Steven Yeh

Practice Point 2.2.3 underscores using a 2-year kidney failure risk threshold of >40% to determine modality education and timing for KRT preparation, including vascular access planning or transplantation referral. Predicting the optimal timing for these interventions in individuals with declining GFR is challenging. Premature vascular access planning may lead to unnecessary fistula placement, while delayed planning risks central venous catheter overuse at dialysis initiation. Studies advocate for risk-based thresholds, demonstrating comparable efficacy to eGFR alone. While the KDOQI vascular access guideline suggests a >50% risk threshold or eGFR <15 ml/min per 1.73 m², a >40% risk or eGFR of 15 ml/min per 1.73 m² is deemed acceptable for initiating vascular access referral based on current evidence. Lower risk thresholds, like >20%, enhance sensitivity and can prompt modality education or presurgical vascular access planning, particularly in centers with extended wait times. Link to the 2024 KDIGO Guidelines: https://lnkd.in/gDVT83EE #KDIGO2024 #ClinicalPracticeGuideline #ESRD #CKD #ESKD #Kidneydisease #RenalFailure #RenalReplacment #dialysis #hemodialysis #KRT #KidneyReplacementTherapy #CKDCare #ModalityEducation #VascularAccess #TransplantReferral #HealthcareGuidelines #MedicalDecisionMaking #KidneyHealth #PatientOutcomes #HealthcareManagement

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Excellent new pathway for management of acute HF hospitalization - from ACC. https://lnkd.in/eUu9fwtx

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#Openaccess Carlton et al: Frequency & Risk Factors for ⬆️Healthcare Utilization #pedsICU #SurvivingSepsis 🖥️2016–2019 MarketScan Comm & Medicaid Link: https://ow.ly/YILQ50TO3OO Editorial: https://ow.ly/UwG350TO3OQ Society of Critical Care Medicine Fig: Risk factors predicting 3d of healthcare use 90d post-sepsis discharge

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Frank & Lizzie interview Dr. Shaun Carpenter MD, FAPWCA, CWSP , CEO of MedCentris, LIVE, from the SAWC Fall in Las Vegas. Dr. Carpenter shares with the audience his most recent publication titled, “Evaluating the number of cellular and/or tissue-based product applications required to treat diabetic foot ulcers and venous leg ulcers in non-hospital outpatient department settings.” in Wounds August 2024. This research examines how the number of CTP applications in various care settings influenced wound closure and reduction in wound area. This study provides valuable insights into optimizing treatment strategies for chronic wounds, such as DFUs and VLUs, which are challenging to heal. The data emphasizes the critical role of CTPs in improving outcomes as part of a clinical decision tree for “non-healers” without being wasteful. The work is essential in guiding clinical practices and future research in wound management. Be sure to stay tuned for more research from Dr. Carpenter and his MedCentris team. Be sure to like and subscribe to The Frank and Lizzie Show for the latest updates and newest episodes. Frank Aviles, PT,CWS,FACCWS,CLT-LANA,ALM,AWCC Elizabeth Faust #publication #ctp #education #realworlddata #medcentris #franklizzieshow https://lnkd.in/eBKUy8KB

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Carilion's Neurosurgery Research Eric Marvin, DO, neurosurgeon, is working on research that could reduce side effects and surgical interventions for older adults with chronic subdural hematomas. When older adults experience a head injury—even a relatively minor one—blood can collect between the skull and the surface of the brain, where it can cause symptoms ranging from headache to paralysis or coma. Dr. Marvin’s research could potentially lead to the development of a sustained local drug delivery release system for treating this condition. This new treatment option could help patients avoid additional surgeries after an initial operation. There is also potential to reduce hospital stays and improve patient outcomes. Dr. Marvin in collaboration with third year neurosurgery resident, Kristine Ravina, MD are recipients of our Research Acceleration Program (RAP) award, a grant that funds our employees to start clinical, biomedical or behavioral research projects. Stay tuned here on LinkedIn for more RAP recipient highlights. Learn more about our RAP grant program https://lnkd.in/grsYdh5x

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📚 Are you prepping for a USMLE exam? In this 🆓 video, review medical ethics with Dr. Jack Krasuski so you're ready on test day. https://buff.ly/4g6dyEr #USMLE #usmleprep #medicalethics #ThePassMachine

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Are you a Kidney Stones patient or advocate? ICHOM is initiating the development of a Set of outcomes that matter most to patients with experience of kidney stones. Chaired by Dr. Khurshid Ghani of University of Michigan and Dr. Margaret Pearle of UT Southwestern Medical Center, this endeavor seeks to bring forth improvements in how kidney stones outcomes are measured and evaluated globally. To participate in the ICHOM Kidney Stones Working Group and shape the future of kidney stones care, please email ICHOM Project Manager, Christina Nielsen, at [email protected] Find out more about how ICHOM commits to patient co-creation: https://bit.ly/3ylY7In #ICHOM #KidneyStones #VBHC #ValueBasedHealthcare #PatientVoice

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Lets talk about interventions for back pain. New study out of UCSF Department of Neurological Surgery, written by rock-star medical student Abraham Dada, shows that, from 2000-2021, Medicare Part B paid for over 300 million back pain interventions, for a total of $21 billion. https://lnkd.in/g2TEXFFd Surgical interventions made up about 14% of these payments, and payment for these services steadily declined over the study period. However, there's one area that did demonstrate substantial growth: surgical interventions by non-surgeons. Interventional radiologists and pain management specialists are increasingly utilizing (and billing for) surgical procedures to address low back pain. Annual growth in non-surgeons billing for lumbar fusions grew over 60% per year while sacroiliac joint fusions saw 400% annualized growth. It's important that patients are aware of these procedures and make educated choices. I acknowledge my bias as a surgeon . These are large procedures. Neurosurgeons and orthopedic surgeons spend at least 6 years in surgical training, learning how to not only perform these cases but to handle complications. Non-surgeons often use techniques and devices that were created specifically to meet bare minimum for inclusion in the Medicare billing codes for fusion, allowing non-surgeons to use them. These procedures are NOT the same as fusion procedures performed by qualified surgeons. Back pain is an extremely common condition and there is an extreme amount of heterogeneity in treatment options, both surgical and non-surgical. Patients should be aware of their options. Praveen Mummaneni, MD, MBA John Knightly Brian R. Gantwerker, MD, FAANS, FACS, FCNS Luis Manuel Tumialan AANS/CNS Section on Disorders of the Spine and Peripheral Nerves Journal of Neurosurgery Publishing Group John Paul Kolcun Ken Porche, MD Erica Bisson Anthony (Tony) Asher John Wilson Cheerag Upadhyaya, MD, MBA, MSc, FAANS, FACS Eric Potts Juan Uribe, MD Sanjay Dhall Dean Chou, MD Katie Orrico

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ACOMS members, have you signed up to participate in the ACOMS Annual Membership Meeting and election? We strongly encourage your participation in this meeting, held virtually next Wednesday, May 1 at 8:00 PM ET. This meeting will introduce President-elect, Dr. Faisal Quereshy, MD, DDS, FACS, who was voted during last year's meeting of the membership. Eligible voting members include Fellows and Associate Members in good standing, as well as Life Members, and may vote live during the meeting or by designating a proxy in advance. Members who designate a proxy may not vote during the meeting. If you are not able to attend the meeting or are uncertain if you will be able to attend, you complete a proxy ballot form by NEXT MONDAY, April 29. Complete a proxy: https://bit.ly/49C72Sl Register to attend: https://bit.ly/4aXJk4g

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What is the real-world prevalence and incidence of CTEPH diagnosis after acute PE? In this study of 573 972 patients with acute PE between 2010 and 2021.  Prevalence of CTEPH among patients with history of PE increased during the period from 0.4% in 2010 to 0.9% in 2021. CTEPH was diagnosed in 2556 patients after acute PE, with most (17.6%) diagnoses reported within the first 3 months after the index PE event. https://lnkd.in/gJdwRTHZ PD Dr. Dr. Lukas Hobohm | Lena Marie Paschke | Ioannis Farmakis | Stefano Barco | Sasan Partovi | Thomas Muenzel | Prof.Dr.Stavros Konstantinides | Karsten Keller | Maike Below

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192 RA pts on MTX: GI Sxs studied w/ MISS (MTX intolerance severity score). GI intolerance seen in 56%, Nausea & pain post-MTX most common. More in afro-descendants, w/ FM, Steroids, or JAKi. MISS results unrelated to Route, Gi Dz, age, MTX dose https://buff.ly/3Sdzp3k

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I so enjoyed speaking with Dr. Mohit Khera, Professor of Urology and Chair of the Department at the Baylor College of Medicine. I'm always interested in delving deeper into why some physicians are so energized by the work that they do. A few things stood out to me from our conversation. --Dr. Khera describes Urology as "the most amazing field", and he feels that Urologists are "the happiest surgeons." --He is able to impact his patients' quality of life in significant ways. As he puts it, men’s health is a great gateway to overall health, and he brings a holistic approach to the practice of Urology. --Dr. Khera is very busy, but one of the things that struck me is how much he enjoys the different areas of his work: the clinical care, basic science and clinical research, education, and administration. He talks about how much he loves the challenge and variety in his work week, which is why he’s embraced these different facets of Urology. --When I asked him how he is able to accomplish so much without burning out, there were several areas that he pointed to. --The first was the importance of collaboration. He gives much credit to his clinical and research teams, and talks about the fact that he spends a lot of time choosing new members of his team, because they become part of his family. --He also points to the practical aspects of running a department and research lab, and says that his background as an MBA analyst has helped. His work week is very structured, and he explains that to be successful, he pays attention to not only clinical care, but also areas such as throughput, finance, and other areas. --For students interested in Urology, he also provides some great advice on how to position yourself for success. If you'd like to listen to the episode, please see the comments for a link.

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📅 Mark your calendars! Join us for the Feature Presentation by Dr. Timothy Dy from Chinese General Hospital and Medical Center on November 12 at 6:30 AM during our BNI GRiT Chapter Meeting. Dive into the topic: “State-of-the-(He)art Non-Surgical Interventional Cardiology: When Every Heartbeat Counts”. This is perfect for anyone curious about heart health and eager to learn about cutting-edge non-surgical cardiology. 💬 Send us a message to register and be part of this enlightening session! #HeartHealth #BNIGRiT #Networking #FeaturePresentation

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Too often, addressing climate change is considered as a chore, or something we have to endure. Success is measured by how much we have given up. The shamer: "Look at me-- I no longer take vacations!" The sullen: "Taking care of Earth means we cannot have more children"" The commander: "Get ready--it's time we tighten our pocketbooks" It's as if misery has become a badge of honor. This scarcity mindset is equally wrong and counterproductive. And as for bringing more people along, it's a dead end. Instead, a much better approach is to come from an abundance mindset: how much can we gain by changing society so that it becomes greener? How can the green transition help those who have been left out? How can we redesign society better? Mindsets are a choice. Which will you choose? Many thanks to Jon Henderson, Elizabeth Schumacher, JD, & Emma Rens for yesterday's fascinating discussion on this topic.

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📢 WEBINAR ALERT! Transplant-Associated Thrombotic Microangiopathy: (TA-TMA) Consensus Definitions and Up-to-Date Management. Presented by Dr. Sonata Jodele of Cincinnati Children’s Hospital Medical Center. 🗓️ November 13th, 12-1pm EST. REGISTER NOW 👇 https://lnkd.in/gJSqEXMu Topics covered include: • Review TA-TMA consensus criteria • TA-TMA organ-specific disease and clinical presentations • Multi-institutional TA-TMA study • Research and utilization of molecular diagnostics #ASH24 #hematology #TATMA #BMT

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Simple Summary: Goals-of-care discussions, by promoting mutual understanding between patients and clinicians, supporting decision making and facilitating care planning, have been found to reduce acute care use and cost of care downstream. However, it is not known if goals-of-care discussions have an immediate impact on the cost of the same hospital stay. In this real-world study, we examined the hospitalization cost before and after the implementation of a goals-of-care program. We found that the overall cost in unselected medical patients did not differ significantly before and after program implementation; however, the cost of hospitalization decreased significantly among ICU patients by 17% after program implementation. This study highlights the potential value-based benefit of goals-of-care programs for patients who have serious illnesses. 🙏🏽 eduardo bruera

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🔍 New insights in FET surgery! 🩺 #CardiacSurgery #AorticSurgery #FrozenElephantTrunk Our latest review, "Head-to-head: Zone 2 vs. Zone 3 Frozen Elephant Trunk," dives into the evolving practice of total arch replacement, comparing outcomes between Zone 2 (Z-2-FET) and Zone 3 (Z-3-FET) techniques. 📊 💡 Findings highlight Z-2-FET as the leading approach for better clinical outcomes, faster operative times, and ease of access—despite slightly less optimal aortic remodeling. 🌐 Don’t miss out on a deep dive into Z-0-FET's future potential as well! Click to read, explore, and stay ahead in FET advancements. https://lnkd.in/gNjWyFuG Jonathan Frimpong-Ansah Eric S. Weiss Alexey Kudrinskiy Sivaraj Pillai Govindasamy Sachin Srinivasan Brad Taylor MD, MPH Attaullah Khan Niazi Scott Cameron M.D., Ph.D. Gianluca Torregrossa Dr. Majid Aized

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