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?Behind the Scenes Youtube Interview:Hospice Music TherapyShow notes & TranscriptHospice 101 Episode 1Sponsor:Imagine leveraging A.I to do pre-charting before seeing a patient. Reach out to [email protected] to integrate Glass A.I into your EMR!For more on Glass or Glass Pro, use the promo code: CoreIMTags: IMCore, CoreIM, primary care, palliative care, end-of-life, oncology nurse practitioner, pharmacist, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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.Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! Use the code CORE50 to get 50% off your first month with FreedTimestamp:01:29 History of Transfusion Guidelines/Studies06:49 Pathophysiology of Anemia in heart disease10:04 Transfusion in MI Studies13:45 MINT Trial22:20 Takeaways/DiscussionTranscript and Show NotesTags: 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 attackFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Strategies to address moral distress and moral injury — hear from the experts on their work on the topic!Timestamps:(01:07) | Strategies for Addressing Moral Distress(09:25) | Strategies for Address Moral Injury(20:52) | ConclusionTranscript and Show notesTags: IMCore, CorelM, Burnout, Moral Distress, Moral Injury, Moral Residue, Medical Humanities, medical ethicsFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What is moral residue vs. moral injury vs moral distress? How do these concepts impact us as clinicians?Sponsor: Whether you're looking to open your own practice or buy into a group, Panacea Financial understands the unique needs of physicians and offers tailored financial solutions. Timestamps:(04:59) | Definitions(6:50) | 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) | ConsequencesTranscript and Show notesTags: IMCore, CorelM, Burnout, Moral Distress, Moral Injury, Moral Residue, medical humanities, humanismFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Listen to 3 cardiorenal cases that highlight that “without flow it really doesn't matter what you're doing with the diuretic!”Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! Use the code CORE50 to get 50% off your first month with FreedTimestamps:(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 PressureTranscript and Show notesCardiorenal Considerations: 5 Pearls SegmentTags:IMCore, CoreIM, Diuretics, Cardiorenal, Medical Education, nephrology, cardiology, CCU, ICU, critical careFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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.Sponsor: Glass Health is a platform that empower clinicians with best-in-class AI for clinical decision supportUse promo code COREIM for 1 month of free access to Glass Pro for unlimited A.I queries !Timestamps:(2:44) What makes this patient different from others with similar symptoms or diagnosis?(7:28) 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 Show notes & transcriptsTags:IMCore, CoreIM, Contingency Planning, Handoffs, Medical Education, Nocturnists. Signouts, hospitalistFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What is the philosophy of hospice? (3:04)Who qualifies for hospice (6:13)Who makes up the hospice team (8:17)Who pays for hospice (17:24)What are the different levels of care (21:31)What are some limitations of the hospice medicare benefit? (31:57)Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! Use the code CORE50 to get 50% off your first month with FreedShow notes & TranscriptTags: IMCore, CoreIM, primary care, palliative care, end-of-life, oncology nurse practitioner, pharmacist, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dive into 4 microskills from the book “Microskills: Small Actions, Big Impact” that offer tangible tools for navigating the professional world with grace and intention.Book by Dr. Adaira Landry, Dr. Resa E. Lewiss: MicroSkills: Small Actions, Big ImpactShow notes & TranscriptTags: IMCore, CoreIM, primary care, humanities, nurse practitioner, pharmacist, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Does colonoscopy prevent colon cancer, and does it save lives? There has never been a randomized controlled trial on screening colonoscopies before NordICC trial, even though it is a guideline based recommendation for everyone over 45! How did this come to be? What do we tell our patients who are on the fence about undergoing screening colonoscopy? To find out, tune into the sixth episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group. Sponsor: At Panacea Financial, you get a personal banker and a competitive high-yield savings account. Learn why its the #1 rated bank on Trustpilot.Timestamp:00:00 Introduction02:28 Pathophysiology of Colorectal Cancer & Why Screening Makes Sense06:15 General Cancer Screening – Observational Studies09:17 General Cancer Screening – Randomized Controlled Trials14:40 NordICC Trial22:36 Implications for Patient CareShow notes & TranscriptTags: IMCore, CoreIM, primary care, gastroenterology, nurse practitioner, pharmacist, physician assistant, sigmoidoscopy, per protocol analysis and intention to treat analysisFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What causes HFpEF? (1:59)Does diastolic dysfunction imply HFpEF? (11:22)Is the BNP level helpful in HFpEF? (19:21)What scoring systems can be helpful in ruling in HFpEF? (25:06)What's the treatment for HFpEF? (32:03)Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! Use the code CORE50 to get 50% off your first month with FreedTags: cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, nursing education, heart failure with preserved ejection fractionFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How do immune checkpoint inhibitors work? (01:56)How do you organize the different immune-related adverse events (irAEs)? (07:15)Generally, when do different adverse events can present? (13:42)What makes someone more likely to develop an adverse effect? (22:20)What role does complementary & alternative medicine play in this patient population? (26:38)Sponsor: At Panacea Financial, you don't need co-signers for personal loans and have reduced payments during training!Tags: Side effects, oncology, cancer, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, pharmacologyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Urinalysis in a patient with AKI from purely cardiorenal syndrome? (~02:05)What is bioavailability, duration of action, and outcomes with furosemide, torsemide, and bumetanide? (~08:47)How can spot urine sodium measurements be used to assess diuretic response? (~18:08)What are the differences between thiazides (PO Metolazone vs. IV Chlorothiazide) and acetazolamide augment diuresis? (~27:35)Spaced Repetition: RAAS inhibitors or SGLT2 inhibitors as GMDT in CKD? (~35:08)Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! Use the code CORE50 to get 50% off your first month with FreedGet CME-MOC credit with ACP!Tags: nephrology, cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, diuretic resistanceFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are the benefits of early rhythm control versus rate control alone? When is electrical cardioversion used and what information can it tell us? What side effects for amiodarone, dofetilide, and sotalol, propafenone and flecainide? When should catheter ablation be considered in patients with atrial fibrillation?Time stamps:02:05 Pearl 1 - Rhythm control11:23 Pearl 2 - Electrical cardioversion17:53 Pearl 3 - Class III antiarrhythmics and side effects26:31 Pearl 4 - Class Ic antiarrhythmics and side effects31:55 Pearl 5 - Catheter ablationTags: cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, nursing education, atrial fibrillation Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Give Factor meals a try: factormeals.com/coreim50 (use code "Coreim50" for 50% of your 1st weekly box & 20% of your next box!)Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Should your patients be reaching for albuterol when their asthma flares up? Some of us may have been treating asthma exacerbations incorrectly for many years… What is the right approach? Tune in to the fifth episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group, to learn about the latest asthma management trials and guidelines, and how to translate them into better patient care.Show Notes & TranscriptTime Stamps01:47 Evolving story of asthma management03:26 Pathophysiology of asthma management06:01 Key players & terms08:56 Story of asthma through the decades17:55 MANDALA TrialTags: IMCore, CoreIM, primary care, pulmonary, nurse practitioner, pharmacist, physician assistant, inhalersFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Give Factor meals a try: factormeals.com/coreim50 (use code "Coreim50" for 50% of your 1st weekly box & 20% of your next box!)Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How do you choose btw PO vs. IV iron? What is the best counseling for oral iron formulations?  How do you choose between different IV iron formulations? Should you use the Ganzoni formula?  What is a Fishbane reaction? And how is it different from anaphylaxis?Sponsor: At Panacea Financial, you don't need co-signers for personal loans and have reduced payments during training!Time stamps:02:09: Spaced repetition from the last Gray Matters Episode05:29: Choosing between oral and IV iron11:17: Considerations with oral iron repletion24:02: Considerations with IV iron repletion32:36: Complications and side effects of IV ironTags: hematology, primary care, CoreIM, IMcore, nurse practitioner, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Head to Factormeals.com/coreim50 to get 50% off! Use the code COREIM50 Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What do the different iron labs mean?! How to interpret iron labs in the setting of inflammation? How to take a good menstrual history? Sponsor: Freed is an AI scribe that listens, prepares your notes, and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! Use the code CORE50 to get 50% off your first month with FreedTime stamps:03:43 Iron deficiency labs and interpretation in inflammation16:08 Heavy menstrual bleeding evaluation27:04 When should a premenopausal woman with iron deficiency have endoscopy?35:15 RecapTags: hematology, women's health, gastroenterology, heavy menstrual bleeding, primary care, CoreIM, IMcore, nurse practitioner, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Head to Factormeals.com/coreim50 to get 50% off! Use the code COREIM50 Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Uncover many blind spots on tube feeds!Sponsor: At Panacea Financial, every single customer gets their OWN 24/7 primary care banker who actually knows you!Youtube Interviews: Short-term enteral accessDurable enteral accessWhat is venting aka decompression?Show Notes & TranscriptTimestamp02:21 Indications for tube feeds09:36 Routes of enteral access19:20 Components of tube feeds7:03 Tube feeds complications34:50 Counseling patients before discharge and medication interactionsTags: IMCore, CoreIM, nursing home, primary care, dietician, nutrition support, hospital medicine, interprofessional education, enteral feedsFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How do you manage GDMT in a frail older adult? When is a guardian needed and what is the process for obtaining guardianship?Sponsor: Echonous, the maker of Kosmos, is redefining point-of-care ultrasound at half the price (or less) of comparable carts. Mention Core IM at the Demo to get a free A.I application of choice!Youtube Interviews: When to consider a guardian?Guardianship ProcessLimitation and value of individualismShow Notes & TranscriptTimestamp04:03 Deep Dive 1: How do you approach guideline-directed medical therapy of heart failure with reduced ejection fraction in a frail older adult?11:55 Deep Dive 2: When is a guardian needed and what is the process for obtaining guardianship?28:30 Deep Dive 3: How do you re-evaluate GDMT in a frail older adult once an adverse event has occurred?33:27 Reflections37:06 RecapTags: IMCore, CoreIM, nursing home, primary care, cardiology, palliative care hospital medicine, interprofessional education, social work, case managementFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Go to https://www.factormeals.com/coreim50 For a great deal: Use the code coreim50Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How do you counsel patients eligible for the RSV vaccines? What do the results of the RENOIR and AReSVi trials tell us and how do they compare? How should we interpret vaccine trials in the first place? Tune in to the fourth episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group. Sponsor: Pathway FREE evidence-based clinical decision support app. Guideline summaries, interactive algorithms, landmark trials & moreShow Notes & TranscriptTime Stamps02:30 Epidemiology of RSV03:46 Development of RSV vaccine05:55 Vaccine trial design12:22 ARESVI and RENOIR Trials18:18 Who should we recommend the RSV vaccine to?19:50 What don’t we know?Tags: IMCore, CoreIM, primary care, infectious disease, nurse practitioner, pharmacist, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Factor 75 and use my code coreim50 for a great deal: https://www.coreimpodcast.com/factor75Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

When you see a low mag or a low phos, what are you thinking about? And do PPIs effect magnesium absorption? How much sodium and potassium are found in a typical oral phosphorus supplement?Sponsor: Pathway FREE evidence-based clinical decision support app. Guideline summaries, interactive algorithms, landmark trials & moreYoutube interview on key points on magnesiumYoutube interview on key points on phosphateCME : http://bit.ly/CIMCME || Show Notes & TranscriptTimestamp01:37 Pearl 1: Magnesium09:39 Pearl 2: Framework for hypomagnesemia16:53 Pearl 3: Magnesium repletion22:39 Pearl 4: Phosphorous28:36 Pearl 5: Phosphorous repletionTags: IMCore, CoreIM, nephrology, hospital medicine, interprofessional education, renalFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Sharpen your de-escalation skills!Sponsor: GlassHealth | Get unlimited A.I queries for 1 month with promo code: COREIM !Timestamps: 02:26 Difficult Patients10:25 Mediation Toolkit17:20 Maxims of Mediation26:46 When the Conversation Still Breaks Down35:11 ConclusionTags: IMCore, CoreIM, ethics, humanities, nurse practitioner, pharmacist, physician assistant, burnoutFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

In community-acquired pneumonia, can steroids improve mortality? Past studies of steroids in CAP have been conflicting, with some showing a mortality benefit and others showing no difference. How does the CAPE COD trial change how we think about patients hospitalized with severe CAP? To find out, tune into the third episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group. Sponsor: Panacea Financial Student Loan ConsultationShow Notes & Transcript01:50 Pathophysiology of Steroids and Infection03:50 Steroids in PNA Studies08:56 CAPE COD Trial14:13 Discussion of CAPE COD Trial18:36 Takeaways/DiscussionTags: IMCore, CoreIM, primary care, cardiology, nurse practitioner, pharmacist, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Syncope history, PPM/ICD prior to MRI or surgery, anticoagulation for pacemaker or ICD procedures and new cardiac devices and how they may look different on EKG or chest x-ray!Sponsor: Post Investment: Real Estate Syndications Show Notes & Transcript Timestamps:01:13 Pearl 1: Should we approach syncope history differently in our patients with pacemakers and ICDs?06:31 Pearl 2: Considerations for patients with implantable devices before surgery.12:26 Pearl 3: Considerations for patients with implantable devices before MRI.14:45 Pearl 4: Anticoagulation in patients undergoing pacemaker or ICD procedures. 18:17 Timestamp 5: Emerging cardiac device technology and how they might look different on EKG or chest x-rayTags: IM Core, CoreIM, cardiology, prodromal symptoms, CRT, biventricular pacingFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Is Cr or Cystatin C better to assess eGFR? What are pros & cons of each? Does eGFR tell the full picture of kidney function? What may cause false positive albuminuria?Sponsor: Panacea Financial Student Loan ConsultationCME : http://bit.ly/CIMCME || Show Notes & TranscriptTimestamp:00:13 Reviewing CKD Classification: G1-5 stage, A1-3 stage04:20" What's wrong with how we estimate GFR?06:50 Why is creatinine flawed as an estimator of GFR?10:52 Enter new contender...Cystatin C!16:16 Importance of the A Stage!20:21 Which patients should you measure proteinuria in?22:10 Treatments for albuminuria!24:27 Summary and ClosingTag: Creatinine, nephrology, renal, CoreIM, IMcore, internal medicine, primary care, nurse practitioner, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Get a great deal on HelloFresh (use code 50COREIM): http://hellofresh.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Who should be referred for genetic counseling? How can we set our our patients and genetic counselors up for success? And let's do some genetics myth busting!Sponsor: Hellofresh (50% off + free shopping with code: 50COREIM)Show Notes & TranscriptTimestamp03:13 Part 1: Who should be referred to genetic counseling?11:23 Part 2: How do we set up genetic counselors for success?22:38 Part 3: Genetic counseling myth busting!Tags: IMCore, CoreIM, primary care. oncology, surgonc, medonc, cancer, nurse practitioner, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Get a great deal on HelloFresh (use code 50COREIM): http://hellofresh.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What is the evidence behind K+ repletion? What is a framework to think through for hypokalemia? What are the different repletion formulations and what else can you do to mitigate hypokalemia? Stepping back, do we really need to get labs every single day?!Sponsor: Hellofresh (50% off + free shopping with code: 50COREIM)CME : http://bit.ly/CIMCME || Show Notes & TranscriptTimestamp01:45 Pearl 1: Evidence for potassium repletion 09:10 Pearl 2: Framework for hypokalemia17:09 Pearl 3: Repletion goals23:00 Pearl 4: Options for hypokalemia treatment29:13 Pearl 5: Frequency of lab checks and repletionTags: IMCore, CoreIM, nephrology, hospital medicine, potassium diet, interprofessional educationFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Get a great deal on HelloFresh (use code 50COREIM): http://hellofresh.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What is the difference between semaglutide (ozempic) and tirzepatide (mounjaro) in outcomes and mechanism? How did we find out diabetes medications can help with weight loss?Sponsors: Post Investment: Real Estate Syndications || Hellofresh  Show Notes & Transcript02:08 Framework for thinking about obesity03:42 History of obesity treatment06:29 Gila monsters and GLP and GIP mechanisms08:29 Story of how medications for diabetes were found to have a weight loss benefit12:50 SURMOUNT-1 trialTags: IMCore, CoreIM, primary care, cardiology, nurse practitioner, pharmacist, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Use code 50COREIM for HelloFresh, America's #1 Meal: http://hellofresh.com/50COREIMAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

With progressing CKD &HFrEF, what GDMT medications can you start, continue or stop? What does the data on hydralazine/isosorbide tell us and what does it NOT tell us? What are the pros and cons of starting GDMT inpatient versus outpatient? Do you still keep patients on GDMT once their EF recovers? Sponsors: Hellofresh | Pranay's Effective Living Formula CoursePranay's Free Masterclass (Sept 20 and 27th at 5pm PST) CME : http://bit.ly/CIMCME || Show Notes & TranscriptTimestamps 01:54 Pearl 1 – Recap of GDMT and CKD09:15 Pearl 2 – Hydralazine and Isosorbide Dinitrate 20:59 Pearl 3 – Ivabradine 25:47 Pearl 4 – Inpatient vs Outpatient Initiation of GDMT30:55 Pearl 5 – Ejection Fraction Recovery  Tags: IMCore, CoreIM, hydralazine, heart failure reduced ejection fraction, HFmrEF, HFimpEF, chronic kidney disease, cardiology Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Use code 50COREIM for HelloFresh, America's #1 Meal: http://hellofresh.com/50COREIMAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What does medical education research say about improving diagnostic errors? What habits help in getting to diagnostic excellence?Timestamps01:00 System 1 vs. System 207:46 Cognitive Biases13:46 Case for Knowledge18:29 Other Practices to Decrease Error28:26 Conclusion CME: http://bit.ly/CIMCME || Show Notes & TranscriptThis episode is made in part of ACP’s Diagnostic Excellence curriculumTags: IMCore, CoreIM, clinical reasoning, system 1 vs. system 2, cognitive bias, feedback and reflectionFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out HelloFresh! Use code 50COREIM for a great deal: http://hellofresh.com/50COREIMAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are side effects of tacrolimus and mycophenolate? And what are common medication interactions? What causes of acute kidney injury are unique to renal transplant recipients When a patient has a fever, what are the viral syndromes we should work up? What are signs and symptoms of rejection? Timestamps02:41 Types of Immunosuppression14:31 Medication Reconciliation22:36 AKI in the Transplant Patient31:53 Infections in the Transplant Patient40:00 Transplant rejection, cancer after transplantCME: http://bit.ly/CIMCME || Show Notes & TranscriptTags: IMCore, CoreIM, renal, internal medicine podcast, hospitalist, nephrology, immunosuppressiveFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out HelloFresh! Use code 50COREIM for a great deal: http://hellofresh.com/50COREIMAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

In patients with heart failure with low ejection fraction and chronic coronary disease without unstable symptoms, does stenting open blocked coronary arteries extend life or reduce hospitalizations? There is some literature to suggest those with low EF may benefit from revascularization with surgery.How does the REVIVED trial change how we think about these patients? Tune in to the first episode in this new series brought to you by Core IM in collaboration with NEJM Group.Show notes & TranscriptAccess to Rotation Prep Cardiology guide on NEJM Resident 360 is free for August 2023. View the relevant sections on ACS and CHF.Timestamps00:50 Question REVIVED addressed01:44 Revascularication in HFrEF06:32 Revascularization in stable CAD10:02 REVIVED trial12:20 Summary and takeawaysTags: IMCore, CoreIM, cardiology, internal medicine podcast, hospitalist, stent, CABG, evidence-based medicineFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Laugh and be humbled along some of Dr. Maria Rosasco's most memorable July stories !Listen to the original July Stories: https://bit.ly/3Y4n8jGSubscribe to our new Youtube Channel !Tags: medical humanities, internal medicine, residency, medical school, interprofessional education, rotation, imposter syndrome, feedbackAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

BONUS on Cosyntropin stimulation tests! What exactly is it? How do you interpret them? What is the difference between adrenal insufficiency and steroid withdrawal syndrome?Use promo code COREIM for 1 month of free access to Glass Pro at https://glass.health/coreim Show notes & TranscriptSubscribe to our new Youtube Channel !Tags: IMCore, CoreIM, endocrine, internal medicine podcast, hospitalist, glucocorticoid withdrawal, fatigueAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How do you choose between the different steroids? At what dose and duration do you get concerned about worrisome complications? What types of prophylaxis should be started in patients on steroids and when?In which patients should we wean steroids vs. stop abruptly, and how should we do so? What factors limit steroid weaning?Use promo code COREIM for 1 month of free access to Glass Pro at https://glass.health/coreim Use this link for CME-MOC credit with ACPShow notes & TranscriptTime Stamps02:59 Types of Corticosteroids14:31 Side Effects of Steroids21:15: Prophylaxis 27:32 Steroid Weaning 33:38 Steroid Weaning Limitations Tags: IMCore, CoreIM, endocrine, adrenal insufficiency, internal medicine podcast, hospitalist, hydrocortisone, fludrocortisone, methylprednisolone, prednisone, dexamethasone, steroid withdrawal syndromeAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

In cirrhosis, what actually contributes to the bleeding vs. clotting risk? Does the INR capture it? What is in FFP? Do you have to give FFP prior to a paracentesis and a thoracentesis? How much of FFP stays in the intravascular space? Does indwelling pleural catheters increase risk of malnutrition or infection?Show notes & TranscriptTime Stamps02:36 Deep Dive 1: Bleeding risk of paracentesis and thoracocentesis05:35 Deep Dive 2: FFP effect on bleeding risk15:43 Deep Dive 3: Risks of FFP19:45 Deep Dive 4: Indwelling pleural catheters30:31 RecapTags: IMCore, CoreIM, hepatology, internal medicine podcast, hospitalist, heme/onc, pulmonaryAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How long can fatigue last for after radiation? Are all patient post radiation immunocompromised?  What are the potential acute and long-term side effects after lung, breast, prostate and brain radiation?Use promo code COREIM for 1 month of free access to Glass Pro at https://glass.health/coreim Use this link for CME-MOC credit with ACPShow notes & TranscriptWhiteboard Animation Video of Radiation PhysiologyTime Stamps02:37 Systemic Radiation Side Effects14:29 Lung Radiation Side Effects18:22 Breast Radiation Side Effects21:45 Prostate Radiation Side Effects24:54 Brain Radiation Side EffectsTags: IMCore, CoreIM, cancer, tumor, internal medicine podcast, hospitalist, heme/onc, rad onc, EBRT, brachytherapyAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are the different types of radiation? What should we and shouldn’t we put in our one-liners? What makes palliative radiation different from curative radiation? And when to refer to for palliative radiation?Show notes & TranscriptWhiteboard Animation Video of Radiation PhysiologyTime Stamps02:04 What is radiation?03:17 How does radiation therapy work?04:50 How is today’s radiation different from the past?05:40 What role does radiation play in cancer treatment?07:48 What are the different types of radiation?15:34 How do you write a rad onc one-liner as an internist?19:59 What is palliative radiation and how/when should we use it?Tags: IMCore, CoreIM, cancer, tumor, internal medicine podcast, hospitalist, heme/onc, EBRT, brachytherapy Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What did you have to "unlearn" in your learning journey? How do you organize your time? Organize how you keep up with medical evidence? What is your calendar management system? How can you use your leadership skills to improve the well-being of your team members?Show notes & TranscriptTime Stamps01:12 Learning Journey05:58 Lifelong Learning11:14 Time Management16:38 Role Modeling19:59 Re-Calibrating FailureTags: IMCore, CoreIM, failure, fixed mindset, growth mindset, imposter syndrome, leadership, learning styles, role modeling, success, time managementAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What does the HbA1c really measure? What are its limitations? How does fructosamine and glycated albumin work? What will falsely elevate or decrease it? What are the benefits of continuous glucose monitoring? What are the limitations of a glucose-centric view and should we be more insulinocentric? Show notes, Transcript and ReferencesTime stamps00:35 Random Glucose, Fasting Glucose, Glucose Tolerance Test03:03 Hemoglobin A1c08:26 Fructosamine and Glycated Albumin10:50 Continuous Glucose Monitoring15:44 The Overlooked Issue of Insulin Resistance19:11 SummaryTags: IM Core, CoreIM, insulin resistance, diabetes, microvascular and macrovascular complicationAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

When do you have a device interrogated? Do you know what kind of device your patient has? Do you know how to manage patients with a device who develop bacteremia? How do you discuss end of life care in patients with devices such as a pacemaker or ICD?Visit www.medmastery.com/coreim for 15% off Medmastery Pro subscription. Discount code: “COREIM15”Use this link for CME-MOC credit with ACPShow notes, Transcript and ReferencesTime stamps02:51 What are the different types of pacemakers and defibrillators? Who is it indicated for? How can where the leads clue you what the implantable device may do?21:28 How to determine which type of device your patient has?25:10 What can a device interrogation tell you and doesn't tell you?32:13 Do all patients with bacteremia need their implantable cardiac devices taken out? 38:44 End-of-life considerations with pacemakers vs. ICDs Tags: IM Core, CoreIM, sinus node dysfunction, AV dissociation, palliative care, CRT, biventricular pacingAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How does transplant compare to dialysis? Who is a good candidate for a kidney transplant? How long do patients have to wait for a deceased donor kidney transplant? What can increase or decrease the waiting time for your patient? Who is a good living donor candidate? What are the risks of living donors?Use promo code COREIM for 1 month of free access to Glass Pro at https://glass.health/coreim Use this link for CME-MOC credit with ACPShow notes, Transcript and ReferencesTime stamps03:49 Episode start07:13 Dialysis vs. kidney transplant morbidity and mortality11:44 Eligibility for kidney transplant and when to refer21:34 Pre-transplant evaluation process25:38 How long are wait times on the transplant list?36:21 What benefits of living donation? What are risks to the kidney donor?Tags: IM Core, CoreIM, renal, dialysis, nephrology, nephrologist, renal, CKD, chronic kidney disease, living donor kidneyAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What is your approach to trach complications? What do all the words in the one liner of a trach patient mean? What are best practices for airway clearance? When is a patient ready for a speaking valve? What is the process for decannulation?Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E10Show notes, Transcript and References: https://www.coreimpodcast.com/2023/03/08/trac/Time stamps2:56 Trach Components12:47 Trach Complication Management27:48 Airway Clearance34:53 Speaking Valve38:54 DecannulationTags: IM Core, CoreIM, pulmonary, critical care, ICU, nursing care, respiratory therapy, pharmacyAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 Hospital4:36 What is a Safety Net Hospital?11:11 The Origins and Paradox of the Safety Net HospitalLinks 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 Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 stamps01:51 Intro07:57 Case 13:09 Differential16:15 Diagnosis22:20 Problem Representation Tags: IM Core, CoreIM, diagnostic tools, Occam's razor, Hickam's dictum, data collection, mental model, clinical reasoning, rheumatologyAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 stamps04:45 What do we mean by “futility”?11:20 Definitions20:23 Ethical Analysis39:13 RecommendationsTags: IM Core, CoreIM, ATS, autonomy, justice, values, emotions, communication, medical humanities, ethicsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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?Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Show notes, Transcript and References: https://www.coreimpodcast.com/2023/01/18/diagnosis-of-atr…-matters-segment/Time stamps01:12 Intro03:51 Deep Dive 108:16 Deep Dive 215:25 Deep Dive 321:05 Deep Dive 427:07 Deep Dive 5Tags: IM Core, CoreIM, Devices, cardiac, risk, perioperative, stroke, surgery, anticoagulationAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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/Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E8Time stamps01:24 Intro 03:37 Fasting vs. Nonfasting Lipid Panel05:11 Current guidelines07:43 Pathophysiology Overview09:04 Pathophysiology of Apo-B vs. LDL-C with traffic analogy11:23 Apo-B15:40 TG-to-HDL ratio17:06 TakeawaysTags: IM Core, CoreIM, risk, USPSTF, ACC/AHH, family medicine, cardiology, primary careAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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-E7Time stamps01:20 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 ConclusionTags: IM Core, CoreIM, care, communication, goal setting, support, strategies , medical humanities Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 stamps01:42 Intro 04:37 Pearl 1: Diagnosis 13:20 Pearl 2: Differential & Treatment20:48 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 HepatitisAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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?Sponsor: Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E6ACP CME: http://bit.ly/CIMCMEShow notes, Transcript and References:  https://www.coreimpodcast.com/2022/10/19/mind-the-gap-asp…imary-prevention/Time stamps03:03 Guideline recommendations 07:00 How does Aspirin work? 09:11 Trial Data13:00 ASCVD Risk Calculator18:07 Starting vs. Stopping Aspirin 22:11 Summary Tags: IM Core, CoreIM, guidelines, atherosclerosis, ASCVD, plaque, bleeding, shared decision-makingAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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?Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/10/05/ana-antinuclear-…5-pearls-segment/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-imSponsor: Visit www.medmastery.com/coreim for 15% off on all subscriptions. Discount code: “COREIM”Timestamps:01:37 Pearl 103:54 Pearl 213:53 Pearl 318:07 Pearl 429:30 Pearl 5Tags: IM Core, CoreIM, autoimmune, joint disease, titers, Raynaud's, lupus, RheumatologyAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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?Sponsor: Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E5Show notes, Transcript and References: https://www.coreimpodcast.com/2022/09/21/discharge-with-i…atters-segment-2/Time stamps01:30 Deep Dive #117:27 Deep Dive #2Tags: IM Core, CoreIM, outpatient, inpatient, PCP, management, communication, discharge summary, incidentalomaAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Can you identify where along the clinical reasoning pathway the learner is struggling? What coaching exercises can be helpful? What feedback do you fall back on when working with learners? What are common challenges?Digital Education Conference 2022 in Oct 7 2022: https://cmecatalog.hms.harvard.edu/digital-educationShow notes, Transcript and References: https://www.coreimpodcast.com/2020/12/09/hoofbeats-strugg…inical-reasoning/ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-imAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Hear personal stories about racial trauma or stereotype threat. How can we respond and how do we differentiate an up stander from a bystander? What barriers exist when we try to respond?Show notes, Transcript and References:   https://www.coreimpodcast.com/2022/08/24/upstander/ Time stamps00:59 Intro05:51Overview of Microaggressions09:11 Prevalence12:43 How to respond22:03 Barriers to appropriate response27:00 ConclusionTags: IM Core, CoreIM, bystander, race, microaggressions, hidden curriculum, DEIAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are the 3 types of solutes you can use in hyponatremia? What are each of their drawbacks? How do loop diuretics work help in hyponatremia? What can you use to tell you on day 1 that fluid restriction alone will not work?Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/08/03/hyponatremia-man…5-pearls-segment/Sponsor: https://go.amboss.com/CoreIM-E4Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps:01:20 Intro04:46 Pearl 113:13 Pearl 224:03 Pearl 332:49 Pearl 437:05 Pearl 5Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Digital Education Conference 2022 in Oct 7 2022: https://cmecatalog.hms.harvard.edu/digital-educationWhat does each diagnostic test tell you? How do you interpret urine osmolality, urine sodium, or urine urea? What studies can be used to better assess response to treatment? How can uric acid be utilized as a diagnostic tool? What is the interplay between ADH and UOsm?Show notes and Transcript: https://www.coreimpodcast.com/2021/02/10/5-pearls-on-hyponatremia-episode-1/ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-imAmboss Article on HyponatremiaTags: urine studies, SIADH, Core IM, IMCore, antidiuretic hormone, hospital medicine, family medicine, nephrologyAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Other than infection, what do you think about as other causes of fever? How can you distinguish sepsis from drug fever from antibiotics? What medications are most likely to cause neurotoxicity? What are some risk factors? How do you think about goals of care with patients? Show notes & Transcript:  https://bit.ly/3P8wqG6Sponsor: Visit www.medmastery.com/coreim for 15% off on all subscriptionsDiscount code: "coreim" Time stamps02:50 Deep Dive #113:12 Deep Dive #226:39 Deep Dive RecapTags: IM Core, CoreIM, antibiotics, CMO, DNR/DNI, sepsis, reflection, grey mattersAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are the 3 different types of inhaler devices and what should you educate patients about each? When do you stop the inhaled steroid in COPD? And when do you think of increasing the dose? What is important to communicate at the time of diagnosis, and during goals of care discussions? Show notes, Transcript and References:https://www.coreimpodcast.com/2022/06/22/5-pearls-on-copd-management/Sponsor: Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E3Timestamps:Pearl 1: 3:20Pearl 2: 8:20Pearl 3: 15:47Pearl 4: 26:55Pearl 5: 34:10Tags: IMCore, CoreIM, Pulmonary, medication management, spirometryAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How do you ask about spiritual health? How is spirituality different from religion?Show notes, Transcript and References: https://www.coreimpodcast.com/2022/06/15/spirituality/Time stamps00:01 What is spirituality?7:12 Why does spirituality matter?12:09 How do we screen for it?18:50 Chaplains27:49 Conclusion Tags: IM Core, CoreIM, ethics, medical humanitiesAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are the indications for a simple transfusion? And what the indications for an exchange transfusion? What is your approach to pain management in patients with sickle cell? What are the treatment options for sickle cell and which ones actually decrease sickle crisis and improve mortality? What are some of the major sickle cell complications to watch out for and how can we prevent some of them?Show notes, Transcript and References: https://www.coreimpodcast.com/2022/06/01/5-pearls-on-sickle-cell-anemia/Sponsor: https://go.amboss.com/CoreIM-E2Timestamps:1:33 Pearl 14:48 Pearl 218:43 Pearl 329:45 Pearl 435:22 Pearl 5Tags: IM Core, CoreIM, hematology oncology, health inequity, vaso-occlusive crisisAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How do you counsel patients on beta blockers? Is one beta-blocker better than the other? What is preferred: ACEi, ARBs or ARNIs? What are the pros and cons of each? How does spironolactone compare to eplerenone? When do you stop mineralocorticoid receptor antagonist? What are risks with SGLT2 inhibitors? How do you initiate GDMT? Which meds do you start first and in what order?Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/05/11/5-pearls-on-guideline-directed-medical-therapy/Sponsor: https://go.amboss.com/GDMTGet CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps:03:13 Pearl 112:14 Pearl 220:36 Pearl 326:42 Pearl 432:16 Pearl 5Tags: IM Core, CoreIM, heart failure with reduced ejection fraction, GDMT, treatment, cardiologyAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How much of D5W vs. isotonic saline contributes to intravascular volume? How do you distinguish between oncotic pressure and tonicity? What balanced solutions do you reach for? What is the data behind using colloids like albumin as an intravascular expander? How much do pRBCs stay in the plasma? Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/04/27/fluids-colloids-5-pearls-segment/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps:02:14 Intro04:26 Pearl 111:08 Pearl 220:43 Pearl 331:06 Pearl 435:06 Pearl 5Tags: IM Core, CoreIM, fluids, hypertonic, volume, crystalloid, tonicity, blood, nephrology, hospital medicineAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What do you include in your initial basic work-up for suspected pulmonary hypertension? Do you know how to calculate the PASP on the ECHO? What physiological insults that can cause high pulmonary pressures? How can we interpret the E/e’ ratio? Show notes, Transcript and References: https://www.coreimpodcast.com/2022/04/06/pulmonary-hypertension/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-imTime stamps:02:18 Intro05:27 Pearl 1 12:17 Pearl 216:13 Pearl 324:04 Pearl 430:08 Pearl 5Tags: IM Core, CoreIM, PASP, Echo, hypoxia, PA pressure, vascular resistanceAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How can we use food as medicine? How can we best counsel our patients on their diets? Which pre-set diets can we recommend for or against? How can we make the changes sustainable? Show notes, Transcript and References: https://www.coreimpodcast.com/2022/03/23/obesity-and-nutr…-2021-sgim-recap/Time stamps:03:10 Trends in weight and dieting06:01 Counseling patients on diet09:35 Food group recommendations14:53 Pre-set diets20:47 Making sustainable changesTags: Core IM, IM Core, diet, salt intake, fiber, weightAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are some tricks to help you perform a virtual physical exam? What role do these visits play in our overall care for the patient? What tools do we have at our disposal for a more thorough evaluation?Show notes, Transcript and References: https://www.coreimpodcast.com/2022/03/09/telemedicine-and…-2021-sgim-recap/Tags: IM Core, CoreIM, tele visit, gizmos, history taking, virtual, physical exam, assessment, functional status, tips Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How long should you anticoagulant for a PE? When can you safely stop anticoagulation for thrombogenic patients who need an urgent biopsy? Should an IVC filter be placed to prefer further embolization of a DVT? What percentage of patients with cancer associated blood clots will have progression while on anticoagulation?Show Notes, Transcript, and References: https://www.coreimpodcast.com/2022/02/23/24433/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps:02:40 Deep Dive #1 Anticoagulation08:50 Deep Dive #2 DOACs14:08 Deep Dive #3 IVC Filter17:49 Deep Dive #4 Biopsy25:00 RecapTags: Core IM, IM Core, Anticoagulation, Bleeding, DOACs, IVC, reflections, clotsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How can you implement effective note taking for virtual learning? Do you use interleaving during rounds? What is the 5/10/30 rule and how does it apply to mentorship? Does implicit bias affect gender performance scores in clinical rotations? How common are biased patient behaviours? How can you foster a safer learning environment for trainees? How can you promote antiracism?Show notes, Transcript and References: https://www.coreimpodcast.com/2022/02/09/medical-educatio…ng-core-im-recap/Time stamps02:10 Make it Stick Virtually 08:35 Mentoring in the Modern Era: More than the Traditional Dyad13:29 Clinical Update in Medical Education 20:58 Anti-Racism in Medical Education: Concrete Actions to Further Social Justice and Racial Equity Tags: IM Core, CoreIM, virtual learning, note taking, feedback, mentorship, microaggressions, gender bias, sterotype threatAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What’s your comfort level with managing hyponatremia and how does it change in unfamiliar environment? How can you vary your practice to build up adaptive exerptise? Show notes, Transcript & References:  https://www.coreimpodcast.com/2022/01/26/hoofbeats-consult-case/ Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps01:36 Case10:42 Case analysis 22:45 An unfamiliar domain25:50 Lab review40:04 ConclusionsTags: IM Core, CoreIM, hyponatremia, preeclampsia, reasoning, adaptive expertise, situational awarenessAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Have you ever thought about where the 1g/dL hemoglobin appropriate bump after 1 unit of pRBC transfusion? How does the patient's intravascular volume affect this? What rise in hemoglobin should you expect? What factors can impact this?Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/01/05/1-to-1-prbc-bump…-the-gap-segment/Time stamps01:22 Unpacking the question 01:55 The math 04:32 Functional hemoglobin08:50 Donor and Patient 11:18 Scenarios12:58 Summary14:34 Clarification Tags: IM Core, CoreIM, hemoglobin, intravascular volume, irradiation, donationAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Let’s apply to cases! We use the 7 questions framework to 3 practical casesShow notes, Transcript and References: https://www.coreimpodcast.com/2021/12/22/treatment-over-objection-part-2/Time stamps2:19 Case 1: Review of Framework7:59 Case 29:04 Consent vs. Assent 11:11 Role of Consult Services13:16 Role of Surrogates15:29 Conclusion Tags: IM Core, CoreIM, autonomy, capacity, human dignity, non-maleficence, ethics, medical humanitiesAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Get a very useful framework to help you weigh the risks and benefits of treatment over objection!Show notes, Transcript and References: https://www.coreimpodcast.com/2021/12/08/treatment-over-objection/Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps03:02 Ethical and emotional challenges10:08 Case 118:55 Study of the 7 Questions22:46 Conclusion  Tags: IM Core, CoreIM, autonomy, capacity, human dignity, non-maleficence, ethics, medical humantiesAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What degree of hyperkalemia makes you worried enough to send your patient to the ED? Are ECG changes sensitive in detecting hyperkalemia? Do you know how to advise your patient on dietary changes? What medications can you effectively use in the outpatient setting?Show notes, Transcript and References: https://www.coreimpodcast.com/2021/11/17/hyperkalemia-mind-the-gap-segment/ Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps01:01 Introductions07:58 Nutrition17:13 Medications20:48 Outpatient medications26:16 RecapTags: IM Core, CoreIM, outpatient, blood work, diet, electrolytes, ECG, nephrology, chronic kidney disease, nutritionAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are pearls and pitfalls when assessing an older patient for the first time?Time Stamps:02:25 Initial Office Visit08:08 Mobility Assessment 13:25 Cognitive Evaluation 19:27 Medications 26:29 Throwback PearlShow notes, Transcript and References: https://www.coreimpodcast.com/2021/10/31/5-pearls-on-geriatric-care/Tags: Core IM, IM Core, delirium, goals of care, dementia, mini cog, MOCA, deprescribingAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Should we use oral diabetes agents in our hospitalized patients? Do you hold metformin for fear of lactic acidosis? Do you typically order an insulin sliding scale? When can you comfortably restart PTA meds?Time Stamps:02:25 Can we give metformin in the hospital?10:50 Incretin-based therapies14:49 Sodium Glucose Cotransporter-2 Inhibitors16:27 Sulfonylurea & Thiazolidinediones18:00 Basal Insulin inpatientShow notes, Transcript and References: https://www.coreimpodcast.com/2021/10/13/oral-diabetes-medications-in-hospitalization-mind-the-gap-segment/ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Tags: Core IM, IM Core, glucose, insulin, hospitalized patients, oral medications, sliding scale, DPP-4, GLP-1Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are practical phrases can you incorporate to help patients who use drugs? What changes can you make to ensure person-first language? What safe drug practices can you advise? What is MOUD?Show notes, Transcript and References: https://www.coreimpodcast.com/2021/09/29/5-pearls-on-stig…oid-use-disorder/ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps:04:24 Starting the Conversation 10:43 The Shared Agenda14:46 Exploring patient goals18:54 Reducing drug use24:09 Reducing harm in opioid use29:06 RecapTags: Core IM, IM Core, MOUD, buprenorphine, patient centeredness, motivational interviewing, safe practicesAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

A very practical episode around nuanced code status conversations with many examples!Time Stamps:00:08 Introduction04:01 Information Gathering20:41 Informed Consent29:47 Giving Recommendations36:47 Mistakes48:22 Wrap Up Show notes, Transcript and References: https://www.coreimpodcast.com/2021/09/12/code-statusTags: Core IM, IM Core, DNR/DNI, CPR, intubation, goals of care, shared decision making, documentation, conversations, recommendationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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/ ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps: 04:07 SAR vs SNF 13:35 Long term Nursing Home Care 18:30 Assisted Living Facility 24:40 Acute rehab 26:11 LTACH 27:49 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 educationAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are the indications for a stress test?  How to choose stress protocol in a stress test?  How to choose diagnostic imaging in a stress test?  How do we interpret results from stress tests, and how should this be communicated to patients? For full transcript, infographic and show notes: https://www.coreimpodcast.com/2019/04/24/stress-testing/ Tags: Internal Medicine, Internist, Primary Care Physician, Hospitalists, Emergency Medicine, Nurse Practitioner, Physician Assistant, Family Physician, Cardiology, angina, ischemiaAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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   Tags: CoreIM, AMA Discharges, Psych, Competency, medical ethics, medical humantiesAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

20 Qs game with Core IM Team vs. Expert Discussant ! Full Transcript and Show notes Get CME-MOC Credit for listening to this episode Time Stamps 00:20 The game of medical Twenty Questions 04:37 Case introduction 05:50 The CoreIM team attempts to solve the case 15:36 The discussant’s diagnostic schema for abnormal bleeding 23:37 Primary versus secondary hemostasis 30:33 The pathology report ! 37:38 Criteria for the final diagnosis 38:46 Dissecting a diagnostic coup 49:42 Conclusion Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Transitions can be hard. Laugh, commiserate, and be inspired by these July stories in medicine! Very big thank you to everyone who told their stories ! Let's help each other feel a little less alone in the struggle, be more understanding and compassionate or laugh at ourselves. Please share this episode with colleagues.  Do you have a July story? Email us at [email protected]. Tags: Narrative Medicine, CoreIM, IMcore, imposter syndromeAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How can we help colleagues that we think are struggling with substance use disorder? What options are available for physicians? Are these different state to state? What deterrents do physicians face when seeking help? Time Stamps: 00:21 Introduction 02:59 Scope/Definitions 08:05 Systems for Physician Impairment 13:50 Barriers to Care 24:48 Helping an Impaired Physician 28:44 Systems Level Change Show notes, Transcript and References: https://www.coreimpodcast.com/2021/06/09/physician-clinician-impairment/ Tags: Core IM, IM Core, impairment, substance use disorder, mental health, stigma, treatment, costAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Debunk common myths of penicillin allergies! What's the best way to ask about allergies? How can you challenge patients to determine if they have a true allergy? Organic chemistry buffs, what mediates cross-reactivity? What medications can you safely give your patients? Show note, Transcript and References: https://www.coreimpodcast.com/2021/06/02/5-pearls-on-penicillin-allergy/ Time Stamps: 02:49 Penicillin Myths 07:20 Penicillin Allergy 11:21 Allergic Reactions 19:01 Managing allergic reactions 26:53 Alternative medications 33:28 Recap Tags: CORE IM, IM Core, history taking, rash, skin testing, hypersensitivity, medications, over labeling, antibiotics, managementAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are good habits in QI? What are the areas of expertise needed to have a successful career in QI? How can you get involved in quality improvement? What projects can you get involved with, and how do you work outside of your own interests? How can you partner with your healthcare system to make changes? Show notes, Transcript and References: https://www.coreimpodcast.com/2021/05/08/quality-improvement-careers-series/ Time Stamps: 01:36 Getting started 05:01 Formal training 08:27 What are areas of expertise to get good at? 16:27 Typical Day 19:27 Challenges 23:56 Metrics Tags: CORE IM, IM Core, fellowships, jobs, leadership, metrics, training, patient safetyAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How does cost, potency, and bleeding risk affect which antiplatelet you choose P2Y12 inhibitors? How long after starting, do you feel comfortable stopping DAPT on a patient? How do you manage DAPT in patients who need anticoagulation? Show notes, Transcript and References: https://www.coreimpodcast.com/2021/04/07/5-pearls-on-dual…platelet-therapy/ Join Our Team Time stamps 02:35 Indications 08:52 Medications 17:37 Duration 28:23 De-escalation 30:55 Anticoagulation Tags: IM Core, CoreIM, anticoagulation, DAPT, acute coronary syndrome, stents, thrombosis, bleeding risk, cardiology, hospitalist, primary careAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Hear perspectives that don't get as much spotlight! What is it like to be a surrogate? How can we be better listeners for our patients and for their surrogates? Show notes, Transcript and References: https://www.coreimpodcast.com/2021/03/17/supporting-surrogates/ Time Stamps: 01:09 Background Information 03:54 Surrogate Challenges 16:04 Clinician Challenges 36:10 Conclusion Tags: CORE IM, IM Core, decisions, prognosis, goals of care, clinicians, patients, family medicine, palliative care, end-of-lifeAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How can we better serve the public's health? What does the landscape of public health look like? What opportunities are available to better hone your skills? What are common challenges professionals face? Show notes, Transcript and References: https://www.coreimpodcast.com/2021/02/24/public-health-ca…rs-in-gim-series/ Time Stamps: 01:00 Introduction 05:07 Defining Public Health 11:17 Pursuing a Public Health Career 20:12 Politicization of Health Tags: CORE IM, IM Core, fellowships, advocacy, healthcare, jobs, leadership, population healthAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What does each diagnostic test tell you? How do you interpret urine osmolality, urine sodium, or urine urea? What studies can be used to better assess response to treatment? How can uric acid be utilized as a diagnostic tool? What is the interplay between ADH and UOsm? Time Stamps: 04:50 General Diagnostic Approach 12:26 Serum Osmolality 19:34 Urine Osmolality 32:09 Urine Sodium 45:23 Uric Acid Show notes, Transcript and References: https://www.coreimpodcast.com/2021/02/10/5-pearls-on-hyponatremia-episode-1/ ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Tags: urine studies, SIADH, Core IM, IMCore, antidiuretic hormone, hospital medicine, family medicine, nephrologyAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How can I best answer my families medical questions? How can I give my loved ones the best care without providing it directly for them? What boundaries should I have in place? Show notes, Transcript and References:   https://www.coreimpodcast.com/2021/01/13/treating-friends-family/ Time Stamps: 02:45 The tension, the push and pull 05:45 Prevalence 06:32 Stances of societies/professional organizations 08:18 Concerns 10:35 How to respond 17:52 Favors for physician/trainee colleagues, self-doctoring 22:26 Formal vs informal, documentation 23:55 Long-term care Tags: patient care, advocate, advice, healthcare, Core IM, IM Core, medical ethics, medical humanities Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How do you form an educational mission statement? What role do coaches and mentors play? Do you need formal training for a MedEd career? What are the challenges with careers in medical education? Digital Education conference (virtual) on Jan 22, 2021: cmeregistration.hms.harvard.edu/digitaleducation Show notes, Transcript and References: https://www.coreimpodcast.com/2020/12/27/medical-educatio…s-careers-series/ Time Stamps: 00:00 Introductions 05:44 General Tips 18:00 Challenges in Med Ed 24:54 Conclusion Tags: CoreIM, IM Core, mission statement, clinician educator, mentors, coaching, training, feedbackAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Can you identify where along the clinical reasoning pathway the learner is struggling? What coaching exercises can be helpful? What feedback do you fall back on when working with learners? What are common challenges? Show notes, Transcript and References: https://www.coreimpodcast.com/2020/12/09/hoofbeats-strugg…inical-reasoning/ ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps: 00:00 Introduction 03:33 Mental Health & Wellbeing 06:43 Case 1 11:48 Exercise 1 12:53 Exercise 2 14:35 Case 2 19:15 Exercise 3 21:22 Exercise 4 23:24 Case 3 27:29 Exercise 5 28:07 Exercise 6 29:24 Conclusion Tags: CoreIM, IM Core, problem representation, coaching exercises, data gathering, hypothesis generation, clinical reasoning, faculty developmentAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What is the difference between mnemonics and schemata? What does the mnemonic NAACP bring to mind? How do repeat interviews bring you closer to or further away from the diagnosis? Show notes, transcript and references: https://www.coreimpodcast.com/2020/11/25/a-29m-with-cough…oofbeats-segment/ ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps: 00:43 Case presentation Part 1 04:55 Case presentation Part 2 06:50 Expert discussant 28:52 Framing bias 33:38 Concluding thoughts Tags:  IM Core, CoreIM, schemata, mnemonics, eosinophilia, framing biasAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What leads patients to search for alternative treatments than those offered in Western Medicine? How can we provide patients with safer complimentary interventions? How do we prioritize what is important in our patients health? Show notes, Transcript and References: https://www.coreimpodcast.com/2020/10/15/approach-to-patients-with-cam-beliefs/ Time stamps: 01:49 Intro 04:54 What is CAM 06:29 Prevalence of CAM 08:01 Holistic approach to patient care 11:09 Patient empowerment 14:38 Integrating CAM 18:34 Risks and Benefits 19:50 Caution patients 22:29 Indirect Risk 23:45 Big Picture 26:04 Therapeutic Alliance 27:27 Conclusion Tags: IM Core, CoreIM, supplements, homeopathic, naturopathic, Ayurvedic medicine, mind-body interventions, massage, acupuncture, and chiropractic manipulation, qi gong and ReikiAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How can we feel more comfortable in treating these patients? What treatment options do we now have in our toolbox to fight COVID-19? How has the landscape changed in what we can offer patients? Show notes, Transcript and References: https://www.coreimpodcast.com/2020/09/30/covid-management/ Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps 04:16 Supportive Care 07:48 Step-up approach to oxygenation 13:44 Data Points 15:30 Clots 19:13 Steroid use Tags: IM Core, CoreIM, oxygenation, proning, anticoagulationAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How do we respond to challenging times? Are you a driver of change? How can we forge ahead during times of adversity? What lessons can we learn from the stories of our peers and colleagues? Show notes, Transcript and References: https://www.coreimpodcast.com/2020/09/16/transitions-episode/ Time Stamps: 02:48 Minneapolis 2020 with Dr. Uloko 06:44 Early HIV/AIDS with Dr. Kalet 12:07 Hurricane Sandy with Dr. Hwang 17:20 Aftermath of the Syrian Civil War 20:23 Transitions with Dr. Arora Tags: Core IM, IM Core, change, inspiration, narrative medicine Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are common mistakes with protein on the UA? What questions should you ask while obtaining a history that could clue you into nephrotic syndrome? Are kidney biopsies risky business? Is there an associated clot risk in patients with nephrotic syndrome? Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Show note, Transcript and References: https://www.coreimpodcast.com/2020/09/02/5-pearls-on-nephrotic-syndrome/ Amboss Article on Nephrotic Syndrome: https://www.amboss.com/us/knowledge/Nephrotic_syndrome?utm_source=affiliate&utm_medium=link&utm_campaign=coreim-01 Time Stamps: 03:22 Evaluating Proteinuria 09:37 Nephrotic Syndrome specifics 22:31 Who to biopsy 31:39 Diuretics 37:16 Thrombosis Risk Tags - CoreIM, IM Core, edema, proteinuria, kidneys, thrombosis, urinalysis, diuresis Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How tough is it to forge your career in clinical research? What struggles do physicians face in finding protected time? Are there setbacks and frequent rejections? How can you follow your passion and find success? Show note, Transcript and References: https://www.coreimpodcast.com/2020/08/19/research-careers…rs-in-gim-series/ Time Stamps: 1:28 Origins 6:57 Mentorship 14:30 Reality, Roadbumps, and Failures 18:17 The path of many fellowships   Tags - CoreIM, IM Core, clinical investigator, general internal medicine Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 Documentation 14:35 Outpatient PT 18:14 Durable Medical Equipment 22:55 Reimbursement Tags: Core IM, IM Core, physical therapy, durable medical equipment, IPE, multidisciplinary team, interdisciplinaryAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 voluntarism 5:36 Four elements that influence voluntarism 10:26 How do you incorporate voluntarism into the capacity assessment? 16:11 Discussions with uncooperative patients 19:14 Protecting unrepresented patients 21:30 Clinician perspective 25:06 Moral distress Tags: medical humanities, ethics, psychiatry, IM Core, CoreIMAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 HPI 07:33 Past Medical History 04:25 Physician Exam findings 24:22 Historical Figure Revealed 26:30 Reflections on top 3 diagnosis Tags: cognitive and neuropsychiatric disturbances, rabies, mercury poisoning, cholera, delirium, COREIM, IMCORE, clinical reasoning caseAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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/ ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im   Tag: Cardiology, BNP, cardiorenal syndrome, beta-blockers, CoreIM, IMCoreAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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/ ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time stamps: 04:07 SAR vs SNF 13:35 Long term Nursing Home Care 18:30 Assisted Living Facility 24:40 Acute rehab 26:11 LTACH 27:49 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 educationAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 Stamp 01:37 Sodium restriction guidelines 07:13 Current data in outpatient data 11:32 Do inpatient studies show signal? 13:44 Physiology behind sodium balance 16:27 Take away and clinical applicability Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 Stamps 01:32 COVID Crisis as an Outpatient and Advance Care Planning (ACP) 08:06 The virtual visit 12:44 Vital Talk Mnemonic:  “CALMER” 22:03 Challenges to Outpatient COVID Care 26:03 Parting Thoughts Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Episode Outline Disconnection/connection: Patients Disconnection/connection: Family/friends Disconnection: Security, Certainty Connection: 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 Hosts: 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 medicineAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 groundwork 08:56 Asking permission, eliciting values and making a recommendation 15:55 When a patient is dying 16:42 Sharing the prognosis first 20:28 Functional status post-CPR 21:52 Headline statement 23:40 Virtual and PPE Communication Challenges 25:28 Separate process from outcome Tag: coronavirus, COVID, CoreIM, Sars-cov-2, medicine floors, wards, advanced care planningAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 Stamps 02:37 Entrance and Exit strategy 04:25 Prioritizing patient acuity 08:14 PPE uses 11:11 Respiratory concerns in COVID-19 patients 16:35 Patient examination 18:49 Family updates 20:56 Oxygen requirements 23:12 Medications 24:08 Discharging patients 31:00 What we mean by isolation tag: coronavirus, COVID, CoreIM, sars-cov-2, medicine wardsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 contraindications 07:09 Time course for hormone changes 10:21 Hormone risks 19:09 Hormone treatment options 25:22 Preventative Care Screening Tags: CoreIM, gender affirming careAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Practical tips on Gender Affirming Care! Show notes, transcript and references Time Stamps: 02:43 The Gender Unicorn and how it helps us better understand gender identity,  expression, and sex assigned at birth 11:15 Gender dysphoria 14:16 The organ or anatomical inventory 16:46 The inevitability of mistakes 18:39 Ways to ensure gender-affirming care in clinic  Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 making 4:12 Choice 8:24 Understanding 11:22 Appreciation 13:58 Reasoning 21:55 Common myths and misconceptions 25:11 When and how to call a psychiatry consult for capacity assessment 27:47 Conclusion Tags: CoreIM, AMA Discharges, Psych, Competency, medical ethics, medical humantiesAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are the new guidelines for influenza treatment? What are the diagnostic ratios of flu symptoms and tests? Time Stamps 03:10 The art of diagnosing the flu 05:17 Bayesian statistics and the diagnostic odds ratio 07:09 The ins and outs of diagnostic testing for the flu 08:44 Changes in influenza guidelines - testing and treatment 11:17 The not-so-rosy origin story of neuraminidase inhibitors (NAIs) 13:47 Neuraminidase inhibitors (NAIs), mortality benefit and limitations of studies 15:49Take aways Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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? Show Notes and References 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 managers 15:55 The “behind the scenes” paperwork 18:42 Insurance and medications 22:17 Insurance and disposition options 25:08 The importance of creating a safe space for better communication Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What are the symptoms? What distinguishes coronavirus from other influenza-like illness? When coronavirus is suspected, what should you do? Show notes and references CME credit: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im ACP Interactive Learning Module Time Stamps 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? Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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. CME Credit: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps 02:39 Case Introduction 04:46 Yes/No questions with our first two discussants 18:43 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 generation 37:11 The interplay between hypothesis generation and evaluation 38:34 The win-stay, lose-shift heuristic 41:33 Cognitive forcing strategies 49:32 Knowledge vs. experience Tags: Dermatology, rash, DRESS, AGEP, varicella Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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! Prognosis Calculators, Transcript and References Time Stamps 02:48 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, CoreIMAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dive deeper into hx of the influenza virus, how vaccines are made and vaccine effectiveness ! Time Stamps   02:59 The history of the influenza virus 08:18 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 Show Notes, Transcript and References Get CME-MOC credit with ACP!Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 Time Stamps: 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?Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

  Get CME Credit with ACP! Full Transcript with references and show notes Time Stamps 4:30 What is the daily risk of thrombosis if HIT Is left untreated? 5:40 What happens during platelet activation? 07:11 How long does it take for patients to develop for IgG antibodies to Heparin to form? 09:52 Is HIT common? 10:28 Who is at higher risk for HIT? 11:48 Why does low molecular weight heparin have a lower risk for HIT than unfractionated heparin? 15:30 Approach to thrombocytopenia 17:44 How do medications cause thrombocytopenia? 18:38 With medications, what is the time course between medication initiation and thrombocytopenia? 22:20 What is the sensitivity and specificity of anti-PF4 antibody? 23:58 How does the serotonin-release assay (SRA) work? 29:10 What type of anticoagulant do you choose for treating HIT? 31:58 Why is it important to not use warfarin in patients with platelet counts <150,000? 33:32 What is the treatment duration for a patient has confirmed HIT? 36:29 Dr. Cuker’s story and the "Scarlet H" 39:07 Dr. Linkin’s Recap 42:25 Dr. Linkin’s story 44:37 Pearl 5: Throwback to coronary calcium scores    Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

House of God author, Samuel Shem and Prof Katharine Watson share thought-provoking takes on Gallows Humor. Laugh and listen to this captivating take on the different shades of humor in the day-to-day of medicine. Time Stamps 02:33 Episode preview and Guest Introductions 04:20 Definition of Gallows Humor 07:25 Gallows Humor by Comedians vs Patients vs Physicians The Good 08:15 Benefits/Functions of Humor in General 11:10  Connection 13:07 Coping/Catharsis 16:22 Resistance Against Oppression 19:03 Humor as our Authenticity/Humanity The Bad, The Ugly 21:01 Unintended Audiences (e.g., patients, families) 25:30 “Corporeal” Joking 28:00 Toxic Role Modeling 31:10 Desensitization/Losing Empathy Tips, Takeaways & Conclusion33:48 Challenging Inappropriate Jokes 35:45 Excessive Gallows Humor:  Signal of Distress? 37:17 Using Gallows Humor: Questions to Ask Yourself 38:40 Keeping the Faith! 41:11 Excerpt from Man’s 4th Best Hospital by Samuel Shem Transcript and References Tag: medical humanities, medical ethics, CoreIM, IMCoreAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

1st outpatient clinical reasoning case on Core IM Hoofbeats! Get CME-MOC Credit (live at 9AM EST on 10/16) Time Stamps 01:18 Case introduction 11:40 The Casablanca strategy 23:17 The diagnosis revealed 25:30 Logical fallacy: Denying the antecedent 33:22 Components of illness scripts 41:37 Conclusion Show notes, transcripts and references! Do you have a good case or an expert you would like to suggest for an episode? Send it our way at [email protected] Tag: normocytic anemia, splenomegaly, CoreIM, endocarditis, clinic caseAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Go deeper into the world of blood cultures! Time stamps 04:10 Review of Choosing Wisely Guidelines 05:55 What are estimated incidences of positive blood cultures? 06:17 Which clinical signs or patient history is more likely to have positive blood cultures? 09:48 What is the estimated incidence of false positive blood cultures? 11:01 What infections more likely to have bacteremia? 13:50 How do positive blood cultures impact patient outcomes and the use of resources? Show notes, transcript, and references   Tags: Infectious disease, CoreIM, pyelonephritis, cellulitis, community acquired pneumonia        Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Practical tips on smoking cessation! Get CME Credit with ACP! Full Transcript with References and Show Notes Time Stamps 04:50 What questions are important to ask after a patient who contemplative about quitting tobacco? 07:00 Is quitting abruptly on a quit date or gradual cessation to a quit date better? 08:10 How can technology help support patients who are trying to quit? 08:49 How should we prepare patients who quit smoking and are worried about weight gain? 11:06 How can we try to convince patients to use medication as assistance to quit smoking? 11:50 What is the most effective nicotine replacement approach? 13:54 What are the potential side effects of the nicotine patch? 15:00 What should we prescribe for patients who smoke <5 cigarettes a day? 16:28 How can we determine how severe a patient’s nicotine dependence is? 18:26 When is the ideal frequency of nicotine gum or lozenge? 21:45 How does varenicline work? 25:05 Can you start varenicline in patients who have had psychiatric history? 27:15 What major side effect is seen in patients taking bupropion? 29:15 How do e-cigarettes work? 31:18 How should we approach adding e-cigarettes into a patient’s plan for quitting? 31:42 How should we discuss e-cigarette use with our patients? 33:47 Recap 39:54 Screening for Barrett’s Esophagus  Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Do we have to sign the AMA form? Do insurances deny payment for patients who leave AMA? What is your approach to AMA discharges? Core IM At the Bedside speaks to ethics researcher, Dr. David Alfandre, author of Things We Do For No Reason: Against Medical Advice Discharges Show Notes, Full Transcript and References Time Stamps 3:03 Demographics of AMA discharges 5:59 Clinician/System related factors of AMA discharges 10:30 Strategies for mitigating AMA Discharges 15:59 Do we have to make patients sign the AMA form? 18:27 Do insurances deny payment for patients who leave AMA? 23:09 Take Away Points Tags: shared-decision making, harm reductionAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

We hope these stories can make us more introspective and open minded on how these concepts can affect each one of us differently. Let's continue the discussion on the Women in Medicine Twitter chat on 8/25 at 9pm EST ! Full Transcript and Show Notes Time Stamps 2:07 Introduction to one woman’s journey 3:00  Stereotype Threat 6:15 Not all Anger is Created Equal 10:17 Asking and Writing Your Own Job Description 13:08 Imposter Syndrome 15:50 Breaking Points to Self Care 18:50 Work Life Integration 21:40 Support Networks Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

20 Qs with Core IM Team vs. Expert Discussant ! Full Transcript and Show notes Get CME-MOC Credit for listening to this episode (live at 09:00 am EST on 8/7) Time Stamps 00:20 The game of medical Twenty Questions 04:37 Case introduction 05:50 The CoreIM team attempts to solve the case 15:36 The discussant’s diagnostic schema for abnormal bleeding 23:37 Primary versus secondary hemostasis 30:33 The pathology report ! 37:38 Criteria for the final diagnosis 38:46 Dissecting a diagnostic coup 49:42 Conclusion Do you have a good case or an expert you would like to suggest for an episode? Send it our way at [email protected] Tags: Coagulopathy, Bleeding Disorder, Diagnostic Schema, Von Willebrand's Disease, Clinical ReasoningAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Night and Day… join us for part II of our exploration into why we prescribe medications in the morning vs. at night, featuring statins! 03:28 How do statins and cholesterol synthesis work again, anyway? 04:00 Power in numbers - what do the meta-analyses say about timing of statins? 04:40 The long and short of it - how half-life may dictate when to take your statin. 07:35 Effect magnitude - does medication timing actually really impact patient outcomes? 10:30 Practical matters - so what should we tell patients? 11:05 Review of teaching points Show notes, transcripts and referencesAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on Coronary calcium scores and Coronary CTAs! ACP members can claim CME-MOC Credit ! Quiz yourself on the 5 pearls we will be covering below: 3:10 What are the big picture differences of functional stress tests and anatomical cardiac tests? 7:48 What is the role of coronary artery calcium scores in managing coronary artery disease (CAD)? 16:20 How do coronary CTAs compare to stress tests? 24:28 When should we avoid CTA? 29:33 How do we communicate coronary CTA results with patients? 36:02 Recap Full transcript, infographics and show notes ! Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

In ‘At The Bedside’, our newest podcast segment, we tackle important topics that *aren’t* easily indexable in guidelines and UpToDate article –  topics that are better discussed…well…at the bedside. Our first episode examines the all-too-common trope of the ‘difficult’ patient. 01:13      Introduction 05:27      Question 1: What makes a patient difficult for you? 13:22      Question 2: What is a “good outcome” when working with difficult patients? 23:05      Question 3: What have you learned from your difficult patients? 31:56      Conclusion Show notes, Transcript, Further ReadingAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Transitions can be hard. Laugh, commiserate and be inspired by these July stories in medicine! Very big thank you to everyone who told their stories ! Let's help each other feel a little less alone in the struggle, be more understanding and compassionate or laugh at ourselves. Please share this episode with colleagues.  Do you have a July story? Email us at [email protected]. Lets continue conversation over social media. Which stories moved you? Which July stories can you relate to? Tweet us, find us on instagram at coreimpodcast or Facebook. Good luck this coming July !Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect clinical reasoning and dive deeper into an interesting case! 02:04     Initial Presentation 03:03     The Core IM team tackles the case 09:30     Social History 16:05     Physical Exam 22:47     An exercise in Bayesian inference 36:35     Pre-mortem 43:37     Revealing the diagnosis 48:57     How do we define diagnostic success? Full transcript with references and show notes Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dive deeper into why we prescribe medications in the morning vs. at night ! Why do we dose warfarin at night? (2:45) Back to the basics - what are the pharmacodynamics of warfarin and how does vitamin K intake matter? (4:28) Practical matters - so what should we tell patients (6:14) Dippers and non-dippers - what happens to blood pressure (BP) at night? (9:32) The surprising link between dipping and cardiovascular outcomes (11:15) Timing is everything… or is it? The evidence behind taking BP meds at night (11:58) Review of teaching points (15:58) What is your prescribing practice with blood pressure medications? Leave a comment, tweet us or share with us on instagram or facebook on how you dose BP meds? Transcript with references and show notesAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on stress tests! Quiz yourself on the 5 pearls we will be covering: What are the indications for a stress test? (2:18) How to choose  stress protocol in a stress test? (8:29) How to choose diagnostic modality in a stress test? (14:46) How do we interpret results from stress tests, and how should this be communicated to patients? (24:08) Pearl Recap (31:13) Risk of contrast induced nephropathy between arterial and venous contrast load (36:02) For full transcript, infographic and show notes: https://www.coreimpodcast.com/2019/04/24/stress-testing/   Tags: Internal Medicine, Internist, Primary Care Physician, Hospitalists, Emergency Medicine, Nurse Practitioner, Physician Assistant, Family Physician, CardiologyAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect 3 interesting cases and improve your clinical reasoning skills! Time Stamps: New features in this episode [0:30] Case one: 66M w RUQ pain [1:09] Case two: 41M w Afib in RVR [9:26] Case three: 50M w Syncope [14:33] Reveal [19:57] Retrieving illness scripts [22:29] Typical versus Atypical presentation of diseases [26:12] For full transcript and show notes: https://www.coreimpodcast.com/?p=21028 Tag: medical education, clinical cases, expert clinicians, internal medicine podcastAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Check out part 1: Acute Coronary Syndrome and TIMI Risk Score Lets go deeper into 1) How the chest pain history correlates with pathophysiology? [2:40] 2) How has high-sensitivity troponin changed the way we think about unstable angina? [7:34] For transcript, infographic and show notes: https://www.coreimpodcast.com/2019/03/27/unstable-angina/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on inpatient pain management! Quiz yourself on the 5 pearls we will be covering: How effective are non-opioids? ( 3:17) Are NSAIDs contraindicated in patients with kidney, liver or heart disease? If not, how can we use them safely? (10:51) What are the best practices for patients who require opioid analgesia? (19:00) When prescribing opioids at discharge what can we do to minimize harm? (25:02) Throwback to mechanism of acetaminophen and NSAIDs (27:14) How do we believe tylenol works and how does that compare to NSAIDS? (28:27) For full transcript of the audio and show notes: https://www.coreimpodcast.com/2019/03/13/5-pearls-on-pain-management/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Let's go deeper into the world of ACS and the origin of the TIMI score and major adverse cardiac events "MACE" outcomes! The basics – what is acute coronary syndrome? (4:08) Clinical context matters – angina pectoris, atypical chest pain, and troponins (5:22) You can’t just “cath” everyone – risk stratification to identify patients with high mortality risk (9:42) TIMI isn’t perfect – the issues with the score and MACE outcomes (14:00) Review of teaching points (17:58) For full transcript and show notes: https://www.coreimpodcast.com/2019/02/27/acute-coronary-syndrome-acs-and-the-timi-score/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect an interesting case and improve your clinical reasoning skills! Time Stamps: New features in this episode [00:25] Data point 1: Early hypothesis generation? [03:20] Data point 2: Pertinent negatives? [11:18] Data point 3: Representativeness heuristic over-represented in medical education? [13:28] Data point 4: Economical hypothesis generation by expert clinicians [19:20] Data point 5: Diagnosing diagnostic error [22:10] Data point 6: Moving toward a final diagnosis [27:11] Case resolution [29:50] For full transcript and show notes: https://www.coreimpodcast.com/2019/02/13/hoofbeats-47m-with-chest-pain/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on Barrett's Esophagus and more! Quiz yourself on the 5 pearls we will be covering: What is Barrett’s esophagus and why should we care? (4:12) Who do we screen for Barrett’s, and why? (8:41) How do we screen for Barrett’s and counsel? (13:50) How do we treat and monitor Barrett’s esophagus? (18:21) Take Aways (21:45) Throwback to trending troponins (23:05) For full transcript of the podcast, show notes and references: https://www.coreimpodcast.com/2019/01/30/5-pearls-on-barretts-esophagus/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect an interesting case and improve your clinical reasoning skills! Time stamps: Player three has entered the game! [0:15] Case presentation, part 1 [1:20] First impressions [3:24] Rethinking another provider’s diagnosis [4:36] Interpreting the test of treatment [8:48] Keeping your instincts on a leash? [10:58] Case presentation, part 2 [12:33] Diagnostic schemas [14:30] Our discussant’s differential and the final diagnosis [17:46] Shira’s cognitive autopsy [23:02] For full transcript and show notes: https://www.coreimpodcast.com/2019/01/16/hoofbeats-34m-with-fever-headache-and-myalgias/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on troponins and more! Quiz yourself on the 5 pearls we will be covering: What aspects of the history are concerning in a patient with a positive troponin? (4:00) What is the difference between the TIMI, GRACE, and HEART scores, and how should we use them in the evaluation of a patient with an elevated serum troponin? (8:42) How does the change in troponin over time help with diagnosis, and what should we consider in a patient with uptrending troponins but an unremarkable ECG? (14:48) What can a “negative but detectable” troponin tell you about any patient, not just those with suspected ACS? (21:31) Pearls Recap (25:26) Throwback – what are the first-line medications for alcohol use disorder? (28:36) For full transcript of the podcast, show notes and references: https://www.coreimpodcast.com/2019/01/04/5-pearls-on-troponins/ Tags: chest pain, cardiology, myocardial infarction, acute coronary syndromeAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Let's dive deeper into the world of acetaminophen and fever and how it may work and patient outcomes Time Stamps: What data is there to support the use of acetaminophen as a fever reducer? (2:08) Does acetaminophen improve patient outcomes? (4:30) How does acetaminophen compare to other medications like NSAIDs? (9:56) What is the mechanism of acetaminophen action? (10:50) Review of teaching points (16:02) For full show notes and transcript of audio: https://www.coreimpodcast.com/2018/12/19/mind-the-gap-on-acetaminophen-fevers-pathophysiology-and-patient-outcomes/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect an interesting case and think about the way clinicians think! Many clinical reasoning pearls here: Time stamps: Case [1:19] Diagnostic weight [8:42] Hypothesis driven reasoning [12:26] Anomalous clinical data [19:30] Final diagnosis [22:20] Take away points [31:21] Human Dx  Case link: https://www.humandx.org/o/co7yrer3dim2y59t5c0sbd370?s=FEED For show notes: https://www.coreimpodcast.com/2018/12/05/hoofbeats-43m-with-diarrhea/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Women in medicine inspire us with what they would tell their younger selves. Some of the speakers with Shreya Trivedi MD @ShreyaTrivediMD at the Women in Medicine GirlMedLive Conference: Qaali Hussein MD @QaaliHussein1 Clinical Pearl @ClinicalPearl Marguerite Duane MD @mduanemd Kate Prior MBBS @doctorwibble C. Nicole Swiner MD @docswiner Carmen Landrau MD @DrLandrau Jessica Willett MD @jkwillettmd Ilene Brenner MD @irb123 Joannie Yeh MD @BetaMomma Karen Davidson, Esq [email protected] Suzanne Feigofsky MD @DrSuzyFeigofsky GirlMedLive: https://www.girlmedmedia.com/ Episode page: https://www.coreimpodcast.com/2018/11/21/what-would-you-tell-your-younger-self/ Tags: career development, professional development, lifelong learning, burnout, imposter syndrome, mentorship, worklife balanceAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on Alcohol Use Disorder (AUD) treatment and more! Quiz yourself on the 5 pearls we will be covering: Throwback: At what levels of drinking does unhealthy alcohol use start, and how do you screen for unhealthy alcohol use? (1:47) What does the brief intervention and counseling part of SBIRT entail? (4:43) What are the first line medications for AUD and contraindications to them? (11:11) What are the  second-line medications for AUD and their limitations? (18:14) What new therapies are being studied for for alcohol use disorder? (22:09) Pearls Recap (25:06) For full transcript of the podcast, show notes and references: https://www.coreimpodcast.com/2018/11/07/5-pearls-on-treatment-of-alcohol-use-disorder/ tag: naltrexone, acamprosate, gabapentin, topiramate, SBIRT, neuromodulation, nalmafene, psychaedelics, audit-cAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect a working diagnosis through a process of validation! Time Stamps: Your collective differential [0:40] The test results (that you asked for) are in... [2:13] The hospital course, and the diagnosis (or is it?) [7:10] Validating a diagnosis: Base rate, adequacy, and coherence [8:30] Revisiting the differential [14:44] What to do when there is no final diagnosis? [17:39] For full show notes: https://www.coreimpodcast.com/2018/10/24/hoofbeats-85f-with-acute-ams-part-2/ Tags: Clinical reasoning, Diagnostic UncertaintyAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Submit your diagnosis or differential for this episode's case at HumanDx.org (free registration required): http://hdx.org/2VP ! Part 2 (releasing 10/24) will have the final diagnosis! Time stamps: A new challenge and the rules of the game (1:13) Introduction to Human Dx (3:06) The case: An 85 year-old woman with paranoid delusions (5:28) What exactly is problem representation? (15:15) Building the differential (19:53) For full show notes: https://www.coreimpodcast.com/2018/10/10/hoofbeats-85f-with-acute-ams/  Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Join us in this episode with Doctors Who Create where we explore how Core IM was started and some things that happen behind the scenes! Episode page: https://www.coreimpodcast.com/2018/09/27/meet-the-producers/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

  Let's go deeper into the world of UTIs and delirium! The basics – what are the official (IDSA) definitions for bacteriuria, pyuria, and UTI? (02:07) The lay of the land – how common are bacteriuria and delirium? (07:09) The big money question – do UTIs really cause delirium and what does the evidence tell us? (10:50) Review of teaching points (15:59) Full show notes: https://www.coreimpodcast.com/2018/09/12/mind-the-gap-uti-delirium/  Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on Proton-Pump Inhibitors (PPIs) and more! Quiz yourself on the 5 pearls we will be covering: What are associated adverse effects for patients are on long-term PPIs? (2:02) What are strategies to get your patient off PPIs?  (10:57) How do histamine-2 (H2) receptor antagonists blockers work and how can it explain why H2 blockers might not be as effective as PPIs? (13:30) How should you educate patients to take PPIs to get the maximize benefit? (16:48) How do you manage ongoing symptoms in patients on PPIs? (21:41) For full transcript of the podcast and references: https://www.coreimpodcast.com/2018/08/29/5-pearls-on-ppis/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect an interesting case and think about the way clinicians think! Many clinical reasoning pearls here: Case history and exam 00:40 Causal models 11:24 Facets versus diagnoses 13:25 Problem representation 16:37 Part two of the case 17:10 Occam’s razor, Hickam’s dictum, and Crabtree’s bludgeon 23:00 Diagnostic uncertainty 27:10 Learning points 34:24 For show notes: https://www.coreimpodcast.com/2018/08/15/hoofbeats-57f-with-confusion/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Lets go deeper into the misunderstood side of Vancomycin! Where did vancomycin come from, and why is it so controversial? (0:28) What is vancomycin-induced nephrotoxicity and how common is it? (4:37) Vancomycin trough monitoring – what is it good for?  (7:28) AUC to MIC ratio – the real math behind vancomycin dosing (7:53) Review of teaching points (10:27) Full show notes: https://www.coreimpodcast.com/2018/08/01/mind-the-gap-vancomycin/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidy your understanding of unhealthy alcohol use! Quiz yourself of the 5 Pearls we will be covering: What is alcohol use disorder (AUD), and how is it different from unhealthy alcohol use? Who should we screen for unhealthy alcohol use, and which screening tools are preferred? What are the consequences of unhealthy alcohol use? Can moderate alcohol be good for patients, and if so, how much is “moderate”? Who, how and how often should patients with chronic hepatitis B infection be screened for hepatocellular carcinoma? For full show notes: https://www.coreimpodcast.com/2018/07/11/5-pearls-unhealthy-alcohol-use/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect an interesting case and think about the way clinicians think! Many clinical reasoning pearls here: Part one of case (0:56) Cognitive ease and strain (03:51) Metacognition and routine diagnostic timeout (08:15) Think outside the box of organ systems (11:19) Illness behavior (12:30) Part two of case (14:06) Algorithms (17:57) Fast thinking & pattern recognition (19:30) Slow thinking & analytical reasoning (21:31) Diagnosis (25:15) Takeaways (26:52) For full show notes: https://www.coreimpodcast.com/2018/06/27/hoofbeats-54m-with-diarrhea/ Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Be inspired by why so many are proud to be in General Internal Medicine (GIM)! Episode page: https://www.coreimpodcast.com/2018/06/23/celebrating-proudtobegim/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Let’s take your breath away… with a review on steroids in treating COPD exacerbations! Time Stamps How does GOLD (Global Initiative for Chronic Obstructive Lung Disease) define a COPD exacerbation? (2:44) What outcomes do steroids actually improve in treating a COPD exacerbation? (5:08) What is the evidence behind a 5 day steroid “burst”? (7:20) Are IV steroids more powerful than PO? (9:00) For full show notes: https://www.coreimpodcast.com/2018/05/30/mind-the-gap-steriods-in-copd/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your understanding of contrast-induced nephropathy (CIN)! Quiz yourself on the 5 pearls we will be covering: Are there diagnostic criteria for CIN? (2:11) Is there a difference between exposure to intra-arterial vs. intra-venous contrast in terms of risk of CIN? (6:28) What are the biggest risk factors for CIN? (14:48) What preventive measures have been shown to best reduce the risk of CIN? (19:41) Can ESRD patients on hemodialysis still suffer from CIN? (23:32) Recap (25:49) For full show notes: https://www.coreimpodcast.com/2018/05/16/5-pearls-contrast-induced-nephropathy/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dissect an interesting case and think about the way clinicians think! So many clinical reasoning pearls here: Part 1 Case (2:05) Framing bias (7:07) Data-driving reasoning  (11:48) Hypothesis-driven approach (12:38) Periodic paralysis syndromes (16:08) Representativeness heuristic (17:26) Part 2 Case (20:51) Pivot Points (31:36) Diagnosis (35:55) Take aways (37:20) Check out the key teaching points: https://www.coreimpodcast.com/2018/05/02/hoofbeats-a-36f-with-weakness/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on adrenal insufficiency! Quiz yourself on the 5 pearls we will be covering: What are signs and symptoms of chronic adrenal insufficiency (AI)? What is the most sensitive? (2:02) How do we diagnose and differentiate types of adrenal insufficiency? (6:05) How sensitive and specific are the diagnostic tests for AI & at what cutoffs? (12:06) Can we both test and treat adrenal insufficiency at the same time? (16:40) Throwback: How do hypokalemia and hepatic encephalopathy connected? (24:55) Dr. Nidhi Agrawal Recap (19:20) For full show notes: https://www.coreimpodcast.com/2018/04/18/5-pearls-chronic-adrenal-insufficiency/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on latent TB! Quiz yourself on the 5 pearls we will be covering: Who should be screened for latent tuberculosis infection (LTBI)? (1:45) What screening tests are available and how do they differ? (6:30) What are the LTBI treatment options available? (10:24) What are the major adverse drug effects to consider? (13:28) How frequently should you check liver function tests in a patient being treated for LTBI? What do you do with the results? 17:43 Dr. Caplan-Shaw Recap (21:29) For full show notes: https://www.coreimpodcast.com/2018/03/28/5-pearls-latent-tuberculosis-infection/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on albuminuria! Quiz yourself on the 5 Pearls we will be covering: How good is a dipstick, urinalysis and UACR in detecting albuminuria? (1:42) What conditions that lead to transient proteinuria? What is the appropriate interval to recheck and how should be it be repeated? (5:14) Who should be screened for albuminuria and can it prognosticate risk for cardiovascular mortality? (7:47) Does increasing RAAS inhibition improve renal outcomes? (10:57) Throwback Question: How do you prescribe oral iron and what tips do you tell your patients? (13:11) For full show notes: https://www.coreimpodcast.com/2018/02/28/5-pearls-albuminuria/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Let’s go deeper into to why we think about diseases the way we do: COPD Classifications through the years! Time Stamps: How did prior understanding of COPD pathophysiology lead to COPD classifications in the past? (3:25) How is COPD diagnosed? (6:13) How has COPD been classified and why? (6:42) For full show notes: https://www.coreimpodcast.com/2018/02/14/mind-the-gap-copd-classifications/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Quiz yourself on the following 5 Pearls on Chronic Hepatitis B (HBV) Management! What is the focused history, physical and lab workup in a patient with chronic HBV? (1:40) What is the best imaging to evaluate for intermediate stages of liver fibrosis? (4:06) What scoring tools can you use to estimate fibrosis and what are their limitations? What factors do you use to assess which patients get treatment? (7:41) What drugs are available for HBV treatment and how do you choose? (11:18) Which chronic HBV patient should be screened for HCC, and how often? (14:45) For full show notes: https://www.coreimpodcast.com/2018/01/31/5-pearls-on-chronic-hepatitis-b-2/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on Chronic Hepatitis B (HBV) screening and vaccinations! Quiz yourself on the 5 Pearls we will be covering: Who do you screen for HBV? (3:37) How is HBV transmitted and who is at risk for HBV reactivation? What tests do you order when screening for HBV?   (10:48) In which populations is HBV vaccination recommended? What are the four possible meanings of an isolated positive total anti-HBc? (13:55) In an asymptomatic adult, is it necessary to send an anti-HBc IgM to distinguish acute from chronic HBV infection? (15:01) What are the implications of seroconversion of HBeAg from positive to negative? (16:19) For full show notes: https://www.coreimpodcast.com/2018/01/17/5-pearls-on-chronic-hepatitis-b/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Let's go deeper as to why we do what we do: albumin in spontaneous bacterial peritonitis (SBP) ! Time Stamps:1. How much albumin is recommended in SBP? (1:45)2. What antibiotics are used for the treatment of SBP? (2:30)3. Why do we give albumin in SBP? (4:15) - How does albumin compare to crystalloid? (7:15) - Do we always have to give to albumin? (9:00) For full shownotes: https://www.coreimpodcast.com/2018/01/03/mind-the-gap-albumin-in-sbp/ Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Cement your knowledge on Hepatic Encephalopathy (HE)! Quiz yourself on the following 5 Pearls we’ll be covering on HE:  Time Stamps What are other causes of altered mental status in cirrhotics? (1:45) What are common precipitants for an acute episode of HE? What is asterixis? (6:10) What is the diagnostic utility of a cirrhotic with asterixis? How do lactulose & rifaximin reduce symptoms of HE? (11:00) What are their indications? What is the connection between hypokalemia and HE? (14:10) What is the discriminatory power of an ammonia level in HE? (16:40) In what situation does the NH3 has stronger predictive value? For full shownotes: https://www.coreimpodcast.com/2017/12/13/5-pearls-on-hepatic-encephalopathy/ Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Part 2 on Abdominal Paracentesis ! Let's go deeper Time Stamps Should a cirrhotic’s INR and platelets deter you from doing a paracentesis? (3:15) Do generalist have worse procedure complications than specialists?  (5:40) Do you need to send ascites fluid in blood culture bottles? (6:10) For full shownotes: https://www.coreimpodcast.com/2017/11/29/mind-the-gap-abdominal-paracentesis-2/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Solidify your knowledge on iron deficiency anemia! Quiz yourself on the 5 Pearls we will be covering: Should patients be screened for iron deficiency? If so, who and how often? (1:40) What are the indications for diagnostic endoscopy in iron deficient patients? (3:23) How should you advice patients to take oral iron? (5:53) What is optimal dosing for oral iron? In which patients would you consider IV iron? What are the risks? (11:41) Throwback Question: What is a medication-overuse HA? (14:44) For full shownotes: https://www.coreimpodcast.com/2017/11/15/5-pearls-on-iron-deficiency-anemia/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

You have always been told to do a diagnostic paracentesis on admission in cirrhotics with ascites, but why? Can you just get away with clinical judgement to rule out SBP? Is faculty judgement any better? And if you’re going to do a paracentesis on admission, do you need to do it right away? Go deeper with Dr. Steve Liu and Dr. Janine Knudsen! Click the link for the full show notes: https://www.coreimpodcast.com/2017/11/01/mind-the-gap-admission-paracentesis/ Time Stamps What do guidelines say about diagnostic paracentesis in cirrhotics with ascites? (1:51) Can we just use clinical judgement to decide if paracentesis is warranted? (3:13) Do attendings have better clinical judgement than residents to rule out SBP? Does timing of paracentesis on admission matter for mortality? (6:33) Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Cement your knowledge on headaches with 5 Pearls on when imaging is indicated, approach to abortive medications, medication overuse headaches, when to use migraine prophylaxis and effective non-pharmacological treatment for migraines! For full shownotes: https://www.coreimpodcast.com/2017/10/18/5-pearls-on-headaches/ Time Stamps What are the indications for imaging for HA? (1:36) What is your approach to abortive therapy for migraines? (4:45) How do you diagnose medication overuse HA? (6:41) What is your approach to migraine prophylaxis? (8:29) What are some evidence based nonpharmacological therapies for migraines?  (10:42) Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

CORE IM is an independent consortium of educators aligned to create internal medicine-specific portable learning tools in the form of podcasts, corresponding show notes and illustrations. Segments include 5 Pearls and Mind The Gap. For more information: https://www.coreimpodcast.com/2017/10/13/introducing-the-core-im-podcasts-5-pearls-mind-the-gap/ Sincerely, CORE IM team: Executive Producer: Shreya P. Trivedi, MD (@ShreyaTrivediMD) Five Pearls Producer: Marty Fried, MD (@Marty_Fried) Mind the Gap Producer: Steve Liu, MD Advisors: Neil Shapiro MD, John Hwang MD, Vincent Santillo MD Podcast editing and technical set-up: Harit Shah and Steven Liu MD Director of Sound Design, Theme song: Shaun Finnegan Artistic director: Dr. Mike Natter (@mike_natter) Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy