequality during the pandemic VOX and NYTimes articles on inequality 25:30 Critical appraisal for HCQ + azithromycin article from France (Gautret et al IJAA 2020) and Rahul’s tweetorial 49:18 Pre-print data; Rahul discusses a newer HCQ randomized clinical trial article (Chen medRxiv 2020)

Get under the hood of SGLT2 inhibitors! Listen as our guests Dr. Harish Seethapathy, Dr. Matt Sparks, and Dr. Joel Topf give us a tour through the NephMadness 2020 SGLT2i region! How do these promising drugs work, and what evidence is there for using them in non-diabetic kidney disease or kidney transplant patients. Show Notes | Spotify | Swag! | Top Picks | Mailing List | [email protected] Credits Written and Produced by: Hannah R. Abrams Cover Art and Infographic by: Hannah R. Abrams Hosts: Hannah R Abrams, Matthew Watto MD, FACP Editor: Clair Morgan of Nodderly.com (audio), Emi Okamoto MD (written) Guests: Harish Seethapathy MD; Matthew Sparks MD; Joel Topf MD Sponsor: McGraw Hill Time Stamps 00:00 Sponsor 00:26 Intro, disclaimer, guest bio 02:57 Guest one-liner and Picks of the Week*: Michael Pollan audiobook on Coffee and Caffeine Addiction 03:52 SGLT2i definition, background, and why we now consider CV endpoints in diabetes 11:16 Sponsor 12:00 Tubuloglomerular feedback; Balloon analogy 17:40 Other mechanisms for SGLT2i 23:05 Back to the case; Risks from SGLT2i; Counseling and Monitoring 34:18 SGLT2i for non-diabetic kidney disease; Possible mechanisms: Joel’s caution against early adoption 41:42 SGLT2 inhibitors in kidney transplant 45:20 Take home points and picks for the SGLT2 inhibitor region 49:50 Outro