title

The Rounds Table

Dr. John Fralick and Dr. Michael Fralick

9
Followers
15
Plays
The Rounds Table
The Rounds Table

The Rounds Table

Dr. John Fralick and Dr. Michael Fralick

9
Followers
15
Plays
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About Us

The Rounds Table is a free recurring medical podcast covering the latest and most important research from major medical journals. It is intended for all practicing healthcare professionals and aims to to help them keep up to date in the care of their patients.

Latest Episodes

Rapid fire: High Value Care

Welcome back Rounds Table Listeners! andnbsp; For episode 3, we have two very special guests co-hosting. Welcome back to Drs. Amol Verma and Kieran Quinn. This episode, they discuss 4 articles that peaked their interest related to high value care. andnbsp; ClassicRapid Fireformat…4 papers…here we go! Can care guided by patient priorities by associated with reduced treatment burden and unwanted health care? (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2752365) (00:54 – 08:32) Can a collaborative dementia care plan improve outcomes for patients with dementia and their caregivers?(https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2751946) (08:35 – 15:48) Will a modified algorithm for detecting pulmonary embolism in pregnancy help reduce usage of potentially harmful diagnostic imaging?(https://www.nejm.org/doi/full/10.1056/NEJMoa1813865) (16:16 – 25:05) Can point of care CRP levels help reduce unnecessary antibiotics in COPD exacerbations?(https://www.nejm.org/doi/10.1056/NEJMoa1803185) (25:06 – 32:01) andnbsp; And for The Good Stuff: Kieran discusses a NEJM essay on ethical considerations around using artificial intelligence to predict patient preferences -https://www.nejm.org/doi/full/10.1056/NEJMms1904869 Amol discusses an article in the Globe and Mail by Dr. Matthew Burke, a Neurologist in Toronto, on the placebo effect and its implications for clinical care -https://www.theglobeandmail.com/life/health-and-fitness/article-placebos-could-save-lives-and-health-care-dollars-so-why-cant/) andnbsp; Questions? Comments? Feedback? We’d love to hear from you. @roundstable

35 MIN6 h ago
Comments
Rapid fire: High Value Care

Rapid fire: Geriatric Medicine

Welcome back Rounds Table Listeners! andnbsp; Episode 2 is all about geriatric medicine. Rapid fire format, 4 key papers….enjoy! 1. Does loss of scam awareness predict risk for mild cognitive impairment and dementia? (00:35 to 04:28) https://annals.org/aim/article-abstract/2731121/scam-awareness-related-incident-alzheimer- dementia-mild-cognitive-impairment-prospective?doi=10.7326%2fM18-2711 andnbsp; 2. Burdensome end-of-life interventions in patients with advanced dementia(04:28 to 08:55) https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2748053 andnbsp; 3. Can healthy lifestyles lower the risk of dementia for those at increased genetic risk? (08:55 to 13:34) https://jamanetwork.com/journals/jama/article-abstract/2738355 andnbsp; 4. What is the impact of in-patient blood pressure management intensification for older patients?(13:34 to 18:35) https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2747871 andnbsp; And of course, we cant forget the Good Stu...

20 MINNOV 7
Comments
Rapid fire: Geriatric Medicine

Surprise! We’re back…and talking all things cardiovascular…

andnbsp; Rounds Table Listeners, we’ve got some good news for you… the Rounds Table is back! John and I have decided to pick up where Kieran and his excellent team left off; to continue to bring you regular podcasts on the latest and greatest internal medicine research. This reboot wouldn’t be possible without the continued support of Healthy Debate; thank you! For our first episode of the reboot, we’re talking all things cardiovascular. Classic Rapid Fire format…4 papers…here we go! Is there a safe way to manage direct oral anticoagulants for patients undergoing surgical procedures? (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2740207) andnbsp; What is the relationship between white coat hypertension and cardiovascular events? (https://annals.org/aim/article-abstract/2735719/cardiovascular-events-mortality-white-coat-hypertension-systematic-review-meta-analysis) andnbsp; What is the association between thrombectomy for acute stroke and length of sta...

22 MINOCT 11
Comments
Surprise! We’re back…and talking all things cardiovascular…

The Grand Finale of The Rounds Table

This week we bring you a very special episode, the final episode of The Rounds Table podcast. This episode is dedicated to honouring the show and its development over the past five seasons. The show has had an incredibly successful past five years – the podcast has reached an international audience and has been downloaded in 152 countries with over 320,000 downloads to date. During this time, we have developed an evaluations committee, created interview-based special segments, hosted author engagement interviews, and become available across multiple streaming platforms. This past year we have expanded the show to include multiple international co-hosts spanning Australia to the United Kingdom to North America. The Rounds Table has been an opportunity for students and professionals in a variety of fields (health care, technology, and more) to come together, share and appraise medical literature. More than this, it has become a hub of creativity, entertaining on-air personalities, an...

32 MINJUN 28
Comments
The Grand Finale of The Rounds Table

REPLAY: Sugar and Spice – Canagliflozin and Renal Outcomes and Quality of Life in Atrial Fibrillation

Kieran Quinn, general internist and palliative care physician in Toronto, is joined by Emily Hughes, the producer of the show and soon-to-be Internal Medicine resident at the University of Toronto on this weeks episode of The Rounds Table!Together they are covering canagliflozin and renal outcomes, and quality of life among patients with atrial fibrillation receiving catheter ablation versus medical therapy. Type 2 diabetes mellitus is a leading cause of kidney failure; our current treatments include blockade of the renin-angiotensin-aldosterone system. Sodium-glucose transport protein 2 (SGLT2) inhibitors initially designed for glycemic control may provide additional benefits, such as renal protection. Emily discusses the CREDENCE trial, which was designed to assess the effects of canagliflozin compared to placebo on renal outcomes in patients with type 2 diabetes mellitus and albuminuric chronic kidney disease. Patients with atrial fibrillation seek medical attention often if they...

27 MINJUN 21
Comments
REPLAY: Sugar and Spice – Canagliflozin and Renal Outcomes and Quality of Life in Atrial Fibrillation

Fire It Up: Delayed tPA, Lipids and Cardiovascular Outcomes, Stroke Prevention, and Fournier’s Gangrene with SGLT2 Inhibitors

Michael Fralick and John Fralick, general internists in Toronto, are back on The Rounds Table and they are covering four articles in a rapid-fire style. They discuss the use of tissue plasminogen activator (tPA) up to 9 hours after stroke onset, nonfasting versus fasting lipids and cardiovascular outcomes, the use of dabigatran for stroke prevention, and sodium-glucose cotransporter-2 (SGLT2) inhibitors and the risk of Fournier’s gangrene. The gold standard for ischemic stroke is intravenous thrombolysis or tPA if patients present within four and a half hours of symptom onset. After this, there are worse outcomes and risk of bleeding. Perfusion imaging has allowed identification of areas of brain that may be salvageable. John covers an article on thrombolysis guided by perfusion imaging up to nine hours after onset of stroke, compared to placebo, assessing outcomes including score on the modified Rankin scale and safety profile. Guidelines have recommended routine testing of nonfas...

31 MINJUN 14
Comments
Fire It Up: Delayed tPA, Lipids and Cardiovascular Outcomes, Stroke Prevention, and Fournier’s Gangrene with SGLT2 Inhibitors

Slow Motion: Magnesium in Afib and Fall-Related Injuries with Sleep Aids

Christopher Giuliano, clinical pharmacist, is hosting this week’s episode of The Rounds Table alongside Insaf Mohamad, ambulatory care clinical pharmacist in Internal Medicine. Together they are covering treatment of atrial fibrillation with rapid ventricular response with magnesium and falls risk with trazadone and benzodiazepines in patients with insomnia. Atrial fibrillation is the most common cardiac arrhythmia. Patients with rapid ventricular response can be challenging to manage with multiple pharmacologic options. Chris shares the LOMAGHI study on low-dose versus high-dose magnesium versus placebo in the management of atrial fibrillation, comparing the improvement in meeting goal ventricular rate. Managing insomnia is difficult in older adults especially given the side effects associated with certain prescribed sleep aids. Insaf highlights an article evaluating fall-related injuries (emergency visits or hospitalizations) in patients residing in a nursing home when newly pres...

31 MINJUN 7
Comments
Slow Motion: Magnesium in Afib and Fall-Related Injuries with Sleep Aids

A Shock to The Heart: Risk Factors and Cardiovascular Events in T2DM and Cardioversion in AFib

Andre Maddison, General Internal Medicine (GIM) fellow at Western University, is hosting this week’s episode on The Rounds Table alongside his wife, Emily Wilson, family physician in London and adjunct professor at Western University.Together they are covering risk factors, death, and cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and early or delayed cardioversion in new atrial fibrillation. Patients with T2DM are at a higher risk for myocardial infarction and cerebrovascular events.Interventions are targeted at modifying the key risk factors that lead to such events. Emily shares an article that examines the excess risk of death and cardiovascular events in patients with type 2 diabetes mellitus with risk factors modified to the acceptable ranges, compared to the general population. There are practice variations in terms of how to best manage acute, symptomatic, new-onset but stable atrial fibrillation in the Emergency Department. Next, Andre discusses an ...

20 MINMAY 31
Comments
A Shock to The Heart: Risk Factors and Cardiovascular Events in T2DM and Cardioversion in AFib

A Total Eclipse: Treatment of Status Epilepticus and Aclidinium Bromide in COPD

Freddy Frost, research fellow in cystic fibrosis in Liverpool, and Alex Pickard, trainee in acute and emergency medicine in South London, are back on The Rounds Table this week.They are covering treatment of paediatric convulsive status epilepticus and the effect of aclidinium bromide on cardiovascular events and exacerbations in patients with chronic obstructive pulmonary disease (COPD) who are high-risk. Convulsive status epilepticus in the paediatric population is managed using the Advanced Paediatric Life Support (APLS) algorithm. After two doses of benzodiazepines, in the APLS algorithm the next step is second-line treatment. There is a gap in high-quality literature to support second-line agents and these medications have differences in terms of ease of administration, preparation, and drug interactions. Alex summarizes the EcLiPSE trial, comparing the efficacy and safety of levetiracetam to phenytoin for second-line treatment for status epilepticus in the paediatric populatio...

30 MINMAY 24
Comments
A Total Eclipse: Treatment of Status Epilepticus and Aclidinium Bromide in COPD

Infectious Love: Coronary Angiography in Out-of-Hospital Cardiac Arrest and Risk of HIV Transmission in Serodifferent Gay Couples

Jonathan Gravel, family medicine resident at the University of Toronto and soon-to-be emergency medicine resident, is joined by Max Deschner, a resident in Internal Medicine at Western University. Together they are covering coronary angiography after cardiac arrest without ST-elevation (COACT trial) and the risk of HIV transmission through condomless sex in serodifferent gay couples. Ischemic heart disease is one of the leading causes of out-of-hospital cardiac arrest. Patients with out-of-hospital cardiac arrest undergo complex management and consideration of coronary angiography.Immediate PCI (percutaneous coronary intervention) in patients with STEMI (ST-elevation myocardial infarction) improves mortality but how about beyond STEMI, who should undergo PCI?Max shares the COACT trial, which compared immediate versus delayed coronary angiography in patients following out-of-hospital cardiac arrest without STEMI; survival at 90 days was analyzed. Previous literature has provided info...

37 MINMAY 17
Comments
Infectious Love: Coronary Angiography in Out-of-Hospital Cardiac Arrest and Risk of HIV Transmission in Serodifferent Gay Couples

Latest Episodes

Rapid fire: High Value Care

Welcome back Rounds Table Listeners! andnbsp; For episode 3, we have two very special guests co-hosting. Welcome back to Drs. Amol Verma and Kieran Quinn. This episode, they discuss 4 articles that peaked their interest related to high value care. andnbsp; ClassicRapid Fireformat…4 papers…here we go! Can care guided by patient priorities by associated with reduced treatment burden and unwanted health care? (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2752365) (00:54 – 08:32) Can a collaborative dementia care plan improve outcomes for patients with dementia and their caregivers?(https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2751946) (08:35 – 15:48) Will a modified algorithm for detecting pulmonary embolism in pregnancy help reduce usage of potentially harmful diagnostic imaging?(https://www.nejm.org/doi/full/10.1056/NEJMoa1813865) (16:16 – 25:05) Can point of care CRP levels help reduce unnecessary antibiotics in COPD exacerbations?(https://www.nejm.org/doi/10.1056/NEJMoa1803185) (25:06 – 32:01) andnbsp; And for The Good Stuff: Kieran discusses a NEJM essay on ethical considerations around using artificial intelligence to predict patient preferences -https://www.nejm.org/doi/full/10.1056/NEJMms1904869 Amol discusses an article in the Globe and Mail by Dr. Matthew Burke, a Neurologist in Toronto, on the placebo effect and its implications for clinical care -https://www.theglobeandmail.com/life/health-and-fitness/article-placebos-could-save-lives-and-health-care-dollars-so-why-cant/) andnbsp; Questions? Comments? Feedback? We’d love to hear from you. @roundstable

35 MIN6 h ago
Comments
Rapid fire: High Value Care

Rapid fire: Geriatric Medicine

Welcome back Rounds Table Listeners! andnbsp; Episode 2 is all about geriatric medicine. Rapid fire format, 4 key papers….enjoy! 1. Does loss of scam awareness predict risk for mild cognitive impairment and dementia? (00:35 to 04:28) https://annals.org/aim/article-abstract/2731121/scam-awareness-related-incident-alzheimer- dementia-mild-cognitive-impairment-prospective?doi=10.7326%2fM18-2711 andnbsp; 2. Burdensome end-of-life interventions in patients with advanced dementia(04:28 to 08:55) https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2748053 andnbsp; 3. Can healthy lifestyles lower the risk of dementia for those at increased genetic risk? (08:55 to 13:34) https://jamanetwork.com/journals/jama/article-abstract/2738355 andnbsp; 4. What is the impact of in-patient blood pressure management intensification for older patients?(13:34 to 18:35) https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2747871 andnbsp; And of course, we cant forget the Good Stu...

20 MINNOV 7
Comments
Rapid fire: Geriatric Medicine

Surprise! We’re back…and talking all things cardiovascular…

andnbsp; Rounds Table Listeners, we’ve got some good news for you… the Rounds Table is back! John and I have decided to pick up where Kieran and his excellent team left off; to continue to bring you regular podcasts on the latest and greatest internal medicine research. This reboot wouldn’t be possible without the continued support of Healthy Debate; thank you! For our first episode of the reboot, we’re talking all things cardiovascular. Classic Rapid Fire format…4 papers…here we go! Is there a safe way to manage direct oral anticoagulants for patients undergoing surgical procedures? (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2740207) andnbsp; What is the relationship between white coat hypertension and cardiovascular events? (https://annals.org/aim/article-abstract/2735719/cardiovascular-events-mortality-white-coat-hypertension-systematic-review-meta-analysis) andnbsp; What is the association between thrombectomy for acute stroke and length of sta...

22 MINOCT 11
Comments
Surprise! We’re back…and talking all things cardiovascular…

The Grand Finale of The Rounds Table

This week we bring you a very special episode, the final episode of The Rounds Table podcast. This episode is dedicated to honouring the show and its development over the past five seasons. The show has had an incredibly successful past five years – the podcast has reached an international audience and has been downloaded in 152 countries with over 320,000 downloads to date. During this time, we have developed an evaluations committee, created interview-based special segments, hosted author engagement interviews, and become available across multiple streaming platforms. This past year we have expanded the show to include multiple international co-hosts spanning Australia to the United Kingdom to North America. The Rounds Table has been an opportunity for students and professionals in a variety of fields (health care, technology, and more) to come together, share and appraise medical literature. More than this, it has become a hub of creativity, entertaining on-air personalities, an...

32 MINJUN 28
Comments
The Grand Finale of The Rounds Table

REPLAY: Sugar and Spice – Canagliflozin and Renal Outcomes and Quality of Life in Atrial Fibrillation

Kieran Quinn, general internist and palliative care physician in Toronto, is joined by Emily Hughes, the producer of the show and soon-to-be Internal Medicine resident at the University of Toronto on this weeks episode of The Rounds Table!Together they are covering canagliflozin and renal outcomes, and quality of life among patients with atrial fibrillation receiving catheter ablation versus medical therapy. Type 2 diabetes mellitus is a leading cause of kidney failure; our current treatments include blockade of the renin-angiotensin-aldosterone system. Sodium-glucose transport protein 2 (SGLT2) inhibitors initially designed for glycemic control may provide additional benefits, such as renal protection. Emily discusses the CREDENCE trial, which was designed to assess the effects of canagliflozin compared to placebo on renal outcomes in patients with type 2 diabetes mellitus and albuminuric chronic kidney disease. Patients with atrial fibrillation seek medical attention often if they...

27 MINJUN 21
Comments
REPLAY: Sugar and Spice – Canagliflozin and Renal Outcomes and Quality of Life in Atrial Fibrillation

Fire It Up: Delayed tPA, Lipids and Cardiovascular Outcomes, Stroke Prevention, and Fournier’s Gangrene with SGLT2 Inhibitors

Michael Fralick and John Fralick, general internists in Toronto, are back on The Rounds Table and they are covering four articles in a rapid-fire style. They discuss the use of tissue plasminogen activator (tPA) up to 9 hours after stroke onset, nonfasting versus fasting lipids and cardiovascular outcomes, the use of dabigatran for stroke prevention, and sodium-glucose cotransporter-2 (SGLT2) inhibitors and the risk of Fournier’s gangrene. The gold standard for ischemic stroke is intravenous thrombolysis or tPA if patients present within four and a half hours of symptom onset. After this, there are worse outcomes and risk of bleeding. Perfusion imaging has allowed identification of areas of brain that may be salvageable. John covers an article on thrombolysis guided by perfusion imaging up to nine hours after onset of stroke, compared to placebo, assessing outcomes including score on the modified Rankin scale and safety profile. Guidelines have recommended routine testing of nonfas...

31 MINJUN 14
Comments
Fire It Up: Delayed tPA, Lipids and Cardiovascular Outcomes, Stroke Prevention, and Fournier’s Gangrene with SGLT2 Inhibitors

Slow Motion: Magnesium in Afib and Fall-Related Injuries with Sleep Aids

Christopher Giuliano, clinical pharmacist, is hosting this week’s episode of The Rounds Table alongside Insaf Mohamad, ambulatory care clinical pharmacist in Internal Medicine. Together they are covering treatment of atrial fibrillation with rapid ventricular response with magnesium and falls risk with trazadone and benzodiazepines in patients with insomnia. Atrial fibrillation is the most common cardiac arrhythmia. Patients with rapid ventricular response can be challenging to manage with multiple pharmacologic options. Chris shares the LOMAGHI study on low-dose versus high-dose magnesium versus placebo in the management of atrial fibrillation, comparing the improvement in meeting goal ventricular rate. Managing insomnia is difficult in older adults especially given the side effects associated with certain prescribed sleep aids. Insaf highlights an article evaluating fall-related injuries (emergency visits or hospitalizations) in patients residing in a nursing home when newly pres...

31 MINJUN 7
Comments
Slow Motion: Magnesium in Afib and Fall-Related Injuries with Sleep Aids

A Shock to The Heart: Risk Factors and Cardiovascular Events in T2DM and Cardioversion in AFib

Andre Maddison, General Internal Medicine (GIM) fellow at Western University, is hosting this week’s episode on The Rounds Table alongside his wife, Emily Wilson, family physician in London and adjunct professor at Western University.Together they are covering risk factors, death, and cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and early or delayed cardioversion in new atrial fibrillation. Patients with T2DM are at a higher risk for myocardial infarction and cerebrovascular events.Interventions are targeted at modifying the key risk factors that lead to such events. Emily shares an article that examines the excess risk of death and cardiovascular events in patients with type 2 diabetes mellitus with risk factors modified to the acceptable ranges, compared to the general population. There are practice variations in terms of how to best manage acute, symptomatic, new-onset but stable atrial fibrillation in the Emergency Department. Next, Andre discusses an ...

20 MINMAY 31
Comments
A Shock to The Heart: Risk Factors and Cardiovascular Events in T2DM and Cardioversion in AFib

A Total Eclipse: Treatment of Status Epilepticus and Aclidinium Bromide in COPD

Freddy Frost, research fellow in cystic fibrosis in Liverpool, and Alex Pickard, trainee in acute and emergency medicine in South London, are back on The Rounds Table this week.They are covering treatment of paediatric convulsive status epilepticus and the effect of aclidinium bromide on cardiovascular events and exacerbations in patients with chronic obstructive pulmonary disease (COPD) who are high-risk. Convulsive status epilepticus in the paediatric population is managed using the Advanced Paediatric Life Support (APLS) algorithm. After two doses of benzodiazepines, in the APLS algorithm the next step is second-line treatment. There is a gap in high-quality literature to support second-line agents and these medications have differences in terms of ease of administration, preparation, and drug interactions. Alex summarizes the EcLiPSE trial, comparing the efficacy and safety of levetiracetam to phenytoin for second-line treatment for status epilepticus in the paediatric populatio...

30 MINMAY 24
Comments
A Total Eclipse: Treatment of Status Epilepticus and Aclidinium Bromide in COPD

Infectious Love: Coronary Angiography in Out-of-Hospital Cardiac Arrest and Risk of HIV Transmission in Serodifferent Gay Couples

Jonathan Gravel, family medicine resident at the University of Toronto and soon-to-be emergency medicine resident, is joined by Max Deschner, a resident in Internal Medicine at Western University. Together they are covering coronary angiography after cardiac arrest without ST-elevation (COACT trial) and the risk of HIV transmission through condomless sex in serodifferent gay couples. Ischemic heart disease is one of the leading causes of out-of-hospital cardiac arrest. Patients with out-of-hospital cardiac arrest undergo complex management and consideration of coronary angiography.Immediate PCI (percutaneous coronary intervention) in patients with STEMI (ST-elevation myocardial infarction) improves mortality but how about beyond STEMI, who should undergo PCI?Max shares the COACT trial, which compared immediate versus delayed coronary angiography in patients following out-of-hospital cardiac arrest without STEMI; survival at 90 days was analyzed. Previous literature has provided info...

37 MINMAY 17
Comments
Infectious Love: Coronary Angiography in Out-of-Hospital Cardiac Arrest and Risk of HIV Transmission in Serodifferent Gay Couples
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