Clinician's Roundtable

Host: Lisa Dandrea Lenell, PA-C, MPAS, MBA Guest: William Leinweber, MBA Chief executive officer of the American Academy of Physician Assistants, Bill Leinweber, discusses the developments and goals of the organization with host Lisa D'Andrea Lenell. Mr. Leinweber highlights the professional responsibilities of physician assistants, the need to ensure physician assistants fill the increasing demand for primary care services, and the issues arising out of specialization within the profession. The conversation outlines the organization's goals in terms of addressing the needs of its membership and supporting the medical community.

Host: Lisa Dandrea Lenell, PA-C, MPAS, MBA Guest: Vic Germino, PA-C Guest Vic Germino, a member of the 1961 first graduating class of the physician assistant program established at Duke University, discusses the history of the profession with host Lisa D'Andrea Lenell. Mr. Germino explains how Dr. Eugene Stead, Jr., then chairman of the department of medicine at Duke University, conceived of the program and the obstacles confronting the first physician assistants. Mr. Germino also discusses the development of the practice and the changes he has observed of the physician assistant's role in providing healthcare services.

Host: Bruce Bloom, DDS, JD Guest: Yuri Danilov, PhD Patients with brain damage can learn to see and balance through sensory substitution using the tongue. Join host Dr. Bruce Bloom for a fascinating look into new research with Dr. Yuri Danilov, senior scientist at the Tactile Communication & Neurorehabilitation Laboratory at the University of Wisconsin-Madison. A new understanding of the anatomy and physiology of the central nervous system can help patients with neurological and neuromuscular diseases such as multiple sclerosis and Parkinson's disease regain visual and motor skills.

Host: Susan Dolan, RN, JD Guest: Sue Ann Thomas, PhD, RN Should terminally ill patients have implantable cardioverter defribrillators (ICDs)? Join Dr. Sue Thomas, assistant dean for PhD studies and professor at the University of Maryland School of Nursing, as she discusses the implications of ICDs for terminally ill patients. Dr. Thomas tells host Susan Dolan how the ICDs is deactivated. They also talk about whether an ethics committee should be involved in the decision to deactivate an ICD, and the nurse's role in caring for patients with these implanted devices.

Host: Susan Dolan, RN, JD Guest: Sue Ann Thomas, PhD, RN What is the psychological impact of having an ICD? Dr. Sue Thomas, assistant dean for PhD studies and professor at the University of Maryland School of Nursing, shares her research as principal investigator on the PRHAT trial, in which she investigated long-term changes in anxiety and depression amongst patients post-MI. Dr. Thomas also outlines a holistic model of cardiovascular health. Susan Dolan hosts.

Host: Shira Johnson, MD Guest: Trevor Duke, MD In 2000 the UN developed the Millennium Developmental Goals and the fourth goal is to reduce child mortality by 2015. Dr. Trevor Duke is head of the Centre for International Child Health in Australia and collaborates with the World Health Organization to meet this goal. He is interviewed by Dr. Shira Johnson to discuss the mammoth task of reducing pediatric mortality world wide and the initial steps taken by countries involved in this effort.

Host: Shira Johnson, MD Guest: Trevor Duke, MD A simple medical device such as an oxygen saturation monitor can make all the difference in a developing country. Dr. Trevor Duke, an intensive care specialist at Royal Children's Hospital in Melbourne, Australia, talks about his study which reduced the death rate from pneumonia in New Guinea by measuring oxygen saturation and administrating oxygen through a concentrator. He and host Dr Shira Johnson discuss this study and his work with the World Health Organization.

Host: Larry Kaskel, MD Guest: William Jessee, MD Each year the Medical Group Management Association produces a report on practice operating costs and profitability. Dr. Larry Kaskel discusses the most recent results with Dr. William Jessee, president of Medical Group Management Association. The critical finding is that practice-operating costs are increasing at a higher rate than practice revenue in all areas of medicine. Dr. Jessee reports that the greatest driver of costs is labor due to shortages of healthcare workers and resulting increases in salaries. Notwithstanding, Dr. Jessee notes that practices with more FTE support staff were more profitable than those with fewer FTE support staff, highlighting the importance of proper staffing for the job function. Dr. Jessee discusses the importance of real-time adjudication and the developing trend of more hospital-owned practices.

Guest: Caleb Alexander, MD Out-of -pocket costs account for approximately one fifth of healthcare expenditures. Dr Caleb Alexander,an assistant professor of medicine at the University of Chicago, discusses with host Larry Kaskel, MD, the findings of his recent study that focused on patient-physician communications regarding out-of-pockets costs for outpatient treatment. An unfortunate finding is that doctors rarely communicate with patients about these costs, notwithstanding the fact that patients are quite burdened by these expenses. Tune in to hear Dr. Alexander discuss the key barriers to communications between physicians and patients and the recommendations for overcoming such hurdles. Interestingly, Dr. Alexander's research has found that giving patients free drug samples can often increase a patient's out-of-pockets costs, rather than reduce these expenses.

Host: Jennifer Shu, MD, FAAP Guest: Andrew Muir, MD Type 1 diabetes has long been considered a disease of childhood and adolescence. However, current research suggests that infant nutrition, in addition to genetics and other factors early in life, can significantly impact a child's risk for developing the condition later in life. How can we identify children at risk for Type 1 diabetes, and what can we do to prevent or intervene with the disease process? Dr. Andrew Muir, professor of pediatrics and chief of pediatric endocrinology at Emory University School of Medicine, speaks with host Dr. Jennifer Shu about early predictors of Type 1 diabetes.

Host: Maurice Pickard, MD Guest: Alexia Torke, MD, MS Dr. Alexia Torke, assistant professor of medicine at Indiana University, discusses how standard bioethical approaches with surrogates do not often match what actually happens at the bedside. Physicians use their clinical judgement and what they feel is right for the incompetent patient in determining a course of action. Much can be done to establish this important relationship with surrogates, beginning with creating trust and assessing their own grief and emotional stress. Hosted by Dr. Maurice Pickard.

Host: Bruce Japsen Guest: Maureen Corry, Ms. New data suggests that nearly one in five women suffers postraumatic stress following labor and delivery; however, the postpartum experience of new mothers runs the gamut, oftentimes meaning little or no support. Maureen Corry, executive director of the Childbirth Connection, tells host Bruce Japsen of the Chicago Tribune about issues facing these women and their medical care providers.

Host: Cathleen Margolin, PhD Guest: Helen Mayberg, MD Standard treatments for depression are effective in providing relief in most cases. However, some individuals suffer from depression that does not diminish despite adequate trials of antidepressants, psychotherapy and even electroconvulsive therapy. There is new hope for those suffering from treatment-resistant depression in the form of deep brain stimulation. Electrodes implanted in the brain that provide continuous current to a specific area of the brain has provided relief to subjects in groundbreaking new studies . Dr.Helen S. Mayberg, professor of Psychiatry and Neurology at Emory University School of Medicine joins host, Dr. Cathleen Margolin to discuss deep brain stimulation for depression. Dr. Mayberg's studies over the past 20 years in neural network models of mood regulation in health and disease have led to the recent development of a new intervention for treatment resistant patients using deep brain stimulation.

Host: Cathleen Margolin, PhD Guest: Helen Mayberg, MD Dr. Helen Mayberg, professor of psychiatry and neurology at Emory University School of Medicine, joins host Dr. Cathleen Margolin to discuss neural network models of depression. Sharing more than two decades of work in this area, Dr. Mayberg explains how models of mood regulation have led to the development of a new intervention for treatment-resistant patients using deep brain stimulation.

Host: Shira Johnson, MD Guest: Christopher B. Colwell, MD Evidence-based medicine has changed resuscitation in the field and in the emergency department. Dr. Christopher Colwell, associate director of emergency medicine at Denver Health Medical Center and medical director of the Denver Paramedic Division and the Denver Fire Department, reviews what what we know now about pre-hospital care. He discusses CPR, medications, and therapeutic post-arrest hypothermia with host Dr. Shira Johnson.

Host: Shira Johnson, MD Guest: Calvin A. Brown III, MD Once the sole domain of anesthesiologists, rapid sequence intubation is now a skill practiced by all emergency department physicians. Dr. Calvin Brown III, attending physician in the emergency department at Brigham and Woman's Hospital in Boston, explains the state of the art in intubation. Dr. Brown is interviewed by Dr. Shira Johnson as he reviews the basic technique of RSI, some of the pearls and pitfalls, and what is on the horizon for this skilled intubation technique.

Host: Shira Johnson, MD Guest: Rachel Chin, MD Tattoos and body piercings have been around for hundreds of years. But now they are turning up in your office or your ED. Dr. Rachel Chin is a professor of emergency medicine at the University of California San Francisco School of Medicine. She and Dr. Shira Johnson look at the potential complications you may see and how to treat them.

Host: Mark Nolan Hill, MD Guest: Howard Heit, MD Pain is generally considered to be the most common reason our patients come to see us. Yet it's a phenomenon that we don't fully understand and one that varies widely from patient to patient. With regard to the prescription of potent painkillers like methadone, should the often cryptic nature of pain warrant additional pain management training for practitioners ordering these meds? Dr. Howard Heit, a nationally recognized chronic pain and addiction medicine specialist practicing in northern Virginia, and an assistant clinical professor at the Georgetown University School of Medicine, joins host Dr. Mark Nolan Hill to address the challenges of properly prescribing pain medication. What grade would Dr. Heit give our profession for our overall performance on pain management, and how can we improve that evaluation?

Host: Mark Nolan Hill, MD Guest: Howard Heit, MD A drug that first gained prominence as a treatment for heroin addiction, methadone is now more commonly prescribed by medical practitioners for a range of severe pains. Why are we seeing this rise in methadone use? Are we, as prescribers, doing everything we can to understand the pharmacokinetics and pharmacodynamics of methadone, and to ensure that our patients are also cognizant of the dangers? Dr. Howard Heit, a nationally recognized chronic pain and addiction medicine specialist practicing in northern Virginia, and an assistant clinical professor at the Georgetown University School of Medicine, shares his clinical expertise on the perils of the drug that is now the fastest growing cause of narcotic death in the United States. Dr. Mark Nolan Hill hosts.

Host: Larry Kaskel, MD Guest: Wayne Peters, MD Recent studies indicate that some patients may not obtain the full benefits of aspirin's antiplatelet effects Guest Dr. Wayne Peters discusses with host Dr. Larry Kaskel the benefits of aspirin to prevent and manage heart disease, and the tests available to measure aspirin resistance or platelet function. Dr. Peters outlines the clinical importance of these tests and the various factors that can affect absorption including medications such as ibuprofen, smoking and high cholesterol. Tune in to hear how a simple urinary test will provide the primary care physician the information to effectively use aspirin for the prevention and management heart disease in combination with other prevention mechanisms.