Eli Beer is a pioneer, social entrepreneur, President and Founder of United Hatzalah of Israel. In thirty years, the organization has grown to more than 6,500 volunteers who unite together to provide immediate, life-saving care to anyone in need - regardless of race or religion. This community EMS force network treats over 730,000 incidents per year, in Israel, as they wait for ambulances and medical attention. Eli’s vision is to bring this life-saving model across the world. In 2015, Beer expanded internationally with the establishment of branches in South America and other countries, including “United Rescue” in Jersey City, USA, where the response time was reduced to just two minutes and thirty-five seconds. Episode Chapters (0:00) intro (1:04) Hatzalah’s reputation for speed (4:48) Hatzalah’s volunteer EMTs and ambucycles (5:50) Entrepreneurism at Hatzalah (8:09) Chutzpah (14:15) Hatzalah’s recruitment (18:31) Volunteers from all walks of life (22:51) Having COVID changed Eli’s perspective (26:00) operating around the world amid antisemitism (28:06) goodbye For video episodes, watch on www.youtube.com/@therudermanfamilyfoundation Stay in touch: X: @JayRuderman | @RudermanFdn LinkedIn: Jay Ruderman | Ruderman Family Foundation Instagram: All About Change Podcast | Ruderman Family Foundation To learn more about the podcast, visit https://allaboutchangepodcast.com/ Looking for more insights into the world of activism? Be sure to check out Jay’s brand new book, Find Your Fight , in which Jay teaches the next generation of activists and advocates how to step up and bring about lasting change. You can find Find Your Fight wherever you buy your books, and you can learn more about it at www.jayruderman.com .…
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Sisällön tarjoaa Brilliant Board Review & CME, Brilliant Board Review, and CME. Brilliant Board Review & CME, Brilliant Board Review, and CME tai sen podcast-alustan kumppani lataa ja toimittaa kaiken podcast-sisällön, mukaan lukien jaksot, grafiikat ja podcast-kuvaukset. Jos uskot jonkun käyttävän tekijänoikeudella suojattua teostasi ilman lupaasi, voit seurata tässä https://fi.player.fm/legal kuvattua prosessia.
🎙️ Brilliant Medicine: Your Internal Medicine Edge
Stay sharp, stay current, and stay confident with Brilliant Medicine — the go-to podcast for Internal Medicine and Family Medicine physicians, residents, nurse practitioners, and physician assistants.
Each episode delivers high-yield insights on the latest breakthroughs, practice-changing guidelines, and cutting-edge treatments in Internal Medicine — with just enough board review to keep your clinical reasoning razor-sharp.
We cut through the noise, simplify complex studies, and translate new data into actionable knowledge for your daily practice. Whether you're prepping for boards or staying ahead in clinic, hospital, or telemed — we've got your back.
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Sisällön tarjoaa Brilliant Board Review & CME, Brilliant Board Review, and CME. Brilliant Board Review & CME, Brilliant Board Review, and CME tai sen podcast-alustan kumppani lataa ja toimittaa kaiken podcast-sisällön, mukaan lukien jaksot, grafiikat ja podcast-kuvaukset. Jos uskot jonkun käyttävän tekijänoikeudella suojattua teostasi ilman lupaasi, voit seurata tässä https://fi.player.fm/legal kuvattua prosessia.
🎙️ Brilliant Medicine: Your Internal Medicine Edge
Stay sharp, stay current, and stay confident with Brilliant Medicine — the go-to podcast for Internal Medicine and Family Medicine physicians, residents, nurse practitioners, and physician assistants.
Each episode delivers high-yield insights on the latest breakthroughs, practice-changing guidelines, and cutting-edge treatments in Internal Medicine — with just enough board review to keep your clinical reasoning razor-sharp.
We cut through the noise, simplify complex studies, and translate new data into actionable knowledge for your daily practice. Whether you're prepping for boards or staying ahead in clinic, hospital, or telemed — we've got your back.
🩺 Fast. Practical. Evidence-based.
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Brilliant Board Review & CME
Send us a text 🧠 Clinical Context: You're prepping a patient for non-cardiac surgery —what's their cardiovascular risk? Turns out, it’s not always about echo reports or cath results. It starts with a stairs test (sort of). Duke Activity Status Index (DASI) and METs >4 can tell you if the heart's got enough reserve. 🚶♂️ “Can you walk up a flight of stairs without gasping?” If yes, you’re likely good to go! If functional status is poor or unknown , consider labs: BNP, pro-BNP, or troponin — but evidence is weak. Elevated? Time to huddle with a multidisciplinary team (or at least buy time for the patient and lawyer to meet). 🧪 Risk Tools, Not Rituals: Stress testing isn’t reflexively helpful anymore. Reserved for high-risk anatomy or major ischemia concerns. Studies show no outcome improvement in most cases. Important caveat: those with severe CAD were excluded from trials! 🧊 Meds to Pause: SGLT2 Inhibitors (dapagliflozin, empagliflozin): 🔴 Stop 3–4 days pre-op to avoid euglycemic ketoacidosis . GLP-1 Agonists : ⏸️ Hold 1 week before due to risk of delayed gastric emptying , aspiration , and nausea under anesthesia. 🫀 Post-op Cardiac Surveillance: Watch for MINS – Myocardial Injury after Noncardiac Surgery Troponin trending may help spot silent ischemia post-op. Elevated levels? 🧠 Consider further cardio eval, especially in high-risk patients. 🧩 Clinical Takeaway: Modern pre-op cardiac clearance is about functional fitness, thoughtful labs, and smart medication pauses . Don’t just tick boxes—evaluate risk in context . And yes, if grandma can climb stairs without wheezing, she might just be ready for her hip replacement. Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
Send us a text 🧠 Clinical Context DOACs (Direct Oral Anticoagulants) have revolutionized anticoagulation—goodbye routine INRs, hello convenience. But while they’ve made our lives easier, they’re not always a fit for every scenario. Here's how to navigate the DOAC jungle. ✅ When DOACs Are Preferred Venous Thromboembolism (VTE) Atrial Fibrillation ⚠️ Exclude patients with: Mechanical heart valves Rheumatic mitral valve disease (That’s why cardiologists note “non-rheumatic” AF in their documentation—treatment plan hinges on it.) ⛔ When DOACs Are a No-Go Mechanical Heart Valves → Warfarin only Rheumatic AF → Warfarin still rules Thrombotic Antiphospholipid Syndrome → Warfarin Transcatheter Aortic Valve Replacement (TAVR) → Antiplatelet therapy Embolic Stroke of Undetermined Source → Antiplatelets preferred 🤔 The Gray Zone: Uncertain Use Cases These aren’t absolute yes or no. Instead, cue shared decision-making and expert input: Pregnancy No strong evidence yet; avoid unless discussed with OB and hematology. End-Stage Renal Disease (ESRD) Initially excluded from DOAC trials. Some are doing well, but still a case-by-case basis. Others That Require Discussion : Left Ventricular Thrombus Catheter-Associated DVT Splanchnic Vein Thrombosis Cerebral Venous Thrombosis 🧩 Clinical Takeaway DOACs are game-changers—but they’re not plug-and-play for everyone. For classic AF and VTE? Go for it. For valves, rheumatic disease, or complex syndromes? Tread carefully. And when in doubt, involve the patient in the decision. 🎯 Bottom line: Not every clot deserves a DOAC—some still want warfarin or a platelet plan. Let me know when you're ready for the next one! Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
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Send us a text 🧠 Clinical Context GLP-1 receptor agonists have taken center stage for both type 2 diabetes and obesity management , but their gastric side effects are giving anesthesiologists pause. The ASA's recent guidance recommends holding these agents before surgery to reduce risks of gastroparesis , regurgitation , and pulmonary aspiration . 🔬 ASA Guidelines Overview Daily Dosing? Hold on the day of surgery Weekly Dosing? Hold one week prior If asymptomatic and held as above? Proceed as usual ⚠️ But Here’s the Controversy There’s no strong evidence that holding GLP-1s as recommended reliably reduces gastric content risk. Recent endoscopy studies show no correlation between hold duration and gastric content retention. Gastroparesis risk may persist despite withholding the drug, especially in patients with: Diabetes Obesity Opioid use Alcohol, marijuana, or TCA use 🧪 What We Do Know Peak delay in gastric emptying appears within the first 12 weeks of therapy. Normalization of gastric motility might require holding meds for 5+ half-lives—often impractical. Meanwhile, GLP-1s improve glycemic control and may reduce post-op MACE (Major Adverse Cardiac Events). 🧭 Pragmatic Recommendations All GLP-1 patients should be considered at elevated aspiration risk , regardless of symptom status or hold duration. Use pre-op gastric ultrasound to assess contents. Plan anesthesia accordingly: Airway protection Rapid sequence induction Appropriate surgical location 🍽️ Fasting Guidelines? A Gray Area ASA’s updated fasting guideline (2023) applies to healthy patients without reflux, obesity, diabetes, or delayed emptying—aka, not your typical GLP-1 patient . Recommendation: Modify fasting guidelines based on judgment. Don’t follow enhanced recovery protocols blindly. 🧩 Clinical Takeaway Don’t assume that simply holding a GLP-1 agonist clears the gut. Evidence is lacking . Every GLP-1 patient should be approached with caution: Assume delayed gastric emptying Use tools like ultrasound for verification Customize fasting and airway protocols 🔍 Until we have more data, err on the side of protecting your patient’s airway—not just the guideline. Key Reference: Ushakumari DS, Sladen RN. ASA Consensus-based Guidance. Anesthesiology. 2024 Feb;140(2):346–348. PMID: 37982170 Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
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Brilliant Board Review & CME
Send us a text 🧠 Clinical Context Hydrochlorothiazide (HCTZ) vs. Chlorthalidone—a classic cardio debate! ALHAT once hinted at chlorthalidone’s superiority, but did a modern head-to-head trial confirm that? Let's break it down. 🧪 Study Snapshot: The HEADS-UP Trial Design: Randomized, head-to-head trial Population: ~14,000 patients, age ≥65, already on HCTZ 25–50 mg + 1–2 antihypertensives Prior CV disease: 15% had MI, stroke, or HF Groups: Continue HCTZ Switch to Chlorthalidone 12.5–25 mg daily Follow-up: Median 2.4 years 📈 Outcomes Primary endpoint: Composite of MI, stroke, HF, urgent revascularization, or non-cancer death → Occurred in 10% of both groups BP Control: No significant difference Hypokalemia: Chlorthalidone: 4.4% HCTZ: 6.0% 💡 What About CKD? 23% had GFR <60 at baseline, but… No strong data on severely reduced renal function for HCTZ In a 12-week placebo-controlled study, chlorthalidone lowered BP in GFR 15–30 , but HCTZ didn’t have similar data Still, in randomized trials: no difference in mortality or cardiovascular outcomes ⚠️ Surprises & Caveats Despite historical bias toward chlorthalidone, outcomes and BP control were equivalent Hypokalemia was actually slightly lower with chlorthalidone More robust data is still needed for advanced CKD patients 🧩 Clinical Takeaway Despite all the hype, chlorthalidone isn’t clearly superior . In practice, both meds perform similarly for hypertension control and cardiovascular outcomes in older adults. But if your patient has significantly impaired renal function , chlorthalidone may edge ahead —at least for now. 💬 Bottom line? Choose the thiazide based on patient profile, tolerance, and renal function —not legacy dogma. Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
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Brilliant Board Review & CME
Send us a text 🧠 Clinical Context Patients over 65 undergoing inpatient surgery face unique risks. Cognitive impairment, frailty, and increased vulnerability to delirium demand a proactive and nuanced approach to anesthesia and postoperative care. 🔍 Preoperative Priorities Age ≥65 and inpatient status should automatically trigger a frailty and cognitive assessment Engage a multidisciplinary team early—geriatrics, anesthesia, surgery, and nursing 🛌 Postoperative Delirium: A Common Pitfall Use dexmedetomidine in the PACU or ICU setting for sedation/delirium prevention Avoid these culprits : Benzodiazepines Antipsychotics Anticholinergics Ketamine Corticosteroids Gabapentin 💡 Practical Strategy Optimize environment: quiet, well-lit rooms with clocks and calendars Encourage mobility and family engagement Hydrate, monitor electrolytes, and manage pain thoughtfully Avoid over-sedation and unnecessary polypharmacy 🧩 Clinical Takeaway Older adults need tailored perioperative management . Screening for frailty and cognition is just as important as lab work and EKGs. Avoid high-risk meds, plan for delirium prevention, and build a team around the patient. 🎯 When it comes to older surgical patients: less is more, and team-based care is everything. Key Reference: Sieber F et al. 2025 ASA Practice Advisory for Perioperative Care of Older Adults. Anesthesiology. 2025 Jan;142(1):22–51. PMID: 39655991 Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
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Send us a text 🧠 Clinical Context: Subclinical atrial fibrillation = asymptomatic episodes of AF detected by implantable monitors or Holters, lasting 6 minutes to 24 hours . Big Question : Should we anticoagulate these patients? 🧪 Study Highlights – ARTESiA Trial: Design : 4,012 patients (mean age 76.8), randomized to apixaban 5 mg BID vs ASA 81 mg daily . Inclusion : Age >55 with or without history of stroke/TIA; device-confirmed subclinical AF. 📈 Outcomes: Primary endpoint : Stroke or systemic embolism. With prior stroke/TIA : Apixaban significantly reduced events: 1.2% vs 3.4% annually . Without prior stroke/TIA : No significant difference: 0.74% (apixaban) vs 1.07% (ASA) . 🧩 Clinical Pearls: Don’t reflexively anticoagulate all device-detected AF — stratify by stroke history . Consider CHA₂DS₂-VASc , but more importantly, patient-specific functional risk . Use the Modified Rankin Scale to contextualize why stroke prevention matters: 0 = no symptoms, 5 = severe disability, 6 = death. Patient framing tip : “If a stroke leaves you unable to walk, speak, or go to the bathroom independently, would that be worth preventing with a pill?” Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
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Brilliant Board Review & CME
Send us a text 🧠 Clinical Context: Nursing home residents are fragile fall-prone patients . Starting a new antihypertensive could trigger orthostasis → serious fractures. 🧪 Study – VA Nursing Home Cohort: 13,000+ residents tracked from 2006–2019, mean age ~78. Examined fracture risk 30 days after starting an antihypertensive. Fractures studied : Pelvic, hip (requiring surgery), humerus, radius, ulna. 📈 Outcomes: New antihypertensive initiated → 4.5 serious falls per 100 person-years . No med change → 2.2 events per 100 person-years . That’s >2x risk with a new med. 🩺 Clinical Tips: Orthostatic BP check should be done 3–6 minutes after standing (not just 1–2 min). Median best time: 4.5 minutes . Use shared decision-making: Is the BP goal worth a possible hip fracture? Consider deprescribing or "start low, go slow" approach in long-term care. Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
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Brilliant Board Review & CME
Send us a text 🧠 Clinical Context: Blood pressure errors due to bad positioning = misdiagnosis and mistreatment . We often blame the drug, when the data was flawed to begin with. 🧪 Study Highlights: 104 patients tested with 3 positions: Hand in lap : BP falsely elevated by 4 mmHg . Arm unsupported : +6 mmHg (most common real-world scenario). Arm supported at heart level : accurate . ✅ Gold Standard Technique: Seated, feet flat on floor, arm supported at heart level , relaxed. No caffeine, nicotine, or exercise 30 minutes prior. No talking. Cuff on bare skin, correct size (80% of upper arm). Wait 5 minutes pre-reading. Repeat if >5 mmHg difference. ⚠️ Clinical Consequences: Misclassified HTN → overtreatment, hypotension, dizziness. Standardize BP checks in your clinic— “militant consistency” matters. Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
Send us a text 🧠 Clinical Context: Episodic migraines (<15 days/month) that don’t respond to traditional preventives . Patients often fail beta blockers, AEDs, TCAs, CCBs — need new options. 🧪 Study – RCT on Atogepant: 315 patients , mostly women, who failed ≥2 oral preventives . Randomized to atogepant 60 mg daily vs placebo . Follow-up: 3 months. 📈 Outcomes: ≥50% migraine reduction : 51% in atogepant group vs 18% placebo . Most common side effect: Constipation (10% vs 3%). 💊 Mechanism: CGRP receptor antagonist – blocks calcitonin gene-related peptide, a known migraine mediator. 🧩 Clinical Application: Strong option for treatment-refractory episodic migraine . Easier than injectables; potential for earlier use in future guidelines. Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
Send us a text 🧠 Clinical Context: BBs have been MI standard since the thrombolysis era. But do they still help when patients get PCI, statins, and ACEs? 🧪 Two Major Studies: Swedish Registry Study : Post-MI patients with preserved EF . All received PCI + standard meds . BB vs no BB : No difference in death or recurrent MI. French Study (New England Journal): MI 2.9 years prior, preserved EF. BB continuation vs discontinuation : Slight reduction in composite endpoint (death/MI/stroke/hospitalization). Driven mostly by fewer hospitalizations (17% vs 19%). ⚖️ Pros and Cons of Beta Blockers: ✅ Pro: Cardioprotection, arrhythmia prevention. ❌ Con: Depression, fatigue, ED, bradycardia. BBs aren’t benign — side effects matter to patients. 🧩 Clinical Pearls: If EF is normal and patient is stable post-MI: Reassess need for long-term BB . Ongoing trials will help guide “de-prescription” thresholds. Don't forget individualized care: patient preference, arrhythmia risk, BP goals. Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
Send us a text 🧠 Clinical Context: For patients who absolutely cannot tolerate statins — despite trying multiple options or experiencing severe side effects. Reminder: Always try multiple statins first (different types, dosages, timing) before declaring “statin intolerance.” 💊 What is Bempedoic Acid? Non-statin oral agent , works upstream of HMG-CoA reductase . Liver-activated – avoids muscle toxicity seen in statins. First oral non-statin to reduce MACE-4 endpoints . 📈 Clinical Impact: LDL-C reduction : 20–25%. Cardiovascular events : 23% ↓ in MI . 19% ↓ in coronary revascularization . ⚠️ Adverse Effects: Gout , gallstones , elevated transaminases. Avoid if history of uric acid disorders . 🧩 Clinical Takeaway: Great adjunct to maximally tolerated statin or for rare, true statin-intolerant patients . Not first-line — statins remain king , with 40–50% LDL reduction. Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
Send us a text 🧠 Clinical Question: What's the optimal hemoglobin threshold for transfusion post-MI? Old dogma: “Keep Hgb >10” . New data: Less might be just as safe . 🧪 The MINT Trial (Myocardial Ischemia & Transfusion): Compared liberal (Hgb <10) vs restrictive (Hgb <8) transfusion strategies. Lower 30-day recurrent MI or cardiac death seen with Hgb ≥10 approach. But... secondary analysis showed no major difference between 9 vs 10 . ⚠️ Risks of Transfusion: Volume overload (TACO) . Hemolytic and allergic reactions. Cost and hospital stay increase. 🧩 Clinical Takeaway: Consider transfusing at Hgb 9–10 in post-MI , particularly if symptoms or hemodynamics justify it. Be cautious , but not rigid — individualize based on patient condition. Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
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Brilliant Board Review & CME
Send us a text 🧠 Clinical Problem: Behavioral disturbances in Alzheimer’s are notoriously hard to treat. Guidelines tell us: “Don’t use antipsychotics” — but what do you do at 2AM when Nana's throwing punches? 💊 Study Overview: 345 patients , moderate-severe Alzheimer’s + aggressive agitation. Brexpiprazole 2–3 mg daily vs placebo. Dosing didn’t differ much in effect. 📈 Outcomes: Significant reduction in agitation inventory scores in brexpiprazole group. Well tolerated; most common side effect: headache (7%) . ⚠️ Caveats: Costly medication. Atypical antipsychotic — still carries black box warning for mortality in dementia. 🧩 Clinical Takeaway: Brexpiprazole may offer a much-needed option in patients with severe behavioral disturbances . Not for mild sundowning — reserve for safety-critical scenarios . Discuss risks/benefits carefully with family or POA. Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
Send us a text 🧠 Clinical Context: Hypertrophic obstructive cardiomyopathy (HOCM) : Genetic disorder causing LVOT obstruction . Traditionally managed with BBs, CCBs, disopyramide… or surgery. 💊 Drug: Mavacamten (Cardiac Myosin Inhibitor) Targets sarcomeric hypercontractility directly. FDA approved for NYHA Class II–III obstructive HCM. 🧪 EXPLORER-HCM Trial: 62-week follow-up : ↓ LVOT gradient (resting & post-exercise). Improved NYHA class. ↑ Peak oxygen consumption (VO₂). ⚠️ Key Considerations: Follow-up echocardiograms required — risk of LVEF drop . Avoid negative inotropes . Can worsen HF if EF <55%. 🧩 Clinical Takeaway: First disease-modifying med for obstructive HCM. Exercise no longer strictly off-limits — patients should be supervised and tailored . If surgery is needed, refer to high-volume HCM centers only . Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
Send us a text 🧠 Clinical Background: Inflammation plays a big role in atherothrombosis . Colchicine — an old gout drug — shows promise in CV risk reduction . 🧪 COLCOT Trial: Colchicine 0.5 mg daily post-MI. Greatest benefit in patients with type 2 diabetes . 📈 Outcomes: Reduced MACE (MI, stroke, death) in diabetics. Adverse Effects : Nausea, diarrhea, ↑ risk of pneumonia (unclear why). 🧩 Clinical Takeaway: Consider colchicine in diabetics post-MI or with recurrent ACS . Cheap, oral, and anti-inflammatory — a new use for an old drug. Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.…
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