Are fall prevention programs helping our patients? Should patients receive outpatient PT based on clinical diagnosis? How has the landscape changed because of insurance reimbursement?Show note, Transcript and References: https://www.coreimpodcast.com/2020/08/05/physical-therapi…education-series/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im
Time Stamps:01:47 Functional Assessment 07:47 Documentation14:35 Outpatient PT 18:14 Durable Medical Equipment22:55 Reimbursement
Tags: Core IM, IM Core, physical therapy, durable medical equipment, IPE, multidisciplinary team, interdisciplinary
What goes into decision making? What are the invisible tugs that may keep patients from acting in line with their values? Why isn't it part of the formal capacity assessment?
Show notes, Transcript and References: https://www.coreimpodcast.com/2020/07/22/capacity-2-0-and-voluntarism/
Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im
Time Stamps:2:57 Defining voluntarism5:36 Four elements that influence voluntarism10:26 How do you incorporate voluntarism into the capacity assessment?16:11 Discussions with uncooperative patients19:14 Protecting unrepresented patients21:30 Clinician perspective25:06 Moral distress
Tags: medical humanities, ethics, psychiatry, IM Core, CoreIM
Unpack a famous historical legend's medical dilemma on a special "Historical CPC" episode!
Show notes, transcript and references: https://www.coreimpodcast.com/2020/07/08/22729/
Time Stamps:02:55 HPI07:33 Past Medical History04:25 Physician Exam findings24:22 Historical Figure Revealed26:30 Reflections on top 3 diagnosis
Tags: cognitive and neuropsychiatric disturbances, rabies, mercury poisoning, cholera, delirium, COREIM, IMCORE, clinical reasoning case
Packed with so many clinically relevant points taking care of a patient with decompensated heart failure on general medicine floors!
Time Stamps:03:17 What are the key initial clinical variables in evaluating heart failure admissions?10:09 What are key lab findings for patients with heart failure exacerbation?17:14 Which guideline-directed medical therapy, and in what circumstances? 22:12 What are diuretics dosing strategies and monitoring tips to help guide initial volume removal?28:43 What role do thiazides and ultrafiltration play in diuresis, why does diuretic-induced metabolic alkalosis happen and what should you do about it? 38:09 Expert Recap
Show notes, transcript and references: https://www.coreimpodcast.com/2020/06/24/5-pearls-on-inpatient-heart-failure/
Tag: Cardiology, BNP, cardiorenal syndrome, beta-blockers, CoreIM, IMCore
SNF vs. NH? SAR vs. SNF? What are the differences in resources, nursing and clinician oversight and who pays for what?!
Show notes, transcript and references: https://www.coreimpodcast.com/2020/06/10/snf-sar-nh-alf-and-more-discharge-options-interprofessional-education-series/
Time stamps:04:07 SAR vs SNF13:35 Long term Nursing Home Care18:30 Assisted Living Facility24:40 Acute rehab26:11 LTACH27:49 Home
Tags: Subacute rehab, skilled nursing facility, long-term acute care hospital, CoreIM, Core_IM, hospital medicine, family medicine, emergency medicine, physician assistant, nurse practitioner, interprofessional education
Let's dive deeper into the dogma of salt restriction in heart failure!Show notes, transcript and references: https://www.coreimpodcast.com/2020/05/20/salt-restriction-in-heart-failure-mind-the-gap-segment/Get CME-MOC credit with ACP!Time Stamp01:37 Sodium restriction guidelines07:13 Current data in outpatient data11:32 Do inpatient studies show signal?13:44 Physiology behind sodium balance16:27 Take away and clinical applicability
- How do you navigate new challenges with goals of care with your patients in clinics?
Show Notes, Transcript, References: https://www.coreimpodcast.com/2020/05/06/outpatient-advanced-care-planning-during-covid-19/Time Stamps01:32 COVID Crisis as an Outpatient and Advance Care Planning (ACP)08:06 The virtual visit12:44 Vital Talk Mnemonic: “CALMER” 22:03 Challenges to Outpatient COVID Care26:03 Parting Thoughts
- Episode OutlineDisconnection/connection: PatientsDisconnection/connection: Family/friends Disconnection: Security, CertaintyConnection: Other clinicians Sharing fears, supporting each other)Shared ethos in healthcare (one workforce, no division of specialty or hierarchy) Conclusion: Post-traumatic growth / Peri-Traumatic Growth
Thank you to everyone we interviewed, particularly to the voices you heard:
Dr. Kimberly Manning (@gradydoctor)
Dr. John Hwang (Hoofbeats segment)
Dr. Steve Liu (Mind the Gap segment)
Dr Katherine Arthur
Dr. Maria Garcia-Jimenez
Dr. Kelsey Luoma
Dr. Margot Hedlin (@MargotHedlin) - Introduction and Ending
Dr. Tamar Schiff
Dr. Michael Shen (also audio editing)
Dr. Jafar Al-Mondhiry (@mondhiry)
tags: COVID19, COVID-19, CoreIM, coronavirus, narrative medicine
What is your approach to goals of care conversations, particularly during COVID-19? How do you navigate some of the new challenges with COVID19?
Show notes, transcript and references: https://www.coreimpodcast.com/2020/04/22/goc-on-inpatient-service-during-covid-19/
Time stamps:05:54 Laying the groundwork08:56 Asking permission, eliciting values and making a recommendation15:55 When a patient is dying16:42 Sharing the prognosis first20:28 Functional status post-CPR21:52 Headline statement23:40 Virtual and PPE Communication Challenges25:28 Separate process from outcome
Tag: coronavirus, COVID, CoreIM, Sars-cov-2, medicine floors, wards, advanced care planning
How do you organize your day? How do you minimize exposure of yourself and your colleagues? What are the new things to keep in mind with discharging patients?
Show notes, transcripts and references:
CME Credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im
Time Stamps02:37 Entrance and Exit strategy 04:25 Prioritizing patient acuity 08:14 PPE uses11:11 Respiratory concerns in COVID-19 patients16:35 Patient examination 18:49 Family updates20:56 Oxygen requirements 23:12 Medications 24:08 Discharging patients31:00 What we mean by isolation
tag: coronavirus, COVID, CoreIM, sars-cov-2, medicine wards
Practical tips on starting estrogen or testosterone on patients who are transgender and approach to primary care with cancer screening.
CME Credit with ACP; https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im
Show notes, transcripts, and references: https://www.coreimpodcast.com/2020/04/01/5-pearls-on-transgender-health-hormone-therapy-and-preventive-screening/
Time Stamps:02:54 Hormone therapy contraindications07:09 Time course for hormone changes10:21 Hormone risks19:09 Hormone treatment options25:22 Preventative Care Screening
Tags: CoreIM, gender affirming care
Practical tips on Gender Affirming Care!
Time Stamps:02:43 The Gender Unicorn and how it helps us better understand gender identity, expression, and sex assigned at birth11:15 Gender dysphoria14:16 The organ or anatomical inventory16:46 The inevitability of mistakes 18:39 Ways to ensure gender-affirming care in clinic
What goes into a capacity assessments? Is it just reciting risks, benefits and alternatives? Explore this and more on this At the Bedside Episode!
Show notes, Transcript and References: https://www.coreimpodcast.com/?p=22310
Time Stamps:2:04 Introduction to decision making4:12 Choice8:24 Understanding11:22 Appreciation13:58 Reasoning21:55 Common myths and misconceptions25:11 When and how to call a psychiatry consult for capacity assessment27:47 Conclusion
Tags: CoreIM, AMA Discharges, Psych, Competency, medical ethics, medical humanties
What are the new guidelines for influenza treatment? What are the diagnostic ratios of flu symptoms and tests?Time Stamps03:10 The art of diagnosing the flu05:17 Bayesian statistics and the diagnostic odds ratio07:09 The ins and outs of diagnostic testing for the flu08:44 Changes in influenza guidelines - testing and treatment11:17 The not-so-rosy origin story of neuraminidase inhibitors (NAIs)13:47 Neuraminidase inhibitors (NAIs), mortality benefit and limitations of studies15:49Take aways
What is the difference between a case manager and social worker? What are the limitations that social workers and case managers face? How do you create a safe space for the interdisciplinary team?
Get CME-MOC credit with ACP!
Time Stamps:03:54 What are the various roles within a multidisciplinary teams?10:42 Understanding limitations of social workers and case managers15:55 The “behind the scenes” paperwork 18:42 Insurance and medications22:17 Insurance and disposition options25:08 The importance of creating a safe space for better communication
What are the symptoms? What distinguishes coronavirus from other influenza-like illness? When coronavirus is suspected, what should you do?ACP Interactive Learning Module
01:30 Novel parts of coronavirus
03:00 What symptoms do patients present with for the novel coronavirus?
04:22 What distinguishes coronavirus from other influenza-like illness?
05:31 When coronavirus is suspected, what should you do?
07:13 What does testing for coronavirus entail?
09:06 What kind of isolation is required?
10:13 Do patients need to be isolated in biocontainment units?
10:42 What is treatment for the novel coronavirus?
12:30 Potential for vaccines
15:23 What is R0?
17:12 Animal reservoirs with 2019-nCoV, SARS, and MERS
19:18 What should we tell patients for prevention?
How do you learn from diagnostic errors? Walk through a case that the host had initially gotten wrong and uncover possible reasons as why from data gathering to hypothesis generation to the interplay between hypothesis generation and evaluation. Learn interesting tidbits on prior work in medical education around how we think, particularly around diagnostic failures.
Time Stamps02:39 Case Introduction 04:46 Yes/No questions with our first two discussants18:43 The diagnosis is revealed 21:14 Why did I miss the diagnosis?27:44 Using diagnostic problem solving to break down the case and understand our errors 30:20 The importance of data gathering 30:49 Introducing our third clinician 34:17 Hypothesis generation37:11 The interplay between hypothesis generation and evaluation38:34 The win-stay, lose-shift heuristic 41:33 Cognitive forcing strategies 49:32 Knowledge vs. experience
Tags: Dermatology, rash, DRESS, AGEP, varicella
Why is prognostication hard? How do we improve at communicating prognosis? How should we approach uncertainty? Explore this and more on this At the Bedside episode!
Time Stamps02:48 What is prognosis?04:00 Why offer prognostication?08:32 Why is prognostication hard?16:41 How do we improve at communicating prognosis?21:56 How should we approach uncertainty?31:06 Take Aways
Tag: life expectancy, CoreIM
- Dive deeper into hx of the influenza virus, how vaccines are made and vaccine effectiveness !Time Stamps02:59 The history of the influenza virus08:18 What does the influenza vaccine target?13:20 Chickens, and bugs, and mammalian cells, oh my! How the vaccine is made.14:00 What to do about egg allergies.15:53 Vaccine effectiveness and herd immunity.17:43 Waning immunity and other debates
Get CME-MOC credit with ACP!
Explore gaps in your knowledge about the home health world, particularly on home health aides!Get CME-MOC credit with ACP !Full transcript, show notes, references
02:33 What support do our patients have at home and how does those people play a role in their care?
06:00 Are there various types of home care workers?
07:25 What role do home attendants play in caring for a patient?
08:31 What tasks do home health aides do?
10:11 What are the types of "skilled carez'?
13:17 What can Medicare cover for older adults in terms of home health aides?
15:17 How does Medicare define homebound?
16:03 How does having Medicaid impact access to home care?
19:10 What if a patient isn’t eligible for Medicare or Medicaid?
19:43 What is the cost to use a private agency for home health services?
24:02 What are some challenges that home health aides face?
25:42 What are “plans of care”?
30:01 Who makes up the home care workforce?
31:52 When patients get discharged from the hospital, do they go home to the same home care assistance?