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Organized labor is having a moment. Medicine has not been immune. In recent months, 75,000 Kaiser healthcare workers went on strike, and that was just one of 26 healthcare worker strikes in 2023. One of the biggest changes for medicine, though, is a significant uptick in the unionization of trainees. As of December 202... |
I think a lot of folks feel like they're basically a warm body with an NPI and that they can be slotted in like any other person can be slotted into this equation to solve the staffing needs of the hospital. We have very little control over our working conditions. And that's an area where a union could potentially help... |
Yeah, I appreciate that perspective, David. And like I have told everybody who I've ever worked with, you know, unions are not going to be the only solution to the problem of American health care, nor are they going to be the only solution to your burnout. What I can say, and the only thing that I promise people is tha... |
Because in my opinion, having a seat at the table is important, but really having what I need to be the best physician I can be, to deliver the best care possible to my patients, to learn what I need to learn in order to operate safely and well, that's what I really care about, not necessarily for a limited short perio... |
I think it's partly what Philip mentioned and partly the era, unfortunately, we live in. We're in a moment in history where if you disagree with me, it's not viewed as you disagree with me. It's viewed as you're the other, that you're this kind of evil person who may or may not have what I think is the best interest of... |
Many of them have taken a gap year to get requisite research experience to get into a good medical school. They will work hard in medical school, continue to do scholastic work, engage in what I will say sometimes is this process to ensure that they get into a competitive residency. And that oftentimes may require extr... |
And so we want to be able to do that through unionization. And so I don't think unionization was the first lever, but rather the ultimate lever that was pulled to try to affect these types of changes. And so how did you respond to them when they came to you saying that we are organizing to vote to unionize? I think to ... |
I think it would be helpful to hear a little bit more about what happened when you attempted to have an open and honest forum to talk about the unionization process and some potential pros and cons, benefits and risks, weighing the evidence, however you want to think about it, with your house staff. I've always had and... |
When I came on to do, serve as the Red Sea program director, I was already a full-time, I already had a full-time job being a basic science investigator in the Division of Infectious Disease. And so I always operated under having essentially two jobs. And so for me, it was very easy because I only acted how I thought w... |
But I wanted to understand from Jay why pointing out this risk before the vote to unionize wasn't well received. During that conversation, Lisa, you know, I raised what I thought were some of the potentials that might happen should unionization come to pass. And one of those things I did mention was that there would be... |
I do want to ask you one more question because it's something you said to me when we talked, which is that some of the most gifted educators don't want to get in this game anymore. And I, you know, I've heard that from a lot of educators, honestly, that for some reason, lots of reasons, complex reasons, it's become a l... |
Welcome to the New England Journal of Medicine summary for the week of December 5, 2013. I'm Dr. Lisa Johnson. This week, we feature articles on APOL1 risk variants, race, and chronic kidney disease, targeted temperature management for cardiac arrest, bivalorudin during transport for primary PCI, and fertility treatmen... |
In this trial, 950 patients who had been resuscitated from out-of-hospital cardiac arrest were randomly assigned to targeted temperature management at either 33 degrees Celsius or 36 degrees Celsius. At the end of the trial, 50% of the patients in the 33 degrees Celsius group had died, as compared with 48% of the patie... |
This depends on the relative incidence of major bleeding versus that of stent thrombosis and the association between these events and subsequent mortality and morbidity. Few observers would dispute that stent thrombosis is a serious, albeit infrequent, event that results in either reinfarction or death in most cases. O... |
As we celebrate the fact that the annual number of deaths among children younger than five years of age has fallen to 6.6 million, which is a 48% reduction from the 12.6 million deaths in 1990, despite an increased number of births in many high-burden countries during the same period, the sobering realization is that e... |
How early should obesity prevention start? A perspective article by Matthew Gilman from Harvard Medical School, Boston. Overweight or obese women are likely to gain excessive weight during pregnancy. This increases their risk of disease and potentially causes higher adiposity in their offspring, who may grow up to perp... |
Hey folks, just a quick reminder that this episode is not meant to be used for medical advice, just good old-fashioned education. All patient information has been modified to protect their identity and the views expressed in our podcast do not necessarily reflect the opinion of our employers. Welcome back Clinical Prob... |
And so whenever you see an elevated, indirect, unconjugated bilirubin, take a quick look at the CBC and make sure you're not having an anemia, thrombocytopenia. Don't need to go ahead and check a peripheral smear. After that, in the indirect bucket, some less common causes. So you can have some drugs can cause an indir... |
And sometimes with external compression, you can get early satiety as well. Vascular one is an important one to remember because mesenteric schema falls into that category, is that if you have a lot of atherosclerotic disease in the vessels of the GI tract, then when you're eating and trying to digest food, you can get... |
Well, there's a lot of biliary pathogens, you know, those flukes and whatnot. Oh, this is bringing me a huge smile. Let me give you the next aliquot of the case. So the patient's past medical history included hypertension, hyperlipidemia, and a recent diagnosis of diabetes three months prior. He took lisinopril, Atorva... |
So this patient not only is experiencing jaundice, but they're also experiencing some cough and shortness of breath and some sort of symptom complexes that refer us to the lung. So, you know, that there's one sort of major helpful action in this case is to move us away from the biliary system as we were sort of beginni... |
It can be from lymph nodes. It can be from the pancreatic head. So anything around that area that can cause obstruction can cause this picture. And, you know, what diagnostic step is next whenever you are thinking about a cholestatic liver injury? There are so many imaging modalities that you can choose to try to inves... |
So pulling up our extrahepatic biliary obstruction schema, the question that I'm asking myself is what could happen inside the lumen of that bile duct, the wall of the bile duct, or the external environment that the bile duct sits in, what could happen that will cause obstruction and bleeding to jaundice? And in terms ... |
And this is where the assistance of our GI colleagues or the hepatobiliary team can be quite helpful because they have the skills necessary to perform an ERCP. What an ERCP can help us do in this case is be not only diagnostic, but also therapeutic. The ERCP can give us a look at the biliary tree. Do we see a stone the... |
But one tip off for central lobular nodules is if you look at the part of the lung abutting the pleura is there shouldn't be any nodules actually touching the pleural space. If we move on to randomly distributed nodules, these are nodules that have no relationship to the pulmonary lobule. And how do you get random dist... |
Biopsies of both the pancreatic head mass and of one of the lung nodules revealed pancreatic adenocarcinoma. And the patient was discharged home with plans to follow up with oncology for initiation of systemic chemotherapy. And just to clarify here, the reason that one of the lung nodules was biopsied is because it's q... |
Welcome to the New England Journal of Medicine summary for the week of February 28, 2013. I'm Dr. Michael Bierer. This week's issue features articles on high-frequency oscillation for ARDS, on dancitron and risk of adverse fetal outcomes, and an artificial pancreas versus sensor-augmented pump, review articles on idiop... |
Indexes of recruitability may help to define which patients may benefit from high mean airway pressures and which patients are likely to suffer deleterious effects without major lung protection. Third, currently recommended strategies that use low tidal volumes may have effectively minimized mechanical stress on the lu... |
Bracing is commonly recommended in patients with an immature skeleton with curve progression of 25 to 45 degrees, but data to support this approach are observational and inconsistent. A randomized trial comparing bracing with observation for idiopathic scoliosis is currently in progress. Surgical treatment is recommend... |
Radiologists do not always report visualized Tarlov cysts, or they may report an imaging study as normal, despite the presence of Tarlov cysts, as in the case of this patient's initial MRI scan. For the sake of inquiry and knowledge, the inevitability of open access, a perspective article by Anne Walpert from MIT Libra... |
As part of the open access movement and with the mission of expanding the terms of use for increasingly accessible information, Creative Commons has produced six copyright licenses that permit a range of uses beyond fair use, subject to certain conditions. The four conditions are combined into six permutations reflecti... |
Hey folks, just a quick reminder that this episode is not meant to be used for medical advice, just good old-fashioned education. All patient information has been modified to protect their identity and the views expressed in our podcast do not necessarily reflect the opinion of our employers. Welcome back, family. It i... |
Intersex people exist and have always existed. There are people whose reproductive or sexual anatomy doesn't fit the typical definitions of male or female. For example, a person may be born appearing to be female on the outside, but having mostly male typical anatomy on the inside. Or a person may be born with genitals... |
The same goes for men. If someone identifies as a man or a woman, this is a self-identification independent of what anyone assigned them to be. It is based on what is important to them as an individual, including gender roles, behavior, expression, identity, and or physiology. Period, Vale. And you also may have heard ... |
So we would like to suggest to you, our listener, that in the setting of meeting a patient, it's not, or really anyone, it's not really the way to start building trust with them by assuming their gender and their pronouns. You don't want to start by that. And so we suggest you offer your pronouns. That way, the person ... |
The colloquial term used to refer to heterosexual people is as straight. On the other hand, gay is a term used to describe a person attracted mostly or exclusively to someone of their same gender. For example, I am gay. Some people still use the term homosexual to refer to gay people. But, you know, that's like a mouth... |
Welcome to the New England Journal of Medicine audio summary for the week of February 24, 2011. I'm Dr. Lisa Johnson. This week's issue features articles on environmental microorganisms and childhood asthma, heterogeneity of hemoglobin H disease, BMI and risk of death in Asians, perilipin deficiency and lipodystrophy, ... |
Patients with H constant spring have a significant growth delay, require intermittent blood transfusions, have iron overload in the first decade of life, and have a good response to splenectomy. A similar drop in hemoglobin during infection does not occur in patients with hemoglobin H disease, and blood transfusion app... |
Over a three-year period, a total of 41 cases of tuberculosis were diagnosed in a British Columbia community struggling with the challenges of alcoholism, drug use, and transient housing arrangements. Because of the recognized limitations of contact tracing, field epidemiologists used social network analysis early in t... |
Tachycardia, hypotension, hypoxemia, and fever developed, and he was admitted to the coronary care unit. There are many causes of septic shock that are consistent with his presentation, so the physicians needed a way to limit and focus their differential diagnosis. The immune status of the patient is an important consi... |
Standards for health policy curricula in medical education are long overdue. Matters affected by health policy ultimately affect patient care, and physicians need the skills to address them. Training must begin with the building of foundational knowledge and analytic skills during medical school, and perhaps even as ea... |
Welcome to Intention to Treat from the New England Journal of Medicine. I'm Rachel Gottbaum. For decades, scientists have tried to find effective ways to treat Alzheimer's disease, with very little success. But that could be changing. New medications may help slow the progression of the disease, and new diagnostic tool... |
I was offered a drug that they felt it's showing great improvement to take away the amyloid plaque, which will then lead to possibly preserving him longer. And I get a call saying, your name was on the list. And we really want you to tell us if you want to try this drug, because there's a waiting list of 20 people. And... |
So because of the blinding, there's no way of knowing. Jim's functioning has declined quite a bit over the last several months. So Jim's short-term memory right now is non-existent. His memories go back in his early childhood, but not even his later childhood. We know that the next stages of this disease are terrible, ... |
Patients have to think about taking these drugs, that they're willing to come in for whether it's every month or every two weeks for an infusion or eventually a sub-Q injection, whether they are willing to tolerate the side effects which occur in some people, and whether or not the improvement that has been statistical... |
So the amyloid occasionally is there for more than a decade before you get this where the tau suddenly explodes out of the deep parts of the brain and the medial temporal lobe and goes around the rest of the brain. And that's very commonly associated with a rapid cognitive decline. So I very much agree that you need bo... |
I really think that when people begin to get Alzheimer's well into their 80s and their 90s, there are many, many comorbidities, not the least of which is some vascular disease too. None of the therapies we're currently thinking about are addressing the comorbidities, copathologies actually. What we are also beginning t... |
How do we diagnose if people come in and they have amyloid in their brain, but they don't have any issues? How do we handle this? Well, I think that's when we should diagnose and treat Alzheimer's disease, just like we do most other diseases where we find it in the asymptomatic stage. I think we have to risk stratify. ... |
This is the New England Journal of Medicine audio summary. The full text of all articles is available to personal subscribers on our website. We offer discounts on personal subscriptions to residents and students. Go to NEJM.org and click on subscribe. Welcome to the New England Journal of Medicine audio summary for th... |
The median age of the eight patients was 8.5 years. Four patients required mechanical ventilation, and the overall proportion of deaths was 50%. In each cluster, patients with H5N1 virus infection were family members, and most lived in the same home. In two clusters, the source of H5N1 virus infection in the index pati... |
We now find ourselves in the far less noble position of seeking new technology to mitigate the unintended and undesirable consequences of our last ineffective, but nonetheless persistent, technologic innovation. Vivala Rudin for Patients with Acute Coronary Syndromes, by Greg Stone, from the Columbia University Medical... |
A 35-year-old pregnant woman with new hypertension, a case record of the Massachusetts General Hospital by Ann Klebanski and colleagues. A 35-year-old pregnant woman was admitted to the hospital at 19 weeks and 6 days of gestation because of the recent onset of hypertension and diabetes. She had recently had polyuria a... |
Welcome, my name is Devine. This is episode 494 of the Devine Intervention Podcast. In today's podcast, we're going to be examining thalassemia. It's a high-yield topic, frequently tested on all the USMLEs, so I just want to make sure that you kind of have it down. So, typically, let's start off with a question. So, wh... |
So if you mess up, if you don't have enough iron, you're also going to cause microcytic anemia or again remember heme is iron plus protoporphyrin so if you mess up if you don't have enough iron you're also going to have microcytic anemia for those reasons so there are many causes of microcytic anemia the big ones on ex... |
That's alpha 2 and delta 2. Notice it does not have beta globin chains in it. So since it doesn't require beta globin chains in it and your body is kind of struggling with having beta globin chains your hemoglobin e2 is gonna go up and what other hemoglobin will go up in beta thalassemia i would hope you're also seeing... |
Now, since you have four genes, you can already begin to see that, oh, there's more disease permutations. Now, what are the disease permutations to know? Well, number one is, let's say you lose one alpha, let's say you lose one alpha globin chain. If you lose one alpha globin chain, it's not a big deal. You're going to... |
They'll still be making hemoglobin A2, alpha 2, delta 2, but again, it's going to be vastly decreased because they have a shortage of hemoglobins. They're still going to be making hemoglobin F, alpha 2, gamma 2, but again, that's going to be vastly decreased. But one thing to kind of keep in mind when you have this pro... |
From more in utero perspective, right? In utero, you need alpha 2 gamma 2 hemoglobin F. They have no alpha, so they're going to be able to make hemoglobin F at all. So those gammas, since there's a ton of it while you're in utero, the gammas are going to start pairing up with each other. They're going to form gamma 4. ... |
So some of you may wonder, Divine, what are some of the symptoms a person may see when they have these thalassemias? They can actually see a bunch of symptoms, right? So one, you may notice that they have these chipmunk faces. You may wonder, Divine, what's the mechanism there? They may have chipmunk faces. They may ha... |
And the thing is, since they are making so many red cells all the time, their bone marrow just expands. So it's almost like your bone marrow has bone and marrow. But if the marrow part, because you're making so many red cells all the time, right, their bone marrow just expands. So it's almost like your bone marrow has ... |
You already know this from your studies that hemoglobin F has a higher affinity for oxygen compared to regular hemoglobin compared to regular adult hemoglobin A it has a higher affinity for oxygen right if you have a high affinity for oxygen are you going to be delivering oxygen to the tissues no you're not going to be... |
Yeah, absolutely. You have extramedullary hematopoiesis just to keep up with the constant making of red cells. And, again, I've discussed the reasons why you may need to keep making these red blood cells. So since the liver becomes a site of extramedullary hematopoiesis, the liver is like struggling. It's like working ... |
And again, remember, this one can develop jaundice because of an increase in indirability. And obviously, because their red cells just keep getting broken, right? Again, that's going to cause that indirect hyperbilirubinemia. So how in the world do we treat these people? Well, the thing is, if they're asymptomatic, you... |
test and also this book should also get folate supplementation uh because again the their red cells they just use them up so quickly so they are always like in red blood cell production mode remember you have only about three months worth of folate in the body right but this book they just use up their folate so quick ... |
Welcome to Intention to Treat from the New England Journal of Medicine. I'm Rachel Gottbaum. Today, part two of our examination of the journal's racist history and what we can learn now. There are still such deep legacies from the past in our present practices. And it's the past that's Historical Injustice series. And ... |
In practice, it remains a question. And of course, in this same period when hospitals were largely segregated, doctors continued to approach research and medicine with a lot of internalized notions of race. How did this evolve as medicine evolved? Over the course of the 20th century, the kinds of diseases that are comm... |
The ways in which the questions, the research questions that the scientists were engaged in trying to answer, which were based on a fundamental flaw at the very beginning of it, that they understood who these people were, and they did not understand who these people were. And they did not understand how these people we... |
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