Core IM | Internal Medicine Podcast

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.

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Show notes & transcripts

Behind the Scenes YouTube Interview

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(02:44) | What makes this patient different from others with similar symptoms or diagnosis?

(07:28) | 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 

Tags: IMCore, CoreIM, Contingency Planning, Handoffs, Medical Education, Nocturnists. Signouts, hospitalist

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Behind the Scenes Youtube Interview

Show notes & Transcript

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(03:04) | What is the philosophy of hospice?

(06:13) | Who qualifies for hospice?

(08:17) | Who makes up the hospice team?

(17:24) | Who pays for hospice?

(21:31) | What are the different levels of care?

(31:57) | What are some limitations of the hospice medicare benefit?

Tags: IMCore, CoreIM, primary care, palliative care, end-of-life, oncology nurse practitioner, pharmacist, physician assistant

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 Impact

Show notes & Transcript

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Tags: IMCore, CoreIM, primary care, humanities, nurse practitioner, pharmacist, physician assistant

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. 

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Show notes & Transcript

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamp:

(00:00) | Introduction

(02:28) |Pathophysiology of Colorectal Cancer & Why Screening Makes Sense

(06:15) | General Cancer Screening – Observational Studies

(09:17) | General Cancer Screening – Randomized Controlled Trials

(14:40) | NordICC Trial

(22:36) | Implications for Patient Care

Tags: IMCore, CoreIM, primary care, gastroenterology, nurse practitioner, pharmacist, physician assistant, sigmoidoscopy, per protocol analysis and intention to treat analysis

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Behind The Scenes YouTube Interviews

Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(01:59) | What causes HFpEF?

(11:22) | Does diastolic dysfunction imply HFpEF?

(19:21) | Is the BNP level helpful in HFpEF?

(25:06) | What scoring systems can be helpful in ruling in HFpEF?

(32:03) | What's the treatment for HFpEF?

Tags: cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, nursing education, heart failure with preserved ejection fraction

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Behind the Scenes YouTube Interview

Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(01:56) | How do immune checkpoint inhibitors work?

(07:15) | How do you organize the different immune-related adverse events (irAEs)?

(13:42) | Generally, when do different adverse events can present?

(22:20) | What makes someone more likely to develop an adverse effect?

(26:38) | What role does complementary & alternative medicine play in this patient population?

Tags: Side effects, oncology, cancer, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, pharmacology

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Get CME-MOC credit with ACP!

Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(02:05) | Urinalysis in a patient with AKI from purely cardiorenal syndrome?

(08:47) | What is bioavailability, duration of action, and outcomes with furosemide, torsemide, and bumetanide?

(18:08) | How can spot urine sodium measurements be used to assess diuretic response?

(27:35) | What are the differences between thiazides (PO Metolazone vs. IV Chlorothiazide) and acetazolamide augment diuresis?

(35:08) | Spaced Repetition: RAAS inhibitors or SGLT2 inhibitors as GMDT in CKD?

Tags: nephrology, cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, diuretic resistance

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?

Behind the Scenes YouTube Interview

Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Time stamps:

(02:05) | Pearl 1 - Rhythm control

(11:23) | Pearl 2 - Electrical cardioversion

(17:53) | Pearl 3 - Class III antiarrhythmics and side effects

(26:31) | Pearl 4 - Class Ic antiarrhythmics and side effects

(31:55) | Pearl 5 - Catheter ablation

Tags: cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, nursing education, atrial fibrillation

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 & Transcript

Timestamps:

(01:47) | Evolving story of asthma management

(03:26) | Pathophysiology of asthma management

(06:01) | Key players & terms

(08:56) | Story of asthma through the decades

(17:55) | MANDALA Trial

Tags: IMCore, CoreIM, primary care, pulmonary, nurse practitioner, pharmacist, physician assistant, inhalers

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?

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Behind the Scenes YouTube Interview

Transcript and Show Notes

Time stamps:

(02:09) | Spaced repetition from the last Gray Matters Episode

(05:29) | Choosing between oral and IV iron

(11:17) | Considerations with oral iron repletion

(24:02) |Considerations with IV iron repletion

(32:36) | Complications and side effects of IV iron

Tags: hematology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant

What do the different iron labs mean?! How to interpret iron labs in the setting of inflammation? How to take a good menstrual history?

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Behind The Scenes YouTube Videos

Transcript and Show Notes

Time stamps:

(03:43) | Iron deficiency labs and interpretation in inflammation

(16:08) | Heavy menstrual bleeding evaluation

(27:04) | When should a premenopausal woman with iron deficiency have endoscopy?

(35:15) | Recap

Tags: hematology, women's health, gastroenterology, heavy menstrual bleeding, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, iron deficiency diagnosis

Uncover many blind spots on tube feeds!

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Behind the Scenes Youtube Interviews: 

• Short-term enteral access
• Durable enteral access
• What is venting aka decompression?

Show Notes & Transcript

Timestamps:

(02:21) | Indications for tube feeds

(09:36) | Routes of enteral access

(19:20) | Components of tube feeds

(27:03) | Tube feeds complications

(34:50) | Counseling patients before discharge and medication interactions

Tags: IMCore, CoreIM, nursing home, primary care, dietician, nutrition support, hospital medicine, interprofessional education, enteral feeds

How do you manage GDMT in a frail older adult? When is a guardian needed and what is the process for obtaining guardianship?

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Behind The Scenes YouTube Interview

Show Notes & Transcript

Timestamps:

(04:03) | 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) | Reflections

(37:06) | Recap

Tags: IMCore, CoreIM, nursing home, primary care, cardiology, palliative care hospital medicine, interprofessional education, social work, case management

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.

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Show Notes & Transcript

Time Stamps:

(02:30) | Epidemiology of RSV

(03:46) | Development of RSV vaccine

(05:55) | Vaccine trial design

(12:22) | ARESVI and RENOIR Trials

(18:18) | 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 assistant

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?

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Youtube interview on key points on magnesium

Youtube interview on key points on phosphate

CME : http://bit.ly/CIMCME || Show Notes & Transcript

Timestamps:

(01:37) | Pearl 1: Magnesium

(09:39) | Pearl 2: Framework for hypomagnesemia

(16:53) | Pearl 3: Magnesium repletion

(22:39) | Pearl 4: Phosphorous

(28:36) | Pearl 5: Phosphorous repletion

Tags: IMCore, CoreIM, nephrology, hospital medicine, interprofessional education, renal

Sharpen your de-escalation skills!

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Timestamps:

• 02:26 Difficult Patients
• 10:25 Mediation Toolkit
• 17:20 Maxims of Mediation
• 26:46 When the Conversation Still Breaks Down
• 35:11 Conclusion

Tags: IMCore, CoreIM, ethics, humanities, nurse practitioner, pharmacist, physician assistant, burnout

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 & Transcript

• 01:50 Pathophysiology of Steroids and Infection
• 03:50 Steroids in PNA Studies
• 08:56 CAPE COD Trial
• 14:13 Discussion of CAPE COD Trial
• 18:36 Takeaways/Discussion

Tags: IMCore, CoreIM, primary care, cardiology, nurse practitioner, pharmacist, physician assistant

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!

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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-ray

Tags: IM Core, CoreIM, cardiology, prodromal symptoms, CRT, biventricular pacing

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?

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CME : http://bit.ly/CIMCME || Show Notes & Transcript

Timestamp:

00:13 Reviewing CKD Classification: G1-5 stage, A1-3 stage

04:20" 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 Closing

Tag: Creatinine, nephrology, renal, CoreIM, IMcore, internal medicine, primary care, nurse practitioner, physician assistant

Check out the original interview on Youtube:

Essentials on Genetic Counselor | Lynch Syndrome

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!

Behind the Scenes YouTube Interview

Show Notes & Transcript

Timestamp

• 03:13 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 assistant

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 & Transcript

Behind the Scenes YouTube Interview

Whiteboard Animation video

Timestamp

• 01:45 Pearl 1: Evidence for potassium repletion 
• 09:10 Pearl 2: Framework for hypokalemia
• 17:09 Pearl 3: Repletion goals
• 23:00 Pearl 4: Options for hypokalemia treatment
• 29:13 Pearl 5: Frequency of lab checks and repletion

Tags: IMCore, CoreIM, nephrology, hospital medicine, potassium diet, interprofessional education

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?

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Show Notes & Transcript

• 02:08 Framework for thinking about obesity
• 03:42 History of obesity treatment
• 06:29 Gila monsters and GLP and GIP mechanisms
• 08:29 Story of how medications for diabetes were found to have a weight loss benefit
• 12:50 SURMOUNT-1 trial

Tags: IMCore, CoreIM, primary care, cardiology, nurse practitioner, pharmacist, physician assistant

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? 

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CME : http://bit.ly/CIMCME || Show Notes & Transcript

Timestamps

• 01:54 Pearl 1 – Recap of GDMT and CKD
• 09:15 Pearl 2 – Hydralazine and Isosorbide Dinitrate 
• 20:59 Pearl 3 – Ivabradine 
• 25:47 Pearl 4 – Inpatient vs Outpatient Initiation of GDMT
• 30:55 Pearl 5 – Ejection Fraction Recovery 

Tags: IMCore, CoreIM, hydralazine, heart failure reduced ejection fraction, HFmrEF, HFimpEF, chronic kidney disease, cardiology

What does medical education research say about improving diagnostic errors? What habits help in getting to diagnostic excellence?

Timestamps

• 01:00 System 1 vs. System 2
• 07:46 Cognitive Biases
• 13:46 Case for Knowledge
• 18:29 Other Practices to Decrease Error
• 28:26 Conclusion

CME: http://bit.ly/CIMCME || Show Notes & Transcript

This episode is made in part of ACP’s Diagnostic Excellence curriculum

Tags: IMCore, CoreIM, clinical reasoning, system 1 vs. system 2, cognitive bias, feedback and reflection

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?

Behind The Scenes YouTube Interview

Timestamps

• 02:41 Types of Immunosuppression
• 14:31 Medication Reconciliation
• 22:36 AKI in the Transplant Patient
• 31:53 Infections in the Transplant Patient
• 40:00 Transplant rejection, cancer after transplant

CME: http://bit.ly/CIMCME || Show Notes & Transcript

Tags: IMCore, CoreIM, renal, internal medicine podcast, hospitalist, nephrology, immunosuppressive

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 & Transcript

Access to Rotation Prep Cardiology guide on NEJM Resident 360 is free for August 2023. View the relevant sections on ACS and CHF.

Timestamps

• 00:50 Question REVIVED addressed
• 01:44 Revascularication in HFrEF
• 06:32 Revascularization in stable CAD
• 10:02 REVIVED trial
• 12:20 Summary and takeaways

Tags: IMCore, CoreIM, cardiology, internal medicine podcast, hospitalist, stent, CABG, evidence-based medicine

Laugh and be humbled along some of Dr. Maria Rosasco's most memorable July stories !

Listen to the original July Stories: https://bit.ly/3Y4n8jG

Behind The Scenes videos on YouTube

Subscribe to our new Youtube Channel !

Tags: medical humanities, internal medicine, residency, medical school, interprofessional education, rotation, imposter syndrome, feedback

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 

Behind The Scenes video on YouTube

Show notes & Transcript

Subscribe to our new Youtube Channel !

Tags: IMCore, CoreIM, endocrine, internal medicine podcast, hospitalist, glucocorticoid withdrawal, fatigue

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?

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Show notes & Transcript

• 02:59 Types of Corticosteroids
• 14:31 Side Effects of Steroids
• 21:15: 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 syndrome

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 & Transcript

• 02:36 Deep Dive 1: Bleeding risk of paracentesis and thoracocentesis
• 05:35 Deep Dive 2: FFP effect on bleeding risk
• 15:43 Deep Dive 3: Risks of FFP
• 19:45 Deep Dive 4: Indwelling pleural catheters
• 30:31 Recap

Tags: IMCore, CoreIM, hepatology, internal medicine podcast, hospitalist, heme/onc, pulmonary

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?

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Show notes & Transcript

Whiteboard Animation Video of Radiation Physiology

• 02:37 Systemic Radiation Side Effects
• 14:29 Lung Radiation Side Effects
• 18:22 Breast Radiation Side Effects
• 21:45 Prostate Radiation Side Effects
• 24:54 Brain Radiation Side Effects

Tags: IMCore, CoreIM, cancer, tumor, internal medicine podcast, hospitalist, heme/onc, rad onc, EBRT, brachytherapy

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 & Transcript

Whiteboard Animation Video of Radiation Physiology

• 02:04 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

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 & Transcript

• 01:12 Learning Journey
• 05:58 Lifelong Learning
• 11:14 Time Management
• 16:38 Role Modeling
• 19:59 Re-Calibrating Failure

Tags: IMCore, CoreIM, failure, fixed mindset, growth mindset, imposter syndrome, leadership, learning styles, role modeling, success, time management

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 References

Time stamps

• 00:35 Random Glucose, Fasting Glucose, Glucose Tolerance Test
• 03:03 Hemoglobin A1c
• 08:26 Fructosamine and Glycated Albumin
• 10:50 Continuous Glucose Monitoring
• 15:44 The Overlooked Issue of Insulin Resistance
• 19:11 Summary

Tags: IM Core, CoreIM, insulin resistance, diabetes, microvascular and macrovascular complication

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?

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• Show notes, Transcript and References

Time stamps

• 02:51 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 pacing

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 
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• Show notes, Transcript and References

Time stamps

• 03:49 Episode start
• 07:13 Dialysis vs. kidney transplant morbidity and mortality
• 11:44 Eligibility for kidney transplant and when to refer
• 21:34 Pre-transplant evaluation process
• 25:38 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 kidney

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?

Behind the Scenes YouTube Interview

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im 

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Show notes, Transcript and References: 

https://www.coreimpodcast.com/2023/03/08/trac/

Time stamps

2:56 Trach Components

12:47 Trach Complication Management

27:48 Airway Clearance

34:53 Speaking Valve

38:54 Decannulation

Tags: IM Core, CoreIM, pulmonary, critical care, ICU, nursing care, respiratory therapy, pharmacy

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 Hospital

4:36 What is a Safety Net Hospital?

11:11 The Origins and Paradox of the Safety Net Hospital

Links 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

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 stamps

• 01:51 Intro
• 07:57 Case 
• 13:09 Differential
• 16:15 Diagnosis
• 22:20 Problem Representation 

Tags: IM Core, CoreIM, diagnostic tools, Occam's razor, Hickam's dictum, data collection, mental model, clinical reasoning, rheumatology

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 stamps

• 04:45 What do we mean by “futility”?
• 11:20 Definitions
• 20:23 Ethical Analysis
• 39:13 Recommendations

Tags: IM Core, CoreIM, ATS, autonomy, justice, values, emotions, communication, medical humanities, ethics

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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?

Behind The Scenes videos

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Show notes, Transcript and References

Time stamps

• 01:12 Intro
• 03:51 Deep Dive 1
• 08:16 Deep Dive 2
• 15:25 Deep Dive 3
• 21:05 Deep Dive 4
• 27:07 Deep Dive 5

Tags: IM Core, CoreIM, Devices, cardiac, risk, perioperative, stroke, surgery, anticoagulation

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-E8

Time stamps

• 01:24 Intro 
• 03:37 Fasting vs. Nonfasting Lipid Panel
• 05:11 Current guidelines
• 07:43 Pathophysiology Overview
• 09:04 Pathophysiology of Apo-B vs. LDL-C with traffic analogy
• 11:23 Apo-B
• 15:40 TG-to-HDL ratio
• 17:06 Takeaways

Tags: IM Core, CoreIM, risk, USPSTF, ACC/AHH, family medicine, cardiology, primary care

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-E7

Time stamps

• 01:20 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 Conclusion

Tags: IM Core, CoreIM, care, communication, goal setting, support, strategies , medical humanities

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 stamps

• 01:42 Intro 
• 04:37 Pearl 1: Diagnosis 
• 13:20 Pearl 2: Differential & Treatment
• 20:48 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 Hepatitis

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?

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Show notes, Transcript and References:  https://www.coreimpodcast.com/2022/10/19/mind-the-gap-asp…imary-prevention/

Time stamps

• 03:03 Guideline recommendations 
• 07:00 How does Aspirin work? 
• 09:11 Trial Data
• 13:00 ASCVD Risk Calculator
• 18:07 Starting vs. Stopping Aspirin 
• 22:11 Summary 

Tags: IM Core, CoreIM, guidelines, atherosclerosis, ASCVD, plaque, bleeding, shared decision-making

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?

Whiteboard animation video on YouTube

Show notes, Transcript and References

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Sponsor: Visit www.medmastery.com/coreim for 15% off on all subscriptions. Discount code: “COREIM”

Timestamps:

• 01:37 Pearl 1
• 03:54 Pearl 2
• 13:53 Pearl 3
• 18:07 Pearl 4
• 29:30 Pearl 5

Tags: IM Core, CoreIM, autoimmune, joint disease, titers, Raynaud's, lupus, Rheumatology

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?

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Show notes, Transcript and References: https://www.coreimpodcast.com/2022/09/21/discharge-with-i…atters-segment-2/

Time stamps

• 01:30 Deep Dive #1
• 17:27 Deep Dive #2

Tags: IM Core, CoreIM, outpatient, inpatient, PCP, management, communication, discharge summary, incidentaloma

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

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 stamps

• 04:51Overview of Microaggressions
• 08:11 Prevalence
• 11:43 How to respond
• 21:03 Barriers to appropriate response
• 26:00 Conclusion

Tags: IM Core, CoreIM, bystander, race, microaggressions, hidden curriculum, DEI

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-E4

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im 

Time stamps:

• 01:20 Intro
• 04:46 Pearl 1
• 13:13 Pearl 2
• 24:03 Pearl 3
• 32:49 Pearl 4
• 37:05 Pearl 5