What’s the evidence been for the use of PPIs in mechanically ventilated patients? What do more recent studies reveal about PPIs and possible harmful side effects of aspiration pneumonia and C. difficile colitis? To find out, tune into the second season of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.

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Timestamps:

(02:13) | Define the problem / Clinically important bleeding Outcome/Risk benefit /Risk factors]

(05:58) | Hx and H2 antagonists

(10:42) | SUP-ICU

(15:12) | PEPTIC

(19:30) | REVISE trial

(27:28) | Deprescribing

(29:06) | Outstanding questions

Transcript and Show Notes

Tags: CoreIM, InternalMedicine, CriticalCare, Proton Pump Inhibitors, GIbleeding, ICU, ICU bleeding, Clinical Trials, Evidence Based Medicine, Patient Centered Outcomes, Deprescribing

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Why are we missing peripheral arterial disease (PAD)? How is it diagnosed using the Ankle-Brachial Index (ABI)? What treatments improve symptoms and reduce cardiovascular risks? When should revascularization be considered?

Transcript and Show notes

Behind The Scenes YouTube Interview

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Timestamps:

(02:23) | PEARL 1: When to suspect PAD? Risk factors?

(07:34) | PEARL 2: How to work up PAD?

(16:26) | PEARL 3: Improving symptoms and quality of life 

(25:38) | PEARL 4: Approach to therapy: Preventing CV mortality 

(33:53) | PEARL 5: Deeper Dive into Antithrombotic Therapy and Anticoagulation 

(39:09) | PEARL 6: Who needs revascularization? 

Tags: CoreIM, PAD, Peripheral Arterial Disease, ABI, claudication, vascular medicine, revascularization, internal medicine, smoking cessation, lipid management, primary care, physician assistant, nurse practitioner, cilostazol. supervised exercise therapy

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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?

Transcript and Show notes

Behind the Scenes Youtube Interview

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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?

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?

Transcript and Show notes

Behind The Scenes YouTube Interviews

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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

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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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?

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Behind the Scenes Youtube Interview

Show notes & Transcript

Hospice 101 Episode 1

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Timestamps:

A hospitalized patient elects to enroll in hospice, now what?

What treatments are typically covered  by hospice?

What medications to continue and discontinue?

Code status in hospice

Approaching the hospice patient coming back to the hospital

Hospice enrollment and re-enrollment is voluntary.

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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Transcript and Show Notes

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Timestamps:

(01:29) | History of Transfusion Guidelines/Studies

(06:49) | Pathophysiology of Anemia in heart disease

(10:04) | Transfusion in MI Studies

(13:45) | MINT Trial

(22:20) | Takeaways/Discussion

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!

Transcript and Show notes

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Timestamps:

(01:07) | Strategies for Addressing Moral Distress

(09:25) | Strategies for Address Moral Injury

(20:52) | Conclusion

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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Transcript and Show notes

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Timestamps:

(04:59) | Definitions

(06:50) | 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

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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Transcript and Show notes

Cardiorenal Considerations: 5 Pearls Segment

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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

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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Show notes & transcripts

Behind the Scenes YouTube Interview

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Timestamps:

(02:44) | What makes this patient different from others with similar symptoms or diagnosis?

(07:28) | 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 

Tags: IMCore, CoreIM, Contingency Planning, Handoffs, Medical Education, Nocturnists. Signouts, hospitalist

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