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Core IM | Internal Medicine Podcast

Core Internal Medicine via following segments:5 Pearls || Clinically relevant pearls on IM topics!Mind the Gap || Why do we do what we do?Hoofbeats || Dissecting clinical reasoning!At the Bedside || Explore everyday challenges

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#49 Smoking Cessation: 5 Pearls Segment

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

42mins

18 Sep 2019

Rank #1

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#51 A 65M with Fatigue: Hoofbeats Segment

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 hello@coreimpodcast.com Tag: normocytic anemia, splenomegaly, CoreIM, endocarditis, clinic case

44mins

16 Oct 2019

Rank #2

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5 Pearls Ep2: Iron Deficiency Anemia

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/

17mins

15 Nov 2017

Rank #3

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#77 Complimentary and Alternative Medicine (CAM): At the Bedside Segment

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 Reiki

31mins

15 Oct 2020

Rank #4

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#55 Influenza History and Vaccine: Mind the Gap Segment

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!

22mins

18 Dec 2019

Rank #5

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#39 Stress Testing: 5 Pearls Segment

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, Cardiology

40mins

24 Apr 2019

Rank #6

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#22 Proton-Pump Inhibitors: 5 Pearls segment

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/

27mins

29 Aug 2018

Rank #7

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#13 Chronic Adrenal Insufficiency: 5 Pearls segment

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/

26mins

18 Apr 2018

Rank #8

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#31: Troponins: 5 Pearls Segment

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 syndrome

31mins

2 Jan 2019

Rank #9

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#50 Blood Cultures: Mind the Gap Segment

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

18mins

2 Oct 2019

Rank #10

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#35 Acute Coronary Syndrome and TIMI Risk Score: Mind the Gap Segment

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/

20mins

27 Feb 2019

Rank #11

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#56 Prognosis: At the Bedside Segment

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, CoreIM

32mins

1 Jan 2020

Rank #12

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CORE IM podcast: Mind The Gap on Admission Paracentesis

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)

10mins

1 Nov 2017

Rank #13

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Hepatic Encephalopathy: 5 Pearls Edition Ep3

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/

21mins

13 Dec 2017

Rank #14

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#48 AMA Discharges: At the Bedside Segment

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 reduction

30mins

4 Sep 2019

Rank #15

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#44 Coronary Calcium Score and CTAs: 5 Pearls Segment

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 !

44mins

10 Jul 2019

Rank #16

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#57 A 39M on Inpatient Psychiatry with a Fever: Hoofbeats Segment

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

55mins

22 Jan 2020

Rank #17

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#21 57F with confusion: Hoofbeats segment

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/

35mins

15 Aug 2018

Rank #18

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#14 A 36F with weakness: Hoofbeats segment

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/

38mins

2 May 2018

Rank #19

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#54 Home Health Aides: Interprofessional Education Series

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?

39mins

27 Nov 2019

Rank #20