This is part 2 of a series looking at perioperative medicine, with a few updates from CONVERGE on the effectiveness of mobilization postop and coffee for faster return of bowel function, and a revisit to the Society for Perioperative Quality Improvement (SPAQI) for pulm, GI, and dietary meds. Quick note: we don’t discuss dietary meds in depth at all since there are so many of them and the yield is low, so look to the links below!

| 00.44 - Early mobilization is associated with reduced time in the hospital [JAMA Surgery 2023] |

| 02.08 - Your local coffee shop’s next bespoke coffee formulation: NGT coffee for early gut mobility! [AJS 2023] |

| 03.04 - SPAQI position paper on Pulmonary and GI associated medications [Mayo clin proc 2021] |

| 05.14 - SPAQI position paper on Dietary supplements [Mayo Clin proc 2021] |

| 05.56 - Closing |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Music by Amit Apte. Surgery Vectors by Vecteezy

In this episode, we hear the rest of the interview with Dr. Marlene Martin, Hospitalist and Addiction Medicine specialist at SF General. She spoke at CONVERGE, but this year we got to her first! Last episode she discussed some topics around methadone initiation. Today we will here about Dr. Martin’s thoughts on applying these concepts in the hospital, and how YOU can do it too! Other topics include discussing with patients about the the positive urine screen, and gabapentin in the treatment of AUD. Stick around to hear a bit about Dr. Martin’s touristy wishes!

| 00.00 - Episode open: WE MEET AGAIN |

| 00.41 - Getting motivated and teaching tips |

| 03.33 - TOXing with patients about the UTOX |

| 11.29 - And a random pearl for those that stick it out to the end, Gabapentin in the treatment of AUD |

• Gabapentin For the Treatment of AUD [JAMA 2020, JAMA-IM 2014]

| 15.20 - What got you into Addiction Medicine? |

• Beyond the Purple Journal [JHM 2021]

| 18.55 - Get to know here: Dr. Martin and South America |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Music by Amit Apte. Cover art organized by Neal Tambe.

In this episode, we say Hi to all our new listeners after SHM, we are glad you are joining us and hope you stick around! Make sure to follow on your platform of choice. Today we are broadcasting part 1 of an interview with Dr. Marlene Martin, an addiction medicine specialist who works at the SF General. We talk to her about methadone initiation issues including faster initiation, QTc checks, and pain management during an admission. Note: this episode is provided for informational purposes only. We do not directly endorse the use of these discussions, including CAM2038, without proper input from your local addiction medicine consultants.

| 00.00 - Episode open: HELLO TO OUR NEW LISTENERS! |

| 00.48 -Intro to Dr. Marlene Martin |

| 01.53 - Latine v Latinx - ask people how they want to be referred to! |

| 03.08- Methadone and checking the QTc |

| 09.34 - What happens outpatient with the EKG and the QTc? |

| 10.04 - Discussing needs with other groups. Its a team effort! |

| 11.14 - Methadone changes and EKG followup |

| 12.07 - COMING SOON: FASTER METHADONE TITRATION (spoiler, don’t do it yet without addiction medicine guidance) |

• CAM2038 as a possible depot option. Studies are currently being done

| 17.15 - What to do with pain on top of methadone or Buprenorphine |

• Rapid Clinical Updates: Inpatient Management of Opioids [SHM 2023]
• Marlene’s paper “Inhospital substance use policies” [JAM 2023]

| 24.53 - Closing |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Music by Amit Apte. Cover art organized by Neal Tambe.

Before we head off to SHM CONVERGE this weekend, here are a few articles that may be of use in your practice. A random assortment from end-of-life care to ketamine in pain control, hopefully its something for everyone.

| 00.05 - Intro |

| 00.48 - CONVERGE - come visit me on Saturday in Hall F! Or email [email protected] if you want to discuss at other times! |

| 01.42 - Empagliflozin delays CKD progression in diabetic or glomerular disease, but not necessarily hypertensive or renovascular disease [ACP Journal Club 2024 (subscription required), Lancet D&E 2024]

| 03.14 - Antibiotics and end of life care - I recommend you look at the paper [CID 2024] |

| 06.33 - Low dose ketamine for pain control vs. morphine → Shorter onset, but shorter duration [AJEMEN 2024]

| 08.00 - Using Deep Learning models to estimate CV risk using CXR only [AIM 2024]

• references for the groups’ other studies using Deep Learning: Long-term mortality from CXR [JAMA 2019], Identifying high risk smokers for lung cancer CT screening [AIM 2020]\

| 09.53 - 43s Summary (yes I lied, it wasn’t 30s), disclaimers, credits, etc. |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Taking a look at some of the American Gastroenterological association guidelines from the past 6 months that covers Fecal Microbiota Transplantation, IBD biomarkers and dietary recommendations, and a few more updates in ascites and cirrhosis management via albumin and vasoactive medications.

| 00.00 - Intro

| 00.52 - FMT [AGA 2024] |

| 03.31 - The use of Biomarkers in Crohn’s Disease [Gastro 2023] + a quick call do Dr. Sara Lewin, inpatient IBD specialist at UCSF |

| 10.42 - IBD dietary recommendations [AGA 2024] + a chat with RD Neha Shah, IBD dietary specialist at UCSF |

| 22.26 - Albumin, vasoactives, and ascites [AGA 2022] |

| 24.24 - Summary |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Music by Amit Apte. Image generated using Copilot.

No episode today. Just a brief call to listeners!

We are looking for people to join our team in one of several areas:

1. Content generation: come push your Medical Education agenda and develop episode structure, summarize guidelines and develop content. Record your own clinical updates!
2. Be a guest-host: interview consultants, or summarize information from a conference you attend. Be that informative disembodied voice!
3. Earn the title of Producer: work with us to master your own episodes, collect residents to develop a new resident-driven segment.

If you find one of those interesting, or would like to discuss other opportunities, e-mail us at [email protected] to introduce yourself and what strikes your fancy!

In the sequel to last week’s episode, we are back with Dr. Jonathan Davis, Director of the Heart Failure program from San Francisco General. We continue our tour of GDMT for HF, by covering SGLT2-i, MRAs, as well as some AKI and outpatient considerations. This is part 1 of 2 parts which will cover an overview of GDMT medications, and dive into Beta-blockers and ARNIs. Part 2 to come out next week!

| 00.33 - Previously on Booster Shots |

| 01.31 - Chapter 3: SGLT2-i |

• The now famous EMPA-REG OUTCOME trial [NEJM 2015]

• Empagliflozin in HFpEF (not discussed in this episode [NEJM 2021]

| 04.24 - Chapter 4: MRAs |

• RALES trial demonstrating benefit in Morbidity/Mortality [NEJM 1999]

| 10.04 - Organizing follow up |

| 11.51 - Issues with AKI |

| 15.10 - Some fun questions about Fun questions |

| 16.54 - Summary of All The Things! |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Music by Amit Apte. Medical Heart Vectors by Vecteezy

We talk to Cardiologist Dr. Jonathan Davis, Director of the Heart Failure program from San Francisco General about goal directed medical therapy in heart failure with reduced ejection fraction (HFrEF). This is part 1 of 2 parts which will cover an overview of GDMT medications, and dive into Beta-blockers and ARNIs. Part 2 to come out next week!

| 00.34 - Introduction |

| 01.55 - Consult Q: GDMT for HF |

• Heart failure outcomes

| 05.20 - GDMT medication summary and overview |

| 07.17 - Effect on blood pressure and relative risk reduction for each drug |

| 10.59 - What order to start in |

• Hint: ALL AT ONCE… if you can

| 11.53 - Beta-blockers |

• When not to start (new HF in VOL), and when to re/start (almost all other times)
• Tartrate vs Succinate: duration of action

| 15.40 - ARNI (Sacubitril-Valsartan) |

• Potent natriuresis effect
• Balancing the orthostatics

| 20.37 - Outro |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Music by Amit Apte. Medical Heart Vectors by Vecteezy

Medicines gonna med, surgeons gonna surge. What do we change and do in the perioperative period? Join us for some bites from the MHP 2023 talk on Perioperative management updates, a few JHM articles around NPO status and buprenorphine continuation, and the start of a summary series on SPAQI position papers on what to do with various medications in the perioperative period.

| 00.22 - TOC |

| 01.17 - MHP-1 Post-operative AFib and Anticoagulation [Siontis 2022 - Associations of POAF w/ subsequent outcomes] [AHA 2023 guidelines] |

| 02.50 - MHP-2 ASA for DVT ppx in Ortho trauma cases [METRC study - large multi-center trial of ASA vs LMWH] [ICS-VTE position papers by location of surgery] |

| 04.20 - MHP-3 Post-op delirium [AGS Guidlines] [Kim 2022- Haldol vs atypicals] |

| 05.11 - Perioperative NPO status: When should we start? [JHM 2021] |

| 06.37 - Buprenorphine in the acute pain and perioperative settings [JHM 2019] |

| 07.18 - SPAQI position paper on Endocrine, Hormonal, and Urological meds |

| 09.56 - Summary |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Music by Amit Apte. Surgery Vectors by Vecteezy

ID consult questions with Dr. Sarah Doernberg - today she will discuss the court case Latent v Active TB in patients with planned immunosuppression, the effects of BCG treatment for bladder cancer, and when to think about “treatment failure” for complex bone/joint infections.

| 00.34 - Introduction to Dr. Sarah Doernberg |

| 01.29 - TB associated eConsults: Latent v Active TB in patients planning immunosuppression |

| 07.20 - TB prevalence in SF and testing|

| 09.52 - A case of disseminated BCG in a patient with previous malignancy history and bone disease |

| 15.33 - Possibly silly question about BCG inoculation |

| 16.49 - Sarah’s idea of a running parter |

[The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

Music by Amit Apte. *Image generated through my experimentation with Image Designer by Microsoft.*