Michael Verdon, DO FACOS

Apremilast Benefits and Risks in PsA Dr. Akhil Sood discusses abstracts 1466, 2583, 0598 and 2640 discussing the use of apremilast in PsA, presented at #ACR24. https://buff.ly/491Nc4b

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"What is a C-Arm machine, and what does it do?" 👇️⁠ ⁠ A C-Arm machine is an advanced medical imaging 📸 device based on X-ray technology. ⁠ ⁠ They are primarily used for fluoroscopy capabilities (real-life moving images) but have radiography (viewing the internal form of an object) capabilities too. ⁠ ⁠ Its name comes from its C-shaped arm, which connects the X-ray source on one end and the detector on the other.⁠ ⁠ Have more questions? Drop them below ⬇️. ⁠

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🙋Bunion surgeons: what is your algorithm for adding an Akin? How about a lateral release? These are questions ⁉️I field commonly when teaching or presenting 🗣️🎤on 4th generation minimally invasive hallux valgus surgery. Related to MIS bunionectomies, there does not seem to be consensus 🤝 among surgeons for these additional steps. This is ripe👌🏻for future research 👩‍🔬🔬& warrants investigation 🧐. Comparative studies should be performed and a surgeon’s approach may ultimately influence (open, SERI technique, PECA, META, etc.). But what is correct ✅ & what holds up long-term?! ⏳⌛️ My algorithm 🧮 is simple. If the hallux abuts the 2nd digit (positive “toe touch” sign) after the MT1 osteotomy, then I add a percutaneous Akin. This is mostly a clinical decision (not based on radiographs 🩻). I estimate I add an Akin 85-90% of the time. The last step I’d add is a lateral release (less than 5% of my perc bunion cases). The following Pecaplasty (Enovis Foot & Ankle) case example highlights this thought 🤔process. Moderate bunion deformity in a healthy female. Pay specific attention 👀 to the hallux position after MT1 osteotomy (abuts 2nd toe) & after Akin. A patient’s shoe 👠will push the hallux back slightly, and if I don’t add a lateral release then I’m not concerned 🫣about a varus. What’s your Akin & lateral release algorithm? It’s burr time! 🎥🍿 #MIS #bunion #footsurgeon #percutaneous #akin Emplify Health Thomas A. McDonald, MD FAAOS Cary Chapman Corine L. Creech, DPM, FACFAS Bobby Ndu Amiethab Aiyer Dr. Brian J Burgess Brian Loder William Crawford, MD FAAOS Docteur Joël Vernois Prof. Dr. med. Hazibullah Waizy Gustavo Araujo Nunes David Gordon Raquel Sugino DPM, MS, FACFAS Oliver Schipper Ettore Vulcano, M.D. Noman A. Siddiqui DPM, MHA, FACFAS Patrick DeHeer, DPM Neal Blitz Eric Baskin Richard Freeman A. Holly Johnson Tyler Gonzalez, MD, MBA, FAAOS Peter LamKelsey Millonig, DPM, MPH, AACFAS

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🔪Surgical Trainees: Successful surgery starts hours before: 3 Step Guide Do you Agree? Please add more! ⏰1: Schedule patients for your operating list. ‼️This is critical. Consider if they live alone and have no escort, a common reason patients are cancelled on the days. ➡️Do they need a medical pre-operative or elderly medicine, multi-specialty review to determine benefit vs risk, in chronic conditions. ☝🏽Are the patients appropriate for a weekend day case or need a weekday with an inptient stay afterwards. 📑2: Read the patient notes and review their scans and reports, book any outstanding investigtions and Flag this up to the operating consultant and operating managers. 🩻BTW to learn you need to look at scans first then make your mind up and check the radiologist report. 👩‍⚕️3: Consent patients yourself in clinic (best practice and should really be the standard) BUT if not possible come early and consent patients. #surgicaltrainee #coresurgicaltraining #residentdoctor The Royal College of Surgeons of England Imperial College Healthcare NHS Trust Chelsea and Westminster Hospital NHS Foundation Trust

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Certain corrections are difficult to achieve with clear aligners and require additional biomechanics. Sound knowledge of simple biomechanics is extremely useful for treatment planning of complex cases. Some examples are:- 1) Extrusion 2) Derotation (> 15°) 3) Severe crowding 4) AP discrepancies of more than 2mm 5) CO-CR discrepancies In this case of complete deepbite, use of buttons and interarch elastics is essential to achieve posterior extrusion, along with aligners. Patient compliance is of utmost importance to achieve such critical corrections.

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Progress in any field is built on small, intentional steps—each action compounding over time. The meeting between the leaders of JRCERT, ASRT, and ARRT is a perfect example of how committed leadership drives long-term change in healthcare. It’s not just about big decisions; it’s about consistent efforts to build a better future for everyone involved—students, technologists, and ultimately, patients. The release of the 2024 Consensus Committee’s White Paper is a powerful signal, but real transformation happens when these strategies are put into practice day by day. Here’s to continuous improvement and collaboration as we advance the future of medical imaging and radiation therapy. Melissa Pergola, Ed.D., R.T.(R)(M)(ARRT), FASRT, CAE | Leslie Winter | Liana Watson, R.T.(R)(M)(S)(BS)(ARRT), RDMS, FASRT, CAE #improvement #collaboration #radiology #radiologix #xray #radiologictechnologist

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Study suggests that simplified, handheld 6-lead ECG devices may be effective triage tests for QTc that could reduce the need to perform 12-lead ECG monitoring in resource-constrained settings. https://ja.ma/4eeFYwc

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The latest issue of Detroit Medical News, the newsletter of the Wayne County Medical Society of Southeast Michigan features an interview showcasing the medical speciality of #hematopathology. This piece explains what hematopathologists do, when their expertise is needed, and how their work supports accurate diagnoses and treatment for conditions like anemias, leukemias, and lymphomas. It also provides practical guidance on when to consult a hematopathologist and resources for learning more about this field. Whether you’re a clinician seeking to deepen your knowledge or simply curious about this specialty’s impact, take a moment to explore this article. Available here: https://lnkd.in/e2ysQZYC

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More proof and data that #GenAI is reducing burnout and increasing joy in healthcare. “reduced human effort by an estimated 91% (as measured by gradable items) and dramatically reduced turnaround time (from weeks to days).” #fightburnout #healthtech #aiml #snowflakecortex #cortexai #llama #mistral #anthropic #openai #hcldr #hitsm

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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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In which clinical situations presenting with headache, should we order for a CT or MRI scan of brain? Headaches are common, and more than 90% people suffer from headache at least once in their lifetime. Not all causes of headache are serious, and therefore, not all cases of headache need evaluation by a CT or MRI scan of brain. The commonest causes of headache are migraine and tension headache. However, there are a few serious diseases, which could also present with headaches. These include subarachnoid hemorrhage, head injury, brain tumors, brain fever (meningitis or encephalitis), and blood clots (thrombosis/infarction) in the brain. In these cases, a brain scan is needed. Watch this video to learn more about the clinical scenarios, when a brain CT or MRI scan should be ordered. #bestneurologist #neurologist #migraine #headache #CTScan #MRIScan

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tPA Cost-Effectiveness in Acute Ischemic Stroke 1. Within 3 Hours of Onset: Findings: Administering tPA within 3 hours of stroke onset is cost-effective and results in long-term health benefits. One study showed a gain of 0.39 quality-adjusted life years (QALYs) and lifetime cost savings of $25,000 per patient. Reference:BMJ Open: "Economic evaluation of thrombolysis with tPA for acute stroke" 2. Within 3 to 4.5 Hours of Onset: Findings: Extending the window for tPA administration to 4.5 hours remains cost-effective. Research indicated a gain of 0.28 QALYs at an additional cost of $6,050, yielding an incremental cost-effectiveness ratio (ICER) of $21,978 per QALY gained. Reference:American Heart Association: Cost-effectiveness of extending tPA use Cost-Effectiveness in Myocardial Infarction (MI) 1. Comparison with Streptokinase: Findings: The GUSTO trial demonstrated that tPA reduced 30-day mortality rates compared to streptokinase. While more expensive, tPA was associated with improved outcomes. Reference:PubMed: GUSTO trial results on thrombolytic therapy 2. General Cost Analysis: Findings: In MI settings, tPA’s cost-effectiveness depends on healthcare infrastructure and alternative options like PCI (percutaneous coronary intervention). Cost-effectiveness is often evaluated against these standards. Reference: tPA and GUSTO Trial Conclusion Overall, tPA is a cost-effective therapy for acute ischemic stroke and myocardial infarction, particularly when administered promptly. Its cost-effectiveness in different settings depends on the timely administration, healthcare infrastructure, and availability of alternative treatments.

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Palpation landmarks are great...BUT how great are they really? Who is using MSK US guidance for interventions? Comment below about your thoughts on landmark (BLIND) vs MSK US guided. Here's a great journal article: Daniels EW, Cole D, Jacobs B, Phillips SF. Existing Evidence on Ultrasound-Guided Injections in Sports Medicine. Orthopaedic Journal of Sports Medicine. 2018;6(2) #medical #education #MSKUltrasound #knowledge

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TEER vs surgical MV repair in HF pts with secondary MR? Both non-inferior with regards to CV outcomes, TEER has favorable safety outcomes. Drs. Rudolph and Baldus discuss results of MATTERHORN trial here #ESCCongress

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Skin substitute products & Wound Healing Properties: Amniotic membrane is rich in growth factors, cytokines, and extracellular matrix components that are believed to promote wound healing. These properties may be particularly beneficial in diabetic ulcers, which often exhibit impaired healing.

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How to Shoot the Perfect "Y" View (advice from an RT) 👇 https://lnkd.in/gzSgZ7Yn Central Ray | Perpendicular entering the glenoid cavity and exiting the scapulohumeral joint Evaluation Criteria • Lateral border of the Scapula in profile • Scapula superimposed over the humerus Angulation of Anatomy: body rotated 45 - 60 degrees Shielding: thyroid gland, gonads IR: 10X12in (24X30cm) lengthwise SID: 40 inches (101cm) Breathing: Suspended The AP Scapular "Y" view of the shoulder is a radiographic projection that was first described in 1954 by Dr. Robert E. Morgan. The view is named for the characteristic "Y" shape that is formed by the alignment of the acromion, coracoid process, and glenoid fossa on the radiograph. The AP Scapular "Y" view is used to assess the alignment of the shoulder joint and to evaluate for fractures, dislocations, and other injuries. A doctor may order an AP Scapular "Y" X-ray view of the shoulder for several reasons: 1. Assessment of Scapular Fractures: This X-ray view helps evaluate the scapula (shoulder blade) for any fractures or bony abnormalities. The "Y" view allows for better visualization of the scapular body, including the glenoid fossa (socket) and acromion process, which can aid in the detection of fractures. 2. Evaluation of Shoulder Dislocations: The AP Scapular "Y" X-ray can assist in diagnosing shoulder dislocations. By examining the relationship between the humeral head (upper arm bone) and the glenoid fossa, the doctor can determine if the shoulder joint has become dislocated. 3. Identification of Soft Tissue Injuries: While primarily used to assess bony structures, the AP Scapular "Y" X-ray view may also reveal certain soft tissue injuries. For example, it can show signs of soft tissue swelling or displacement that may indicate associated ligamentous or tendon injuries. 4. Assessment of Shoulder Impingement: This X-ray view can help evaluate the space within the shoulder joint and identify any signs of impingement, where structures like the rotator cuff tendons may be compressed or pinched. It can assist in diagnosing conditions like subacromial impingement syndrome. 5. Preoperative Planning: Prior to certain shoulder surgeries, such as those involving the acromioclavicular joint or scapula, an AP Scapular "Y" X-ray may be ordered to provide a clear view of the shoulder complex. It aids in surgical planning by providing detailed information about the bone anatomy and any associated abnormalities. #xray #radiologix #radiologictechnologist #yview #shoulderxray

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Is "T1 Hand" a Misnomer? A New Paradigm in Brachial Plexus Injury Classification An intriguing editorial in the Journal of Hand and Microsurgery challenges the long-held convention of using the term "T1 hand" for a specific brachial plexus injury. Prepare to have your assumptions challenged! 🤔 Why the Need for Change? * The "T1 Hand" Illusion: The term suggests only the T1 nerve root is functioning. However, C5 (35%) and C6 (3%) nerve roots often play a significant role and are intact in such T1 injuries rendering the term misleading. * The Median Nerve Takes Center Stage: The editorial highlights the crucial role of the intact median nerve (C6, C7, C8, T1) in these injuries. This nerve becomes the powerhouse for restoring essential hand functions: * Elbow Flexion: Powered by the C6, C7 fascicles of the Flexor Carpi Radialis (FCR) * Wrist Extension: Driven by the C6, C7 branches of the Pronator Teres (PT) nerve * Finger Extension: Enabled by the C8, T1 branches of the Flexor Digitorum Superficialis (FDS) ❓ Why Not "Ulnar Hand" or "Radial Hand"? The ulnar nerve (primarily C8) and radial nerve (weak contribution from the posterior division of the lower trunk) are not dominant enough to be a donor or warrant their names in the classification. 💡 Introducing the "Median Nerve Hand" This new term accurately reflects the pivotal role of the median nerve and provides a more precise and scientifically sound description of the injury besides a potential donor Join the Debate! This editorial ignites a crucial conversation about brachial plexus injury classification. Join deeper into the research and share your insights! [Link to the full article: https://lnkd.in/gJ_9YHwv] 📢 Let's discuss on WhatsApp! [https://lnkd.in/gS6hzn9g] #brachialplexus #handsurgery #microsurgery #medicalresearch #T1hand #MedianNerveHand #neuroscience #clinicalterminology #innovation #medicaldebate Dr. J Terrence Jose Jerome India Alistair Phillips Arne Decramer MD FEBHS Ahlam Arnaout Benjamin Ferembach Dr Bassem Elhassan Carlos Heras-Palou Carlos F Morales Hackett Christophe Mathoulin Donald Lalonde Elisabet Hagert, MD PhD Egemen Ayhan Ezequiel Zaidenberg Eva-Maria Baur Fizan Younis Gregory Bain Giuseppe Broccoli Hintringer Wolfgang Jean Paul Brutus MD Lorenzo Garagnani, OSI Anand Murthi MD, FAAOS Mohit Bhandari Massimo Corain massimo massarella Maxime Antoni maxime Rousié Nunzio Catena M.D. Nur Nurbhai DO, FAOAO, FAAOS Olivier Mares Pierluigi Tos Thomas APARD Tom Lattré Tom Quick Dominic Power Global Nerve Foundation Vaikunthan Rajaratnam Xavier Gueffier Brachial Plexus Scotland Mohammadjavad Farahani Marco Guidi Luis Landín Jarillo

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