Why are safety net hospitals barely surviving? What makes a hospital a safety net hospital? How essential are safety net hospitals in caring for low income Americans? How do we pay for that care?

Show notes, Transcript and References:

https://www.coreimpodcast.com/2023/03/02/safety-net-hospitals/

Timestamps:

0:00 Hahnemann University Hospital

4:36 What is a Safety Net Hospital?

11:11 The Origins and Paradox of the Safety Net Hospital

Links to other episodes:

A Complex Patchwork of Supplemental Payments:

https://www.healthaffairs.org/do/10.1377/hp20221223.651856/full/

The Future of Safety Net Hospitals & Payment Policies:

https://www.healthaffairs.org/do/10.1377/hp20221223.105519/full/

Tags: IM Core, CoreIM, health policy, health disparities, insurance, medicare and medicaid

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How does your problem representation change as we get more history in this episode? How can we use Oxaam's razor & Hickman's dictum as powerful diagnostic tools IF used properly?

Show notes, Transcript and References:  https://www.coreimpodcast.com/2023/02/15/25438/

Use promo code COREIM for 1 month of free access to Glass Pro at https://glass.health/coreim 

Time stamps

• 01:51 Intro
• 07:57 Case 
• 13:09 Differential
• 16:15 Diagnosis
• 22:20 Problem Representation 

Tags: IM Core, CoreIM, diagnostic tools, Occam's razor, Hickam's dictum, data collection, mental model, clinical reasoning, rheumatology

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How do you approach requests for 'futile' care? What do we mean by futility? What kind of recovery do we think is meaningful? How do we evaluate potentially inappropriate care? Where can we go for guidance on this?

Show notes, Transcript and References:  https://www.coreimpodcast.com/2023/02/01/futility-at-the-bedside-segment/

Time stamps

• 04:45 What do we mean by “futility”?
• 11:20 Definitions
• 20:23 Ethical Analysis
• 39:13 Recommendations

Tags: IM Core, CoreIM, ATS, autonomy, justice, values, emotions, communication, medical humanities, ethics

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Check out original interviews on our Youtube channel!

What does the duration of afib tell you about the thromboembolic risk? When do you start anticoagulation for post-op afib? What do the most recent guidelines recommend for perioperative anticoagulation management? How many devices do you know that can be useful in post-discharge cardiac monitoring in new atrial fibrillation? How can we improve our communication regarding afib management?

Behind The Scenes videos

Get CME-MOC credit with ACP

Show notes, Transcript and References

Time stamps

• 01:12 Intro
• 03:51 Deep Dive 1
• 08:16 Deep Dive 2
• 15:25 Deep Dive 3
• 21:05 Deep Dive 4
• 27:07 Deep Dive 5

Tags: IM Core, CoreIM, Devices, cardiac, risk, perioperative, stroke, surgery, anticoagulation

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Is it enough to look at LDL-C? What is Apo-B? How do you use TG/HDL ratio to understand your patients cardiovascular risk? Do you need to get a fasting lipid panel? How does it affect the triglycerides and LDL?

Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/12/15/reimagining-the-…-the-gap-segment/

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Time stamps

• 01:24 Intro 
• 03:37 Fasting vs. Nonfasting Lipid Panel
• 05:11 Current guidelines
• 07:43 Pathophysiology Overview
• 09:04 Pathophysiology of Apo-B vs. LDL-C with traffic analogy
• 11:23 Apo-B
• 15:40 TG-to-HDL ratio
• 17:06 Takeaways

Tags: IM Core, CoreIM, risk, USPSTF, ACC/AHH, family medicine, cardiology, primary care

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What are some ways you address unrealistic hopes with your patients? How can you build a portfolio of hope with your patients? Can you learn to guide your patients hope?

Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/11/23/hope/

Sponsor: Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E7

Time stamps

• 01:20 Intro 
• 04:37 What are some definitions of hope?
• 09:57 How can we address unrealistic hope? 
• 21:39 Addressing hope in clinical practice 
• 32:10 Conclusion

Tags: IM Core, CoreIM, care, communication, goal setting, support, strategies , medical humanities

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What tests and history points help with the diagnosis of alcohol-associated hepatitis? What other etiologies should be ruled out? To steroid or not to steroid? What are the medications for alcohol use disorder? Do you make sure your patients have a late night snack? How do you prognosticate? 

Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/11/09/alcoholic-hepati…5-pearls-segment/

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im 

Time stamps

• 01:42 Intro 
• 04:37 Pearl 1: Diagnosis 
• 13:20 Pearl 2: Differential & Treatment
• 20:48 Pearl 3: Nutrition & Alcohol Cessation 
• 27:45 Pearl 4: To steroids or to not steroids?!
• 35:34 Pearl 5: Throwback 

Tags: IM Core, CoreIM, ALT, AST, liver abnormalities, gastroenterology, alcohol use disorder, nutrition, MELD, Lille, Steroids, Alcoholic Hepatitis

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How do you educate your patients on aspirin use? For what reasons do you start, continue or stop aspirin? What does trial data tell us? How does aspirin exerts its effect?

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Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/10/19/mind-the-gap-asp…imary-prevention/

Time stamps

• 03:03 Guideline recommendations 
• 07:00 How does Aspirin work? 
• 09:11 Trial Data
• 13:00 ASCVD Risk Calculator
• 18:07 Starting vs. Stopping Aspirin 
• 22:11 Summary 

Tags: IM Core, CoreIM, guidelines, atherosclerosis, ASCVD, plaque, bleeding, shared decision-making

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Is a positive ANA always significant? What does the titer mean? Is the pattern of the ANA helpful? What patient histories should you not get an ANA for and which aspects of the history would raise suspicion for autoimmunity? How can you use the physical exam to assess likelihood of autoimmune disease? What is the ddx for a positive ANA?

Whiteboard animation video on YouTube

Show notes, Transcript and References

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Sponsor: Visit www.medmastery.com/coreim for 15% off on all subscriptions. Discount code: “COREIM”

Timestamps:

• 01:37 Pearl 1
• 03:54 Pearl 2
• 13:53 Pearl 3
• 18:07 Pearl 4
• 29:30 Pearl 5

Tags: IM Core, CoreIM, autoimmune, joint disease, titers, Raynaud's, lupus, Rheumatology

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How do you decide which lung nodules should be worked up inpatient or outpatient? How common are incidental lung nodules? What considerations are there for patients that could potentially get lost to follow up? What risk adopted approach can be implement in our practice? Do you know what fast forward rounds are?

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Show notes, Transcript and References: https://www.coreimpodcast.com/2022/09/21/discharge-with-i…atters-segment-2/

Time stamps

• 01:30 Deep Dive #1
• 17:27 Deep Dive #2

Tags: IM Core, CoreIM, outpatient, inpatient, PCP, management, communication, discharge summary, incidentaloma

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