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=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

#146 Tube Feeds: 5 Pearls Segment

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:* 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

#145 Heart Failure in Older Adults & Guardianship: Gray Matter Segment

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:* 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

#144 RSV & What Makes Vaccine Trials Different: Beyond Journal Club on the RENOIR and AReSVi Trials

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=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

#143 Hypomagnesemia and Hypophosphatemia: 5 Pearls Segment

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=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

#142 Managing Conflict: At the Bedside Segment

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.Show 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=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

#141 Do Steroids Have a Role in Community-Acquired Pneumonia? Beyond Journal Club on the CAPE COD Trial

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=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

#140 Bonus Pacemaker & ICDs: 5 Pearls Segment

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:* 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

#139 CKD Staging (Cr vs. Cystatin C, Albuminuria & more): Mind The Gap Segment

Check out the original interview on Youtube:Essentials on Genetic Counselor | Lynch SyndromeWho 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!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:* 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

#138 Incorporating Cancer Genetics into Your Practice: Lynch Syndrome and Beyond!

See some of the original interviews on Youtube!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?!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:* 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

#137 Hypokalemia & Potassium Repletion: 5 Pearls Segment

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:* 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

#136 How Did Diabetes Medications Become Obesity Meds? Beyond Journal Club on SURMOUNT-1 Trial

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 & TranscriptTimestamps01:54 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, cardiologyFind 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

#135 Guideline Directed Medical Therapy Part II: 5 Pearls Segment

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:* 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

#134 Diagnostic Errors & Excellence

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:* 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

#133 Post-Kidney Transplant: 5 Pearls Segment

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=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

#132 Does PCI Save Lives in Heart Failure and CAD? Beyond Journal Club on the REVIVED Trial

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, feedbackFind 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

#131 July Stories 2.0

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, fatigueFind 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

#130 Cort (ACTH) Stim Test

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 Subscribe to our new Youtube Channel !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 syndromeFind 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

#129 Steroids: 5 Pearls Segment

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, pulmonaryFind 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

#128 Cirrhosis Bleeding Risk, FFP and Indwelling Pleural Catheters: Gray Matters Segments

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, brachytherapyFind 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

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