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In this new episode of the Danbury medical files, I share with you one of the many adventures I had with my dad Dr. Victor Espana Pinetta MD, MPH. I am trying to describe one of the multiple vaccination campaigns that he led in my home country Guatemala. After that, I have a few thoughts about the situation of the measles cases that are piling up in the United States because of lack of vaccination.

I dive also on three cases I saw of measles in kids one that led to the permanent brain damage of a girl and her likely dead after the disease.  

Hope you find this episode interesting. Also, I hope you find this episode worth to be shared to other non-medical personal.

Thank you

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In this ad-lib podcast, I explore my first impression of my experience in teaching and using POCUS in the outpatient world.

I will try to tell you how this happened, how I feel the program is going, and whether I believe it is useful. 

Also, some of my experiences, feats, challenges, and hopes.

Hope you like the episode.  

Soon, I will have an email for you to give me feedback.  

Right now, I do not follow Twitter or X; I do not follow Facebook or Instagram.   I am trying to learn how to use Bluesky.  

Thank you again for following the Danbury Medical Files.  More to come.

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In our medical career, one of the things that we are thought since we start is importance of privacy in to keep the patience, privacy safe. We even have laws that penalize anyone who shares private information from patients.
This is not true when large companies are irresponsible with the way that they treat our medical information.

It is also important to have awareness of this problem and many other problems that the healthcare oligopoly is creating to patients, pharmacies and physicians, as well as the taxpayers.

In this podcast we explore the data breach of the century and the largest data breach in health care.  Its origins, its impact.  And a call for action from the medical and health care provider community.  

Also we again dive in the effects of the imminent monopoly that medicine is having.

I featured Dr. Glaucomflecken without his permission, hope he does not mind

Here the link to the video

https://youtu.be/A-jZ0eVEbxk?si=6U-fHxq4OrtssDOO

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In this episode I am discussing the effects of hospital and healthcare systems mergers.  I have tried to place a vast amount of information in a few minutes.  
I hope this will be of your interest and will be good information. 
Lastly, a call for action from all the physician community.  We need to participate more, sadly participating more can be risky, however, in the current times not participating will be more detrimental for our profession.  Here some links:

https://www.kff.org/health-costs/issue-brief/ten-things-to-know-about-consolidation-in-health-care-provider-markets/

https://www.aha.org/aha-search?search_api_fulltext=hospital+mergers

https://pubmed.ncbi.nlm.nih.gov/35157040/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170097/

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In this episode of the Danbury Medial Files, I talk about three patients where POCUS was used successfully in the outpatient clinic. 
I also talk about lidocaine side effects, anxiety as a common side effect of procedures.
A second case of abdominal pain and a two minutes diagnosis with POCUS.
A third case in avoiding a readmission. 

Hopefully you find this interesting and entertaining. 

Hit us on X if you want to hear about other topics. 

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Some reading
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8399637/
https://www.sciencedirect.com/science/article/pii/S2211816013001683
https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-021-01459-z

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Erratum:  I called VExUS volume excess ultrasound, and is venous excess ultrasound. 
Also I said the flow of the portal vein should be 20 to 30 mmHg, however is 20 to 30 cm/sec.  

Happy new year!  This is the first episode of the Danbury Medical Files in the 2024.  I talked about volume status, volume status is complex and deserves at least a book chapter, however, I tried to summarize the most important parts and make the case to use point of care ultrasound and learn more about the different option that POCUS has for us.  

Hope you have a great year again.  

Thank you for listening.  

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I stopped podcasting early this year because of personal problems. I will try to keep up the next year, however, I wanted to do a final episode in 2023.  Thank you to my residents for always bringing to my attention topics that could be of benefit.  
How do we know if POCUS B lines are pulmonary edema?
What are the forces that are responsible for pulmonary edema?
What are the factors that protect the lungs from pulmonary edema?
Why we should do POCUS in patients with CHF?
What are stress B lines?

Hope this is a good episode to end the year.  

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Hey everyone.  This is a follow-up chapter from the prior one, exploring how safe it is to auscultate a patient.  Also, how useful.
This time I try to make the case that it is safe and also useful. 
Follow me in this POCUS journey in the second season of the Danbury Medical Files. 
Below I leave some interesting articles if you feel like checking. 

Picano E, Scali MC, Ciampi Q, Lichtenstein D. Lung Ultrasound for the Cardiologist. JACC Cardiovasc Imaging. 2018 Nov;11(11):1692-1705. doi: 10.1016/j.jcmg.2018.06.023. PMID: 30409330.

Mumoli N, Vitale J, Giorgi-Pierfranceschi M, Cresci A, Cei M, Basile V, Brondi B, Russo E, Giuntini L, Masi L, Cocciolo M, Dentali F. Accuracy of Nurse-Performed Lung Ultrasound in Patients With Acute Dyspnea: A Prospective Observational Study. Medicine (Baltimore). 2016 Mar;95(9):e2925. doi: 10.1097/MD.0000000000002925. PMID: 26945396; PMCID: PMC4782880.

Lim JS, Lee S, Do HH, Oh KH. Can Limited Education of Lung Ultrasound Be Conducted to Medical Students Properly? A Pilot Study. Biomed Res Int. 2017;2017:8147075. doi: 10.1155/2017/8147075. Epub 2017 Mar 28. PMID: 28459070; PMCID: PMC5387807.

Espana Schmidt, C. ., & Alam, W. . (2021). Point of Care Ultrasound during the Medical Teaching Rounds in the COVID-19 Era -The Hospitalist Perspective-. Medical Science and Discovery, 8(4), 198–202. https://doi.org/10.36472/msd.v8i4.510

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Inequality in healthcare is a recognized problem.  I had the privilege of interviewing Brenda Ayers, MD.  The head of a task force to decrease and eliminate inequality in NUVANCE-HEALTH.   
I met Dr. Ayers as the Chief Hospitalist at Vassar Brothers Hospital in Poughkeepsie, New York.  
Her work in the Nuvance Health Network (Danbury Hospital, which is my employer, is part of this network) is already changing structures and effectively trying to deal with racial disparity.  
I interviewed her at Vassar in the Hospitalist's office, so some noises were not completely filtered. However, the interview was well worth the occasional noise.  
Please accompany me on this chapter of the Danbury Medical Files.  


Here a couple of articles to read and reflect:  

Sun M, Oliwa T, Peek ME, Tung EL. Negative Patient Descriptors: Documenting Racial Bias In The Electronic Health Record. Health Aff (Millwood). 2022 Feb;41(2):203-211. doi: 10.1377/hlthaff.2021.01423. Epub 2022 Jan 19. PMID: 35044842; PMCID: PMC8973827.

Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, Crews DC, Doria A, Estrella MM, Froissart M, Grams ME, Greene T, Grubb A, Gudnason V, Gutiérrez OM, Kalil R, Karger AB, Mauer M, Navis G, Nelson RG, Poggio ED, Rodby R, Rossing P, Rule AD, Selvin E, Seegmiller JC, Shlipak MG, Torres VE, Yang W, Ballew SH, Couture SJ, Powe NR, Levey AS; Chronic Kidney Disease Epidemiology Collaboration. New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. N Engl J Med. 2021 Nov 4;385(19):1737-1749. doi: 10.1056/NEJMoa2102953. Epub 2021 Sep 23. PMID: 34554658; PMCID: PMC8822996.

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This time I am exploring what is written about the efficacy of lung auscultation.  I found this interesting meta-analysis and saw the difficulties that the authors went thru to find literature about lung auscultation. 
Is it safe?
We have auscultation for so long right now, however is it really giving results?
The article used is below: 

Arts, L., Lim, E.H.T., van de Ven, P.M. et al. The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis. Sci Rep 10, 7347 (2020). https://doi.org/10.1038/s41598-020-64405-6

I also reviewed some of the articles cited in this open-access meta-analysis.  

Listen to the podcast and tell me your opinion.  Contact via Twitter, and leave a review in your favorite app you use for podcasts.   

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