Ep. 327 Building a Pain Interventions Service Line with Dr. Stephen Hunt

In this episode, Dr. Eric Monroe joins Dr. Christopher Beck to discuss using intra-arterial chemotherapy (IAC) as a treatment for retinoblastoma. Dr. Monroe touches on how he has been using telemedicine during this time and the process of considering a patient for IAC. We go over the details of the intra-arterial chemotherapy procedure and we mention some challenges that may arise in dealing with equipment for pediatric patients, specifically how to have a successful procedure while maintaining a low radiation dose. Dr. Monroe speaks about post procedural care including follow-up intervals and what those visits entail. We discuss some of the common complications that can occur during intra-arterial chemotherapy. Dr. Monroe gives some advice about the mental preparation and learning curve that comes with developing skills for IAC. Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/RRlyP6 RESOURCES MENTIONED: A Review of the Literature for Intra-Arterial Chemotherapy used to Treat Retinoblastoma https://pubmed.ncbi.nlm.nih.gov/26886915/ This is the article mentioned by Dr. Monroe which gives an overview of retinoblastoma.

8 Syys 202039min

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/gpvwSB In this episode, Dr. Eric Keller joins Dr. Christopher Beck to discuss medical ethics within IR. He speaks about using a bottom-up approach of applied ethics, and we examine why a combination of casuistry and virtue ethics may be helpful rather than principlism. We dig deeper into medical futility and the challenge of prospectively determining if a procedure is futile. Dr. Keller describes how to design a study that can explore medical ethics as well as methods of collecting and presenting data in an ethical way. We discuss advanced care planning, managing bias, and the role that unbounded ethicality plays in research. We talk through some benefits and drawbacks of ethics boards as well as how using decision support aides may improve informed consent and allow patients to become advocates for themselves. RESOURCES MENTIONED: Journal of the American Geriatrics Society https://onlinelibrary.wiley.com/action/doSearch?AllField=futility&SeriesKey=15325415 This website presents all the papers in the journal that are related to futility. Journal of the American Geriatrics Society (Medical Futility: Where Do We Go from Here?) https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1532-5415.1994.tb06570.x This article discusses various perspectives on medical futility. Decision Aids to Help People who are Facing Health Treatment of Screening Decisions https://www.cochrane.org/CD001431/COMMUN_decision-aids-help-people-who-are-facing-health-treatment-or-screening-decisions This article evaluates the effects of decision aids on health outcomes. Prevalence of Unprofessional Social Media Content Among Young Vascular Surgeons https://pubmed.ncbi.nlm.nih.gov/31882313/ American Geriatrics Society Feeding Tubes in Advanced Dementia Position Statements https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.12924 This article discusses feeding tubes and how to handle feeding for patients with advanced dementia. The Impact of Advance Care Planning on End of Life Care in Elderly Patients https://www.bmj.com/content/bmj/340/bmj.c1345.full.pdf This article describes a randomized controlled trial that examines advanced care planning. Does Facilitated Advance Care Planning Reduce the Costs of Care Near the End of Life? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838173/ This paper discusses the ethical conflicts in advanced care planning. Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units https://www.atsjournals.org/doi/full/10.1164/rccm.201505-0924ST This article describes how to handle treatment disagreements in the ICU. Research Ethics in IR: The Intersection Between Care and Progress https://pubmed.ncbi.nlm.nih.gov/32359529/ This paper mentions the ethical issues in collecting and presenting data. It also discusses the role IR plays in conflict of interest and bias. Understanding Bias: A Look at Conflicts of Interest in IR https://www.researchgate.net/publication/332750177_Understanding_Bias_A_Look_at_Conflicts_of_Interest_in_IR This article examines conflicts of interest and how they affect the field of IR. Reflect and Remember: The Ethics of Complications in Interventional Radiology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531013/ This paper discusses the ethics behind the relationship between IR and complications. Informed Consent: Beating a Dead Horse or an Opportunity for Quality Improvement? https://www.researchgate.net/publication/338303598_Informed_Consent_Beating_a_Dead_Horse_or_an_Opportunity_for_Quality_Improvement This paper examines the ethical implications of informed consent and its complexities. Reconsidering Requests - Futility in IR https://www.jvir.org/article/S1051-0443(19)30069-7/fulltext This article discusses the ethics in challenging healthcare situations.

4 Syys 202056min

Interventional Radiologist Dr. Jeffrey Chick tells us about his deep venous practice at UW Medicine including tips on growing a collaborative, multidisciplinary venous program.

31 Elo 202035min

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/xI8Csf  Interventional Radiologists Dr. Sam Mouli from Northwestern University and Dr. Sandeep Bagla discuss new research examining Y-90 Radioembolization as a novel therapeutic option for treating prostate cancer.

24 Elo 202030min

In this episode, Dr. Neghae Mawla joins Dr. Chris Beck to discuss endovascular AV fistula creation. The episode begins by discussing the advantages of fistulas versus catheters and grafts and how guidelines have changed from “Fistula First” to the most appropriate type of access for the patient. Dr. Mawla explains the details of how he determines candidates for the EndoAVF using ultrasound for vein mapping. We then review patient preparation for EndoAVF including anticoagulation, antibiotics, and anesthesia. We share the two main systems for EndoAVF, Avenu Ellipsys and the WavelinQ device and discuss the similarities and differences between these two approaches for fistula creation. Dr. Mawla walks through his ultrasound-guided techniques and the need for dual venous and arterial access with the WavelinQ device. They review some potential complications with using these devices, including hematomas and uncontrolled arterial bleeds, and post-procedural management. Dr. Mawla discusses timelines for evaluating venous maturation in patients and when a fistula is typically ready for use. He explains the differences between EndoAVF and surgically created fistulas, including several advantages of endo-anastomosis. The episode ends by talking about EndoAVF education in dialysis centers and collaborating with nursing staff, clinics, and both device companies to re-educate staff and patients on differences in cannulation.

17 Elo 202059min

Interventional Radiologist Terence Gade from Penn Medicine, University of Pennsylvania Health System tells us about emerging research and therapies targeting the tumor microenvironment in Hepatocellular carcinoma (HCC).

10 Elo 202027min

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/07FYzi Part II of the discussion with Dr. Martin Radvany and Dr. David Sacks on the role of Interventional Radiologists in stroke interventions, including addressing training requirements and rural access to care.

4 Elo 202046min

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/yS6TGL Dr. Martin Radvany and Dr. David Sacks discuss the role of Interventional Radiologists in the treatment of acute ischemic stroke, including training requirements, the multidisciplinary team approach, and ways to improve patient access to high quality care.

2 Elo 202057min