Episoder
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How is TPN and PPN similar and how is it different? When should each be used? How does bacterial overgrowth lead to complications? Does TPN cause diarrhea?
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Timestamps:
(01:35) | PEARL 1: Basics of PN: What makes up parenteral nutrition?
(06:54) | PEARL 2: Indications and Contraindications for TPN and PPN: When should I order parenteral nutrition?
(13:40) | PEARL 3: Complications of parenteral nutrition: What are the common adverse effects of parenteral nutrition?
(19:41) | PEARL 4: Parenteral nutrition myths: What should patients know before they start TPN?
(23:56) | PEARL 5: Recap on Tube Feeds: How do we determine the amount of free water to give out patients on tube feeds?
Transcript and Show notes
Tags: IMCore, CoreIM, parenteral nutrition, TPN, PPN, clinical nutrition, nutritional support, complications, patient safety, gastrointestinal disorders, critical care, internal medicine, fluid management, ICU, Crit Care, GI, gastroenterology
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Limitations to urine drug screening (UDS) in primary care? What are common false positives and false negatives with the urine drug screen test?
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Timestamps:
(03:01) | PEARL 1: Basics to Urine Drug Screen (UDS)
(08:03) | PEARL 2: Types of urine drug tests, and what are immunoassays (IA)?
(18:44) | PEARL 3: What are gas chromatography/mass spectrometry (GC/MS)-based tests?
(26:51) | PEARL 4: How do you address unexpected test results on a UDS?
(30:29) | PEARL 5: Throwback to “5 Pearls on Stigma in Opioid Use Disorder” episode
Transcript and Show notes
Tags: IMCore, CoreIM, primary care, urine drug screening, opioid use disorder, substance use, harm reduction, addiction medicine, clinical toxicology, patient safety, compassionate care
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Manglende episoder?
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What if a patient can't afford hospice? Which medications do you deprescribe when on hospice? What happens when patients who are on hospice return to the hospital or ED?
Behind the Scenes Youtube Interview:
Hospice Music Therapy
Show notes & Transcript
Hospice 101 Episode 1
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Tags: IMCore, CoreIM, primary care, palliative care, end-of-life, oncology nurse practitioner, pharmacist, physician assistant
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Can the MINT trial change how we treat anemia in acute MI? The largest trial of its kind compared liberal vs. restrictive transfusion strategies in patients with myocardial infarction.
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Timestamp:
01:29 History of Transfusion Guidelines/Studies06:49 Pathophysiology of Anemia in heart disease10:04 Transfusion in MI Studies13:45 MINT Trial22:20 Takeaways/DiscussionTranscript and Show Notes
Tags: Tags: CoreIM, IMCore, cardiology, internal medicine, myocardial infarction, anemia, transfusion, physician assistant, nurse practitioner, pharmacist, clinical trials, MINT trial, transfusion strategies, restrictive vs. liberal transfusion, heart attack
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Strategies to address moral distress and moral injury — hear from the experts on their work on the topic!
Timestamps:
(01:07) | Strategies for Addressing Moral Distress
(09:25) | Strategies for Address Moral Injury
(20:52) | Conclusion
Transcript and Show notes
Tags: IMCore, CorelM, Burnout, Moral Distress, Moral Injury, Moral Residue, Medical Humanities, medical ethics
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What is moral residue vs. moral injury vs moral distress? How do these concepts impact us as clinicians?
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Timestamps:
(04:59) | Definitions
(6:50) | Moral Distress
(09:01) | Moral Residue
(09:01) | Moral Residue
(11:34) | Moral Injury
(13:32) | Causes of Moral Distress and Moral Injury
(18:18) | Consequences
Transcript and Show notes
Tags: IMCore, CorelM, Burnout, Moral Distress, Moral Injury, Moral Residue, medical humanities, humanism
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Listen to 3 cardiorenal cases that highlight that “without flow it really doesn't matter what you're doing with the diuretic!”
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Timestamps:
(01:53) | Case 1: Diuretic Resistance from Ascites and Intra-abdominal Hypertension
(09:57) | Case 2: Diuretic Resistance from Low Cardiac Output
(26:34) | Case 3: Diuretic Resistance from Inadequate Renal Perfusion Pressure
Transcript and Show notes
Cardiorenal Considerations: 5 Pearls Segment
Tags:
IMCore, CoreIM, Diuretics, Cardiorenal, Medical Education, nephrology, cardiology, CCU, ICU, critical care
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Signouts! How can we do them better? Hear these memorable stories & ask yourself these FIVE questions when getting your handoff ready for the covering team.
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Timestamps:
(2:44) What makes this patient different from others with similar symptoms or diagnosis?
(7:28) Does your covering team have the tools to follow up on tasks and information they need for success?
(16:06) Is the handoff updated?
(18:26) What information about goals of care and prognosis should be communicated to the night team, especially for critically ill patients?
(22:41) What are we still uncertain about?
(25:30) Closing thoughts
Show notes & transcripts
Tags:
IMCore, CoreIM, Contingency Planning, Handoffs, Medical Education, Nocturnists. Signouts, hospitalist
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What is the philosophy of hospice? (3:04)Who qualifies for hospice (6:13)Who makes up the hospice team (8:17)Who pays for hospice (17:24)What are the different levels of care (21:31)What are some limitations of the hospice medicare benefit? (31:57)
Behind the Scenes Youtube Interview:
Hospice Music Therapy
Show notes & Transcript
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Tags: IMCore, CoreIM, primary care, palliative care, end-of-life, oncology nurse practitioner, pharmacist, physician assistant
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Dive into 4 microskills from the book “Microskills: Small Actions, Big Impact” that offer tangible tools for navigating the professional world with grace and intention.
Book by Dr. Adaira Landry, Dr. Resa E. Lewiss:
MicroSkills: Small Actions, Big Impact
Show notes & Transcript
Tags: IMCore, CoreIM, primary care, humanities, nurse practitioner, pharmacist, physician assistant
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Does colonoscopy prevent colon cancer, and does it save lives? There has never been a randomized controlled trial on screening colonoscopies before NordICC trial, even though it is a guideline based recommendation for everyone over 45! How did this come to be? What do we tell our patients who are on the fence about undergoing screening colonoscopy? To find out, tune into the sixth episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group.
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Timestamp:
00:00 Introduction02:28 Pathophysiology of Colorectal Cancer & Why Screening Makes Sense06:15 General Cancer Screening – Observational Studies09:17 General Cancer Screening – Randomized Controlled Trials14:40 NordICC Trial22:36 Implications for Patient CareShow notes & Transcript
Tags: IMCore, CoreIM, primary care, gastroenterology, nurse practitioner, pharmacist, physician assistant, sigmoidoscopy, per protocol analysis and intention to treat analysis
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What causes HFpEF? (1:59)Does diastolic dysfunction imply HFpEF? (11:22)Is the BNP level helpful in HFpEF? (19:21)What scoring systems can be helpful in ruling in HFpEF? (25:06)What's the treatment for HFpEF? (32:03)
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Behind The Scenes videos on YouTube
Tags: cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, nursing education, heart failure with preserved ejection fraction
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How do immune checkpoint inhibitors work? (01:56)How do you organize the different immune-related adverse events (irAEs)? (07:15)Generally, when do different adverse events can present? (13:42)What makes someone more likely to develop an adverse effect? (22:20)What role does complementary & alternative medicine play in this patient population? (26:38)
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Tags: Side effects, oncology, cancer, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, pharmacology
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Urinalysis in a patient with AKI from purely cardiorenal syndrome? (~02:05)What is bioavailability, duration of action, and outcomes with furosemide, torsemide, and bumetanide? (~08:47)How can spot urine sodium measurements be used to assess diuretic response? (~18:08)What are the differences between thiazides (PO Metolazone vs. IV Chlorothiazide) and acetazolamide augment diuresis? (~27:35)Spaced Repetition: RAAS inhibitors or SGLT2 inhibitors as GMDT in CKD? (~35:08)
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Tags: nephrology, cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, diuretic resistance
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What are the benefits of early rhythm control versus rate control alone? When is electrical cardioversion used and what information can it tell us? What side effects for amiodarone, dofetilide, and sotalol, propafenone and flecainide? When should catheter ablation be considered in patients with atrial fibrillation?
Time stamps:
02:05 Pearl 1 - Rhythm control11:23 Pearl 2 - Electrical cardioversion17:53 Pearl 3 - Class III antiarrhythmics and side effects26:31 Pearl 4 - Class Ic antiarrhythmics and side effects31:55 Pearl 5 - Catheter ablationTags: cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, nursing education, atrial fibrillation
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Should your patients be reaching for albuterol when their asthma flares up? Some of us may have been treating asthma exacerbations incorrectly for many years… What is the right approach? Tune in to the fifth episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group, to learn about the latest asthma management trials and guidelines, and how to translate them into better patient care.
Show Notes & Transcript
Time Stamps01:47 Evolving story of asthma management03:26 Pathophysiology of asthma management06:01 Key players & terms08:56 Story of asthma through the decades17:55 MANDALA TrialTags: IMCore, CoreIM, primary care, pulmonary, nurse practitioner, pharmacist, physician assistant, inhalers
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How do you choose btw PO vs. IV iron? What is the best counseling for oral iron formulations? How do you choose between different IV iron formulations? Should you use the Ganzoni formula? What is a Fishbane reaction? And how is it different from anaphylaxis?
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Behind the Scenes video - Treatment of Iron Deficiency
Behind the Scenes video - IV Iron Infusion Reactions
Time stamps:
02:09 | Spaced repetition from the last Gray Matters Episode
05:29 | Choosing between oral and IV iron
11:17 | Considerations with oral iron repletion
24:02 |Considerations with IV iron repletion
32:36 | Complications and side effects of IV iron
Tags: hematology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant
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What do the different iron labs mean?! How to interpret iron labs in the setting of inflammation? How to take a good menstrual history?
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Behind The Scenes Videos
Time stamps:
03:43 Iron deficiency labs and interpretation in inflammation16:08 Heavy menstrual bleeding evaluation27:04 When should a premenopausal woman with iron deficiency have endoscopy?35:15 RecapTags: hematology, women's health, gastroenterology, heavy menstrual bleeding, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, iron deficiency diagnosis
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Uncover many blind spots on tube feeds!
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Youtube Interviews:
Short-term enteral access
Durable enteral access
What is venting aka decompression?
Show Notes & Transcript
Timestamp
02:21 Indications for tube feeds09:36 Routes of enteral access19:20 Components of tube feeds7:03 Tube feeds complications34:50 Counseling patients before discharge and medication interactionsTags: IMCore, CoreIM, nursing home, primary care, dietician, nutrition support, hospital medicine, interprofessional education, enteral feeds
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How do you manage GDMT in a frail older adult? When is a guardian needed and what is the process for obtaining guardianship?
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Behind The Scenes videos
When to consider a guardian?
Guardianship Process
Limitation and value of individualism
Show Notes & Transcript
Timestamp
04:03 Deep Dive 1: How do you approach guideline-directed medical therapy of heart failure with reduced ejection fraction in a frail older adult?11:55 Deep Dive 2: When is a guardian needed and what is the process for obtaining guardianship?28:30 Deep Dive 3: How do you re-evaluate GDMT in a frail older adult once an adverse event has occurred?33:27 Reflections37:06 RecapTags: IMCore, CoreIM, nursing home, primary care, cardiology, palliative care hospital medicine, interprofessional education, social work, case management
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