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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... |
My individual house staff union at Stanford Hospital can't address the, you know, the structural issues that exist with the ACGME and the match process, nor can we address the structural issues that exist with American healthcare. So one union alone can't solve this problem, but it doesn't need to, right? If my union c... |
How that comes about, I think, can come about in a number of ways. And so when MGB offered substantial raises that made us the highest paid residents in the country, when they offered retirement benefits, when we had unlimited fertility benefits, and a whole host of kind of different improvements in our salary and our ... |
Though Jay recently decided to step down, he was still the program director during the resident's recent campaign and vote to unionize. So I started out by asking Jay about what he perceived to be the biggest changes in medical education in the last nine years. There were really a number of changes. The most important,... |
But those oftentimes from a program director point of view, we didn't have the levers of power to fix those. And I think that there was a growing realization amongst residents that program directors, even though they served as the direct supervisor of trainees in the graduate medical education space, lack the agency to... |
What were the pros? What were the cons? What are the things that I worried about and the like? It was a well-attended meeting, probably the best-attended noon conference we've had all year. I think that, unfortunately, what was a nuanced conversation got eventually framed up in ways that didn't really reflect the reali... |
Food was a currency of love, as it is in many cultures. And so for me, the idea that you would withhold food was the equivalent of withholding love, and it just didn't make a whole lot of sense to me. Ultimately, I do think that, you know, there was, even after the union vote did occur, there was, you know, a decision ... |
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... |
Few medical situations have enjoyed such absolute improvement over the same time period. Future studies can continue to refine protocols, define subgroups that benefit from individual therapies, and clarify how to best adjust temperature or other interventions to each patient's illness. By Val Arudin, started during em... |
With less than three years to go, these two MDGs are seriously off-target for many countries. Among the 75 so-called countdown countries that have 98% of all maternal deaths and deaths among children younger than 5 years of age, only 17 are on track to reach the MDG4 target for child mortality, and only 9 are on track ... |
Given obesity's numerous developmental determinants, it is logical that effective prevention would target multiple modifiable factors. In combination, two well-studied prenatal risk factors, excessive gestational weight gain and maternal smoking during pregnancy, and two postnatal factors, fewer months of breastfeeding... |
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... |
Is there anything better than learning about jaundice from the future Boss Lady GI fellow? That was awesome. Thanks, Lindsay. Yeah, so this patient's coming in with jaundice. And let's think a little bit about the other aspect of this case, abdominal pain, mostly what it seems like a postprandial pain that this patient... |
Dan, it is not too late to switch from ID to GI. Come on. He did say Moritzu syndrome. So I feel like that is a valid point. You know, I didn't even put that in the script. I like Dan Minter even more now than I thought I could. Well, there's a lot of biliary pathogens, you know, those flukes and whatnot. Oh, this is b... |
As a general rule, pulmonary opacities could be something that's within the alveolar space. That could be pus, water, blood. It could be something within the interstitium, or it could be a sort of tissue-based mass. So if these are pulmonary metastases or primary pulmonary cancer or something like that. Just because I ... |
The abdominal and pelvic portions of the CT scan showed dilation of the common bile duct up to 1.5 centimeters and no discrete stones, masses, or lymphadenopathy. All right. Who am I to get in the way of pulmonary nodules on ID fellows? So I'll leave that up to Dan and then focus with Lindsay's permission under the com... |
Beautiful, Jack. I kind of think that your discussion of epidemiology was put in there in part to just dissuade me from thinking about liver flukes and all the other wonderful parasites. It was not a fluke. I'm dying on the inside. Okay. Well, yeah. Charmaine wanted me to talk about pulmonary nodules as the other part ... |
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... |
Ondansetron taken during pregnancy was not associated with a significantly increased risk of adverse fetal outcomes. Nocturnal Glucose Control with an Artificial Pancreas at a Diabetes Camp by Moshe Philipp from the Schneider Children's Medical Center of Israel, Petah Tikva. This randomized crossover trial compared an ... |
Symptomatic perineurial cysts, such as those described by Tarlov, have been reported for more than 70 years. However, most physicians are either unaware of the existence of Tarlov cysts or believe that they do not cause symptoms. Radiologists do not always report visualized Tarlov cysts, or they may report an imaging s... |
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... |
We only question someone's sex when they don't fit our cultural expectations of what male and female should be. That's so true. For some people, the cultural expectations associated with their sex assigned at birth align with their gender identity. For example, for someone assigned male at birth may identify as a man a... |
Thank you for bringing that up. I would like to say also that assuming someone's pronouns, even if correct, can be harmful. And it's something that actually has happened to me. I assumed someone's pronouns and turned out to be incorrect. And that affected the relationship that I have with them, of course. So we would l... |
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, ... |
These results highlight the dynamically changing effect of globalization on public health, as genetic disorders indigenous to specific populations become more common in the countries to which they migrate and make a strong case for newborn screening for alpha-thalassemia, at least in states with a substantial increase ... |
Three days before admission, weakness, loss of appetite, fatigue, and diarrhea developed, followed by progressive shortness of breath. On the morning of admission, he awoke with dyspnea, which was worse when he was lying flat. He was taken to the emergency room. Tachycardia, hypotension, hypoxemia, and fever developed,... |
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... |
My name is Carol Balmer. My husband, Jim, has been diagnosed with Alzheimer's disease. I started recording symptoms, things that I found unusual back in 2013, but it was not until 2017 that he was officially diagnosed. At that time, his condition was called mild cognitive dysfunction. Jim was doing peculiar things. He ... |
We have to make sure that our patients understand what's been accomplished here. And there's still a long ways to go. 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... |
And we're starting the first combination trial of amyloid and tau where we will look at multiple tau therapies alone and in combination with amyloid because just like cancer, heart disease, diabetes, when people have symptoms, you're going to need more than one approach. So that's what I want to talk about is this path... |
What we have to learn is how to use them, because exactly how much earlier are they going to predict? How are they going to show us progression and dynamic range? There are so many interesting questions that are going to open the door for the use of these biomarkers. And that's where I think one of our biggest advances... |
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 continuing evolution of H5N1 viruses and the clusters of human infections in Indonesia and Turkey raise important questions. First, can the source of H5N1 be eliminated? And second, is the increasing number of clusters of human infection an indicator of evolution toward consistent human-to-human transmission? Clear... |
The authors examine the evidence of possible causal relations to factors such as air pollution, obesity, diet, and exposure to infections, antibiotics, and allergens, including exposure at very young ages. The most strongly supported preventive measure is the avoidance of passive and active exposure to smoke. A 35-year... |
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... |
In this case, there's going to be chromosome 11 actually. So that's a high-yield thing to just come into memory especially for the step one folks i don't know the whole chromosome 11 business so chromosome 11 uh the one you the copy you have from your dad you have one beta globin gene on that the one from your mom you ... |
Now let's go into alpha thalassemia. Alpha thalassemia is also a hormone recessive, but this is more of a chromosome 16 problem. So here you have four genes. Four genes. Four genes. Four genes. You have two on each chromosome from your parents. So you have two on dad's chromosome 16, two alpha genes, and you have two o... |
They tend to be more symptomatic. And one thing I'm going to say is that people that have this alpha-thalassemia, especially people that have hemoglobin H disease, you may actually see, so you'll see target cells like you see for thalassemias. It's going to be a microcylic anemia. But you may actually see Heinz bodies ... |
While you're doing that complete blood count, you'll see the target cells. Again, if you see those Heinz bodies, that should tell you that, oh, wait, I'm probably dealing with alpha thalassemia, where these folks have lost three or four of those genes. But then after that, you're going to do some more specific testing.... |
So this will have brittle bones. They have a pretty high risk of osteoporosis. That's an association you certainly want to know for your exams. And then another association you want to know is you want to, if they tell you that, well, you see like crud upper cauldron pain and fever in one of these folks, it's because t... |
Hydrops, right? Means you're hydropic. That's fluid. Hydrops fetalis in the fetus. Now, another mechanism behind the hydrops fetalis that, again, many people do not kind of give credit for is this, right? So, again, remember I said that one of the things that happens in thalassemias is you have like extramedullary hema... |
Think of like hemochromatosis, right? You can develop liver failure. You can develop pancreatic failure, right? Because the iron, fentanyl reaction, free radical production, damage your pancreas. You can also damage these people's pituitary glands. So that can cause all these problems. You can have iron overload. So ma... |
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 ... |
And so NIH got interested, and there was a research study that was established that ran for decades. And the real hope was that they would find the genes that determined who did or did not get diabetes. And decades later, you know, fast forward to the early 2000s, and they still hadn't found the genes that would explai... |
And that's why their health was compromised. And that's why they were getting tuberculosis at higher rates. And one of the letter writers really put a fine point on this. And they said, well, look, if you focus on these inherent differences, you're robbing us of the desire to intervene. Whereas if you said, look, this ... |
Hello, and welcome to this JAMA Editor's Audio Summary for our August 23, 2016 issue. This is Dr. Phil Fontanarosa, Executive Editor of JAMA. This issue of JAMA includes three research reports, a scholarly special communication article, and four interesting viewpoints. Let's start with the research reports. The value o... |
No population has been harmed more by the COVID-19 pandemic than patients residing in nursing homes and long-term care facilities. The mortality from COVID-19 infection has been extremely high in these places. Once COVID-19 vaccines became available, it was up to a small team at the CDC to determine how to get the vacc... |
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