#172 Microplastics and Macro CV Health Problems: Beyond Journal Club on APACHe Study with NEJM Group

What happens when your first day as an intern spirals into your worst fears?In this episode, we share raw and real stories from July — from rapid responses to unexpected kindness — and reflect on the emotional weight of starting out in medicine.🔹 Sponsor: NEJM Fellowship Program, click here to learn more and/or apply! Due Aug 1, 2025🔹 Transcript and Show NotesPrior July Stories:July Stories 2.0 (2023)July Stories (2019)Timestamps:(00:32) | Dr. Ali Trainor's First Day as an Intern(03:00) | The Patient's Critical Condition and Emotional Response (07:12) | Dr. George Tran's First Night Shift (10:38) | Dr. Ali Trainor's Second Rotation Experience (14:01) | The Importance of Co-InternTags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Narrative Medicine, HumanitiesFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko’s Digital Stethoscope: Get $50 off, plus a FREE custom chest piece cover ($25 value): https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How much do beta blockers help after a heart attack, even when the heart’s pumping well? In this episode, we revisit the origins of beta blockers in post-MI care, examine how evidence evolved, and explore the REDUCE-AMI trial, which questions whether beta blockers are still needed for all.Listen to this latest episode of Beyond Journal Club, a collaboration between Core IM and NEJM Group, where we put research into context tracing the arc of evidence, dissecting the clinical question, and exploring what the findings could mean for real-world patient care🔹 Sponsor: NEJM Fellowship Program, click here to learn more and/or apply!🔹 Transcript and Show NotesTimestamps:(00:48) | Background on Beta Blockers and Their Mechanism(02:41) | Historical Context of Beta Blockers in Heart Disease(04:56) | Capricorn Trial and Its Impact(07:17) | Emergence of Doubts About Beta Blockers(10:09) | Introduction to the REDUCED-AMI Trial(15:52) | Discussion on Trial Interpretation and Clinical Implications(16:18) | Comparison with Other Trials and Future DirectionsTags:  CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Cardiology Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko’s Digital Stethoscope: Get $50 off, plus a FREE custom chest piece cover ($25 value): https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

🔹 What is invasive fungal disease, and who is most at risk for developing invasive fungal disease? (~ 02:46)🔹 What are the main classes of fungi? (~11:35)🔹 What are the pros and cons of B-D Glucan and Galactomannan (~19:16) 🔹 How to increase the yield of blood cultures? How to interpret yeast growth in sputum/BAL and urine cultures? (~ 30:42)🔹 How is invasive fungal disease treated? (~ 35:14)📌  Sponsor: Oakstone CME’s ACP MKSAP Audio CompanionUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP📌 Transcript & show notesTags: CoreIM, IMCore, Infectious Disease, Hospital Medicine, Hospitalist, ICU, Medical Education, Physician Assistant, Nurse Practitioner, Medical Student, moldFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko’s Digital Stethoscope: Get $50 off, plus a FREE custom chest piece cover ($25 value): https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

🔹What are clinically relevant limitations of an A1c vs. a CGM (1:40)🔹What do the different parts of the ambulatory glucose profile tell you? (09:59)🔹What are common pitfalls, medications, lifestyle patterns that are important to ask your patient about when seeing them for a visit to manage blood sugar? (15:19)🔹 How can you titrate insulin based on when you see the hypoglycemia on the ambulatory glucose profile (20:00)🔹 When there is too much hyperglycemia, how do you titrate insulin when adding on GLP-1 agonists? (26:30)📌 Sponsor:  NEJM Fellowship Program, click here to learn more and/or apply!📌 Transcript & show notesTags: CoreIM, IMCore, Endocrinology, Primary Care, Medical Education, Physician Assistant, Nurse Practitioner, Medical Student, diabetes management, insulin titrationFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko’s Digital Stethoscope: Get $50 off, plus a FREE custom chest piece cover ($25 value): https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

🔹When is an U/S vs. CT vs. MRI helpful before consulting Interventional Radiology?🔹What factors go into an IR pre-op evaluation?🔹 When do drains go in, and when do they come out?🔹 When a patient has trouble with a drain, what are things you can do before calling IR?🔹 What does outpatient IR follow up entail, and what does a capping trial of PCN tubes entail?📌  Sponsor: Oakstone CME’s ACP MKSAP Audio Companion Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAPTranscript & show notesTags: CoreIM, IMCore, Gastroenterology, Primary Care, Medical Education, Physician Assistant, Nurse Practitioner, Medical Student, Medical Imaging, Bleeding Assessment, Drain Management, Procedural SedationFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko’s Digital Stethoscope: Get $50 off, plus a FREE custom chest piece cover ($25 value): https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

🔹 High-yield reversible causes of constipation? (02:26)🔹 Which type of fiber is more helpful? And is more hydration really better? And bulk-forming laxatives (9:03)🔹 Osmotic vs Stimulant Laxatives (15:06)🔹 Suppositories and enemas? (25:39)🔹Best practices with opioid induced constipation (34:05)📌  Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! Use the code CORE50 to get 50% off your first month with Freed📌 Earn CME credit with ACP for this episode! CME-MOC credit 📌 Transcript and Show NotesTags: CoreIM, IMCore, Gastroenterology, GI Pharmacology, Digestive Health, Primary Care, Medical Education, Physician Assistant, Nurse Practitioner, Medical Student, Laxatives, Stool Softeners, Senna, Bisacodyl, Polyethylene Glycol, Bowel Regimen, Magnesium Citrate, LactuloseFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko’s Digital Stethoscope: Get $50 off, plus a FREE custom chest piece cover ($25 value): https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How good are we at preventing HIV? How do efficacy and effectiveness differ? We journey from oral pre-exposure prophylaxis (PrEP) to long-acting injectables, and then to the PURPOSE trials, which look at the use of long-acting lenacapavir as PrEP — a potential game-changer in the field of HIV.Listen to this latest episode of Beyond Journal Club, a collaboration between CoreIM and NEJM Group, where we put research into context, telling the story of how we arrived at the current standard of care, appreciating the clinical question of the trial at hand, and interpreting what the findings may mean for these patients.🔹 Sponsor:  NEJM Fellowship Program, click here to learn more and/or apply!🔹 Transcript and Show NotesTimestamps:(02:25) | HIV PrEP Daily Truvada and Descovy (07:48) | On-Demand Prep(13:25) | Purpose Trials(20:56) | Discussion of Effectiveness to Efficacy Tags:  CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, HIV Prevention, Infectious Disease Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko’s Digital Stethoscope: Get $50 off, plus a FREE custom chest piece cover ($25 value): https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What does Lipoprotein(a) tell us that a standard lipid panel doesn’t? Should we be testing everyone for it? Dive into the genetics, clinical implications, and evolving management strategies for Lp(a). Learn how to interpret results, counsel patients, and navigate topics with limited data like aspirin and PCSK9 inhibitors in treatment.🔹 Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! Use the code CORE50 to get 50% off your first month with Freed🔹 Transcript and Show NotesTimestamps:(02:17) | Pearl 1: What makes Lp(a) unique? How does it raise ASCVD risk?(10:32) | Pearl 2: Who should be tested for Lp(a)? When and why?(16:54) | Pearl 3: Understanding and interpreting Lp(a) levels(24:04) | Pearl 4: How does an elevated Lp(a) affect management?(37:05)| Pearl 5: The role of aspirin and PCSK9 inhibitors in Lp(a)Tags: CoreIM, Internal Medicine, Primary Care, Preventive Cardiology, Atherosclerosis, Lipid Management, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical StudentFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko’s Digital Stethoscope: Get $50 off, plus a FREE custom chest piece cover ($25 value): https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

A new way to think of clots beyond provoked vs. unprovoked: Learn all about how important it is to think about reversibility! What patient states affect the inherited thrombophilia testing? Learn the nuances and practical approaches!🔹 Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! Use the code CORE50 to get 50% off your first month with Freed🔹 This episode is also sponsored by Factor! Get fresh, ready-made meals delivered to your door. Use the code factorpodcast for a special discount at factor75.com.Transcript and Show NotesTimestamps:(02:07) | Pearl 1: Reframing Provoked vs. Unprovoked to Reversibility(09:12) | Pearl 2: How can Virchow's Triad help us categorize the etiology of a clot?(17:01) | Pearl 3: What factors affect anti-thrombin III, Protein C and Protein S deficiency(28:50) | Pearl 4: Is the Factor V Leiden or Prothrombin Gene Mutation as important as the family history?(38:41) | Pearl 5: Spaced Repetition of Learning PointsTags: CoreIM, Internal Medicine, ClinicalPearls, Medical Education, IMCore, hospitalist, physician assistant, nurse practitioner, medical student, internal medicine, hematologyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko’s Digital Stethoscope: Get $50 off, plus a FREE custom chest piece cover ($25 value): https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What is the impact of microplastics on human health? How can we use observational data to support the argument that microplastics may lead to poor health outcomes?Join us as we tackle these questions and discuss the APAChE study on microplastics and cardiovascular disease on this episode of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.🔹 Transcript and Show Notes🔹 Behind The Scenes YouTube VideoThis episode is also sponsored by Factor! Get fresh, ready-made meals delivered to your door. Use the code factorpodcast for a special discount at factor75.com.Timestamps:(02:24) | Introduction to Plastic's Key Players(07:59) | Bradhill/Observational Work(10:33) | APAChE Study Deep Dive(18:03) | Discussion📢 Special Thanks:🎙️ Audio Editing: Jerome Reyes📊 Graphics: Dr. Jimin HwangTags:CoreIM, Environmental Health, Medical Education, IMCore, Public Health, Clinical Pearls, Physician, Medical Student, Nurse Practitioner, EpidemiologyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko’s Digital Stethoscope: Get $50 off, plus a FREE custom chest piece cover ($25 value): https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy