Primary Care Update

Episode 175: RSV monoclonals, acupuncture for sciatica, zoledronate in low risk women, and measuring BP at home. Feb 26, 2025

This week, Gary, Kate, Henry and Mark discuss 4 new studies relevant to primary care practice: the effectiveness of RSV monoclonals in infants, acupuncture for sciatica associated with disk herniation, zoledronate every 5 years for low risk women, and the effect of arm position on blood pressure readings. Plus a quiz! Please see below for show notes and links:

Learn more about Essential Evidence Plus: www.essentialevidenceplus.com

Real world study of nirsevemab for average risk infants: https://pubmed.ncbi.nlm.nih.gov/39257372/

Acupuncture effective for sciatica: https://pubmed.ncbi.nlm.nih.gov/39401008/

Zoledronate every 5 years for average risk women: https://pubmed.ncbi.nlm.nih.gov/39813642/

Importance of correct arm position for BP: https://pubmed.ncbi.nlm.nih.gov/39373998/

A nice infographic for measuring BP correctly from the AMA and Johns Hopkins: https://targetbp.org/wp-content/uploads/2016/10/MAPHypertension_7StepsInOfficeInfographic_Landscape_English_NoCropsNoBleeds-12.pdf

Episode 174: sexual dysfunction, GLP-1 benefits, surveillance for DCIS, episodic migraine prevention Feb 12, 2025

Join Kate, Mark, Gary and Henry as they discuss 4 new POEMs on treatment of sexual dysfunction, the benefits and harms of GLP-1 agonists, active surveillance vs usual care for ductal carcinoma in situ, and medications to prevent episodic migraine headache.

Henry mentioned AAFP's uncensored resources:

www.aafp.org/family-physician/patient-care/clinical-recommendations.html

www.aafp.org/family-physician/patient-care/care-resources.html

www.aafp.org/family-physician/patient-care/prevention-wellness/immunizations-vaccines.html

www.aafp.org/family-physician/patient-care/care-resources/sexually-transmitted-infections.html

www.aafp.org/family-physician/patient-care/care-resources/womens-health.html

www.aafp.org/family-physician/patient-care/care-resources/reproductive-health.html

Kate's links on sexual dysfunction:

NEJM review: https://pubmed.ncbi.nlm.nih.gov/39167808/

ED prevalence: https://pubmed.ncbi.nlm.nih.gov/38410029/

GLP-1s do everything: www.ncbi.nlm.nih.gov/pubmed/39833406

Active monitoring of DCIS: https://pubmed.ncbi.nlm.nih.gov/39665585/

Episodic migraines: https://pubmed.ncbi.nlm.nih.gov/39899861/

https://www.ncbi.nlm.nih.gov/pubmed/39631943

Episode 173: prenatal cannabis use, fluids in sickle crisis, single or dual tx for AF plus CAD, and exercise for weight loss. Feb 03, 2025

This week, join Kate, Mark, Gary and Henry as they discuss 4 new studies: prenatal cannabis exposure, fluid resuscitation during acute sickle crises, edoxaban or edoxaban + ASA for afib with CAD, and the impact of aerobic exercise on weight loss in adults

Episode 172: mindfulness for pain, methotrexate and resveratrol for OA, and eradicating HP Jan 15, 2025

Join Henry, Kate, Mark and Gary as they discuss 4 new POEMs: an RCT of mindfulness for chronic pain, use of methotrexate (huh?) for pain relief in adults with knee DJD, a new way to eradicate H., and oral resveratrol for adults with painful DJD of the knee (you know, the stuff from red wine). And a quiz: what actually are the benefits of lower BP targets?

Links

Mindfulness for chronic pain: https://pubmed.ncbi.nlm.nih.gov/39158851/

Methotrexate for OA: https://pubmed.ncbi.nlm.nih.gov/39074374/

Eradicating H. pylori: https://pubmed.ncbi.nlm.nih.gov/38906695/

Resveratrol for OA: https://www.ncbi.nlm.nih.gov/pubmed/39137167

Cochrane Review: Blood pressure targets in adults with hypertension.

Episode 171: obesity in babies, DOACs after stroke, semaglutide for OA, and thunderclap headaches Jan 06, 2025

This week join our intrepid team of skeptical primary care doctors as Kate, Mark, Henry and Gary discuss a web- and text-based intervention to prevent obesity in babies, the best timing of DOAC initiation after ischemic stroke in adults with atrial fibrillation, using semaglutide for knee osteoarthritis, and the differential diagnosis of thunderclap headaches. Plus the BEST quiz ever.

Links:

Preventing obesity in babies: https://pubmed.ncbi.nlm.nih.gov/39489149/

https://www.ncbi.nlm.nih.gov/pubmed/39491870

Semaglutide to reduce pain in knee OA: https://pubmed.ncbi.nlm.nih.gov/39476339/

Causes of thunderclap headaches: https://www.ncbi.nlm.nih.gov/pubmed/39303457

Episode 170: yoga for incontinence, muscle relaxants for pain, maternal cannabis use, and GLP-1 v. surgery Dec 16, 2024

This month Kate, Mark, Gary and Henry discuss yoga for treating urinary incontinence in older women, benefits and harms of muscle relaxants for adults with chronic pain, maternal prenatal cannabis use and developmental delays, and bariatric surgery vs. glucagon-like peptide 1 receptor agonists in obese adults with T2DM.

Links:

Yoga for incontinence: https://pubmed.ncbi.nlm.nih.gov/39186785/

Muscle relaxants for painful conditions: https://pubmed.ncbi.nlm.nih.gov/39298168/

Maternal cannabis use and developmental delays: https://pubmed.ncbi.nlm.nih.gov/39422907/

Bariatric surgery vs. GLP-1s: https://www.ncbi.nlm.nih.gov/pubmed/39235379

Episode 169: migraine, plantar fasciitis, beta-blocker duration and prostate cancer Dec 04, 2024

This week Mark, Kate, Gary and Henry talk about the comparative effectiveness of migraine medications, strategies for adults with plantar fascia pain, whether to continue beta-blocker use after acute MI, and the outcomes of 5-alpha reductase inhibitor use prior to prostate cancer diagnosis.

Links

Migraine: https://www.bmj.com/content/386/bmj-2024-080107

Plantar fasciitis: https://pubmed.ncbi.nlm.nih.gov/38904119/ and https://pubmed.ncbi.nlm.nih.gov/16801514/

Beta-blockers post MI: https://pubmed.ncbi.nlm.nih.gov/39213187/

Prostate cancer: https://pubmed.ncbi.nlm.nih.gov/39190306/

Episode 168: RSV med, colonoscopy by PCP, hair loss drug, and AI for ECGs Nov 18, 2024

This week listen in as Kate, Mark, Gary and Henry discuss antiviral treatment for infant RSV, colonoscopy competence by specialty, oral minoxidil for hair loss in men, and artificial intelligence performance on interpreting electrocardiograms .

RSV medication:

https://www.nejm.org/doi/full/10.1056/NEJMoa2313551#ap2 and https://pubmed.ncbi.nlm.nih.gov/39321361/

Colonoscopy by specialty

https://pubmed.ncbi.nlm.nih.gov/38588561/

https://aapce.wildapricot.org/

Minoxidil:
https://pubmed.ncbi.nlm.nih.gov/38598226/

AI for ECGs:
https://www.ncbi.nlm.nih.gov/pubmed/39096711

Episode 167: laughter, HP eradication, antibiotics for delirium, and MRIs of the knee Nov 06, 2024

Join Kate, Gary, Henry and Mark as they discuss a new therapy for dry eye syndrome, antibiotics for suspected UTI in adults with delirium, a new ACG guideline for treating H pylori, and the prevalence of knee pathology in asymptomatic adults. See below for links to the articles and other stuff:

Dry eye treatment

BMJ: https://www.bmj.com/content/386/bmj-2024-080474

Patient instructions: https://www.bmj.com/content/bmj/suppl/2024/09/11/bmj-2024-080474.DC1/liji080474.ww2.pdf

Antibiotics for UTI in delirium: https://pubmed.ncbi.nlm.nih.gov/38895992/

ACG guideline for H. Pylori: https://pubmed.ncbi.nlm.nih.gov/28071659/ MRI of asymptomatic knees: https://pubmed.ncbi.nlm.nih.gov/32060622/

Elections and CVD: https://pmc.ncbi.nlm.nih.gov/articles/PMC9021908/

Episode 166: vaping cessation, BP meds and dementia, SGLT-2's, and AI for melanoma Oct 23, 2024

Join Gary, Kate, Mark and Henry as they discuss text messages for adolescent vaping cessation, stopping BP meds in nursing home residents with dementia, the benefits of SGLT-2 inhibitors, and mobile phone app–based artificial intelligence for diagnosing melanoma.

Click here for transcript, notes and links for this episode.

Episode 165: psychedelics for depression, preventing and treating influenza, and GLP-2 for...sleep apnea? Oct 08, 2024

It's biscuit week, oops, I mean flu week here on the Great Primary Care Update. Join our bakers, I mean POETs, as they discuss preventing influenza, treating severe influenza, psychedelics for depression, and GLP-1 agonists to treat sleep apnea of all things.

Episode 164: HTN in kids, steroids for hip OA, drugs for T2DM, and AI to develop guidelines Sep 24, 2024

This week, Gary, Henry, Kate and Mark discuss CV events in children with hypertension, intra-articular steroid injections in adults with hip DJD, the best drug classes for treating adults with T2DM, and AI supported development of practice guideline questions. And a quiz, and two sports stories from Henry!

Episode 163: salt substitutes, VR apps for pain, multivitamins, and vitamin D Sep 11, 2024

This week join Kate, Mark, Henry and Gary for a discussion of the cardiovascular benefits of salt substitutes, using virtual reality for cancer-related pain, whether multivitamins reduce mortality, and if and when to recommend vitamin D supplements.

Episode 162: PREVENT risk score, UTI prognosis, sinusitis treatment, and biomarkers for SDAT Aug 29, 2024

This week, Kate, Mark, Gary and Henry tackle 4 new studies: the updated PREVENT cardiovascular disease risk calculators from the AHA, long-term consequences of UTIs in children, antibiotics for sinusitis in kids, and biomarkers to diagnose Alzheimer’s disease

Episode 161: Antibiotics for CAP, melatonin for delirium, screening for lung disease, and seizures after COVID vaccine Aug 15, 2024

This week, join Kate, Gary, Mark and Henry as they discuss screening asymptomatic people for COPD and asthma, the rate of new onset seizures after COVID vaccination, choosing the best oral antibiotic for mild to moderate CAP, and a trail of melatonin for delirium in older, hospitalized adults

Episode 160: prostate meds and dementia, umbilical hernias, mortality for infections, and AF detection Aug 05, 2024

This week, Kate, Mark, Henry and Gary tackle the association between prostate medications and lower dementia risk, the natural history of umbilical hernias in children, differential mortality for flu, RSV and COVID, and what to do about device-detected atrial fibrillation.

Episode 159: DAPT duration, starting contraception, krill oil for OA, and misdiagnosis of CAP Jul 17, 2024

This week, join Kate, Henry, Gary and Mark as they discuss same-day start contraception, krill oil for adults with knee DJD, misdiagnosis of community-acquired pneumonia, and ticagrelor + placebo VS ticagrelor + ASA after PCI. Plus some book recommendations: Whalefall, The Demon of Unrest, and the Commissario Brunetti novels by Donna Leon

Episode 158: dequalinium for BV, mammography, weight loss drugs, and tirzepatide for OSA Jul 03, 2024

Happy 4th of July! This week Kate, Gary, Henry and Mark celebrate by talking about dequalinium for bacterial vaginosis, the comparative effectiveness of weight loss drugs, the new USPSTF mammography recommendation, and tirzepatide for adults with sleep apnea.

Episode 157: Bleeding risk with AF, treating minor ischemic stroke, and beta-blockers after AMI Jun 19, 2024

It's cardiovascular day at Primary Care Update as Kate, Mark and Henry discuss bleeding risk with diltiazem in treatment for atrial fibrillation, whether alteplase improves outcomes in patients with minor ischemic stroke, and whether to continue beta-blockers long-term after acute MI with preserved ejection fraction.

Episode 156: APAP in pregnancy, AI for AOM, current use of Paxlovid, and CGM for T2DM Jun 05, 2024

This week, Kate, Gary, Mark and Henry discuss 4 new studies that answer some important questions: Does acetaminophen in pregnancy and neurodevelopmental outcomes in offspring? Can AI accurately diagnose otitis media in children? Is nirmatrelvir-ritonavir (Paxlovid) still an effective treatment for outpatients with mild to moderate COVID? And finally, what are the benefits and harms of continuous glucose monitoring in patients with type 2 diabetes.

Episode 155: wrist imaging, opioids post-op, rate vs rhythm control, and updated Cologuard, May 22, 2024

This week, Kate, Gary, Henry and Mark discuss 4 new studies: a decision support tool for imaging wrist injuries, how many opioids should be dispensed after ACL reconstruction, an updated fecal DNA + FIT test for colon cancer screening, and rate vs. rhythm control and the risk of dementia/cognitive decline. And a quiz about...cicadas! Bzzzz.

Episode 154: triptans and CV risk, urate levels and flares, tests for acute diverticulitis, and APOE4 May 08, 2024

Quite a diversity of topics this week, as Gary, Henry, Kate and Mark talk about: CV risk with triptans, baseline urate levels and risk of acute flairs in adults with gout, primary care feasible tests for acute diverticulitis, and how APOE4 homozygosity represents a distinct genetic form of Alzheimer’s disease.

Episode 153: gabapentinoids and COPD, shoulder dislocations, and older Alzheimer's drugs Apr 24, 2024

This week, Mark is taking a break so Kate, Henry and Gary will discuss gabapentinoids and the risk of severe COPD, rehab after an initial anterior shoulder dislocation, and cognitive enhancers for patients with Alzheimer’s dementia

Episode 152: SGLT2's for heart failure, bariatric surgery outcomes, UTI in kids, and lung screening outcomes. Apr 10, 2024

Join Kate, Gary, Mark and Henry (who went to the eclipse!) as they discuss SGLT2 inhibitors for older adults and frail adults with heart failure, the long term outcomes of bariatric surgery in adults with T2DM, the best duration of antibiotics for febrile UTI in kids, and real world outcomes of lung cancer screening.

Episode 151: SSRIs and mania, oseltamivir, exercise and BP, and HPV vaccine preventing cancer. Mar 25, 2024

Join us today as Gary, Kate, Mark and Henry discuss risks of SSRIs provoking mania in adolescents, real world effectiveness of HPV vaccination for preventing cervical cancer, whether tamiflu reduces hospitalization in adults with flu, and the effects of exercise on BP.

Episode 150: EXXUA for depression, ubrogepant for migraine, PCI for stable angina, and a simple way to communications Mar 11, 2024

This week, Gary, Kate, Henry and Mark discuss a newly approved medication for major depression in adults, initiation of abortive therapy using ubrogepantduring migraine prodrome, the value of PCI for patients with stable angina, and a simple intervention to improve communication with hospitalized patients. And a quiz!

Episode 149: afib risk scores, tai chi and cognition, flu vax, and managing gallstones Feb 26, 2024

This week join us as Kate, Mark, Henry and Gary discuss clinical prediction tool for patients using DOACs for atrial fibrillation, the benefits of cognitively enhanced tai chi, whether high dose recombinant flu vaccine is useful in adults 50-64, and watching patients with symptomatic gallstone disease.

Episode 148: meds for alcohol withdrawal, opioids and stimulants, and treating agitation in AD Feb 13, 2024

This week, Kate, Henry and Mark discuss pharmacotherapy for alcohol use disorder, using opioids in adults with cancer pain who also use non-medical stimulants, and brexpiprazole for agitation in patients with Alzheimer's dementia.

Episode 147: TENS for post-op pain, Alzheimer's meds, and delivering bad news Jan 30, 2024

Join Kate, Mark, Henry and Gary as they talk about: TENS for pain after cesarean delivery, cholinesterase inhibitors and risk of falls, a meta-analysis of the new Alzheimer’s drugs, and telephone delivery of bad news

Episode 146: nasal suction for infants, amitriptyline for IBS, aspirin to prevent CRC, and talking about hard things Jan 17, 2024

This week, join Henry, Kate, Gary and Mark as they discuss 4 great studies: home suction devices for infants with bronchiolitis, amitriptyline for adults with irritable bowel, high-dose aspirin for preventing colorectal cancer, and communicating about serious illness and end of life.

Episode 145: DAPT for dementia, BP control post-stroke, managing CHD, and probiotics for IBS Jan 03, 2024

This week, Kate, Henry, Mark and Gary discuss antiplatelet medications to prevent dementia, post-stroke blood pressure control, the latest guideline for managing patients with chronic cardiac disease, and probiotics for patients with irritable bowel syndrome.

Episode 144: cellulitis prognosis, chronic migraine tx, long COVID tx, and drugs for lipids Dec 21, 2023

This week Kate, Mark, Henry and Gary talk about how long it takes for lower extremity cellulitis to improve, how long it takes for CGRP monoclonal antibodies to take effect in adults with chronic migraine, whether CBT is effective for fatigue in patients with long COVID, and outcome data for various lipid lowering therapies. Plus a painful quiz, and Gary learns what an umbrella review is!

Episode 143: sponges for acne, renal colic, breast CA overdiagnosis, BP cuff size Dec 05, 2023

This week, Kate, Mark, Gary and Henry will discuss a possible new agent for acne, analgesia in adults with renal colic, breast cancer overdiagnosis in older women, and the importance of BP cuff size. Plus a Dickensian quiz.

Episode 142: Tdap in pregnancy, atogepant for migraine, POCUS for SBO and gastroparesis Nov 22, 2023

This week, join Kate, Mark, Henry and Gary (from his carport) as they discuss third trimester Tdap for prevention of infant pertussis, atogepant for preventing migraines, POCUS for diagnosing small bowel obstruction, and whether any medications work for treating gastroparesis

Episode 141: an app to reduce drinking, e-cigs to quit smoking, and does ADHD lead to substance use Nov 08, 2023

This week, we give Henry the day off, leaving Kate, Mark and Gary to discuss a new app to reduce unhealthy alcohol use, whether e-cigarettes can help you quit smoking, and whether taking stimulant meds for ADHD increases the risk of substance use down the road. And the quiz, and a book recommendation ("A Voyage for Madmen").

Episode 140: Mg+ for CP, amox challenge, ACP guidelines, and carotid surgery Oct 24, 2023

This week Kate, Mark, Gary and Henry discuss magnesium to prevent cerebral palsy, amoxicillin challenge in the primary care clinic for suspectec PCN non-allergy, new ACP guidance on colorectal cancer screening, and surgery for carotid disease.

Episode 139: U=U, tetracyclines and teeth staining, metformin to prevent long COVID and the best med for onychomycosis Oct 10, 2023

This week, Kate, Mark, Gary and Henry discuss viral loads and risk of HIV transmission, tetracyclines and dental staining in kids, metformin to prevent long COVID in obese and overweight adults, and the effectiveness of terbinafine pulse therapy for ugly toenails

Episode 138: Deprescribing, meds for neuropsych symptoms in dementia, and lowering BP too much Sep 30, 2023

While Mark is biking, Kate, Henry and Gary talk about a deprescribing intervention for older adults in the hospital, medications for managing neuropsychiatric symptoms in adults with dementia, and harms associated with aggressive BP lowering in hospitalized older adults.

Episode 137: amox/mono, hearing aids, stem cells for knee OA, and preventing T2DM Sep 18, 2023

This week, Kate, Mark, Henry and Gary talk about whether amoxicillin really causes a rash in kids with mono, whether hearing aids improve cognition in the elderly, stem cell injections and knee OA, and nonpharmacologic approaches to preventing type 2 DM.

Episode 136: Beers, testosterone harms, opioids for back and neck pain, and SDOH Aug 29, 2023

This week, join Mark, Kate, Henry and Gary as they discuss screening for social determinants of health, the updated Beers List of naughty medications, the value of opioids for acute back and neck pain, and testosterone and adverse events.

Episode 135: osteoporosis treatment, evolocumab, mifepristone for adenomyosis, and ambulatory BP Aug 16, 2023

This week, Kate, Gary, Mark and Henry discuss treatments for osteoporosis in post-menopausal women, the effect of adding evolocumab to a statin - a reanalysis of the FOURIER trial, using mifepristone for painful adenomyosis, and real world data comparing 24-hour ambulatory BP with clinic readings.

Primary Care Update Episode 134 Aug 02, 2023

This week, Kate, Gary, Henry and Mark discuss some fun throwbacks to 2003, the new first line medications for treating T2DM, whether you can take a diuretic at bedtime, and how to manage perioperative antihypertensive medications. And a quiz. Get CME credit at iafp.com just for listening, go to their education Web page.

Episode 133: bilirubin in infants, rest after concussion, child abuse, and why words matter Jul 19, 2023

This week, join Kate, Henry, Gary and Mark as they discuss point of care bilirubin tests for neonatal jaundice, guideline for evaluating children in close contact with abused children, early return to activity after concussion, and terminology preferences by patients being treated for substance use disorder.

Episode 132: new drug for hot flushes, screening for autism, and steroids for pneumonia Jul 03, 2023

This week, Kate, Henry and Mark discuss a new drug therapy for vasomotor symptoms of menopause, the accuracy of the M-CHAT tool for autism, and the value of steroids for severe community-acquired pneumonia. And Henry tells a joke about hot air balloons. And the quiz.

Episode 131: non-STEMI management in frail elderly, diagnosing secondary HTN in kids, and RSV vaccine for pregnant women Jun 21, 2023

This week, while Gary tries to learn French in of all places France, Kate, Mark and Henry discuss management of non-STEMI in frail older adults, identifying children with secondary hypertension, and RSV vaccination in pregnant women

Episode 130: bempedoic acid, polypills and dementia, prophylaxis for STIs, and interpreting asymptomatic CAD Jun 13, 2023

This week Kate, Gary, Henry and Mark talk about bempedoic acid for the prevention of ASCVD, the polypill and cognitive decline in the elderly, post-exposure prophylaxis in persons at high risk of STIs, asymptomatic CAD and subsequent AMI risk. And do you know how long ankle arthroplasties last?

Episode 129: estimating mortality in acute HF, a new migraine drug, and 15 year f/u of the largest RCT of prostate CA treatment May 25, 2023

Kate, Gary and Henry discuss 3 new studies: a clinical decision support tool to assess mortality risk in patients presenting with acute heart failure, a new intranasal medication for treating acute migraine attacks, and the pros and cons of different approaches to treatment of low grade prostate cancer.

Episode 128: BP targets, treatment resistant depression, angry and disruptive patients, and putting infants to bed May 10, 2023

This week our intrepid team of primary care physicians (Kate Rowland, Henry Barry, Gary Ferenchick and Mark Ebell) discuss treatment of resistant depression in older adults, recognizing and managing angry and disruptive patients, the best way to settle a cranky infant, and the AAFP 2022 Guideline on BP targets in adults with hypertension.

Episode 127: LDL targets, genicular nerve blocks, adding cytology to HPV, and HCTZ to prevent stones May 02, 2023

This week, Henry, Kate, Gary and Mark discuss: treating to LDL target or intensity-based statin therapy for adults with CAD, genicular nerve blocks for pain relief in adults with DJD, the value of adding cytology to HPV for cervical cancer screening, and HCTZ for preventing kidney stone recurrence

Episode 126: screening for genital herpes, semaglutide for obesity, ACG guideline on lower GI bleed, and whether invasive management is helpful for stable CAD Apr 11, 2023

This week, Gary, Kate, Henry and Mark discuss 2 new studies and 2 new guidelines: screening for genital herpes infections from the USPSTF, semaglutide injections in obese adolescents, ACG guidelines for acute lower GI bleeding, and invasive vs. noninvasive management of patients with stable CAD. And Henry manages to not talk about baseball!

Episode 125: reducing seizure frequency, antidepressants for pain, and periop anticoagulation Mar 31, 2023

Kate is at the Cubs opener today, so you'll have to settle for Mark, Gary and Henry as they discuss reducing seizures in young kids, the best antidepressants for managing pain, and new ACCP guidelines for peri-operative management of anticoagulation and antiplatelet agents.

Episode 124: etonogestrel and lactogensis, celiac guidelines, FODMAPS for IBS, and a new CV drug Mar 20, 2023

This week, join Kate, Henry, Gary and Mark as they discuss: immediate insertion of etonogestrel contraception and lactogenesis, ACG Guideline for managing patients with celiac disease, FODMAPS diet for irritable bowel, and a new way to lower cholesterol and reduce CV events.

Episode 123: mindfulness, PRP for Achilles rupture, lecanab for Alzheimer's, and VTE prophylaxis post-fracture Mar 01, 2023

This week, Kate, Gary, Henry and Mark discuss mindfulness based stress reduction for anxiety, platelet rich plasma for Achilles tendon ruptures, lecanamab for Alzheimer’s, and VTE prevention after fracture. Is aspirin sufficient?

Episode 122: predicing dementia, incentives to quit smoking, HP eradication for dyspepsia, and comparison of diabetes meds Feb 15, 2023

Join Kate, Mark, Gary and Henry as they discuss whether we should (or can) use biomarkers to predict mild cognitive impairment or dementia, financial incentives to promote smoking cessation, the efficacy of HP eradication for functional dyspepsia, and results of the glycemic control arm of the GRADE Trial.

Episode 121: vitamin C for sepsis, probiotics for halitosis, and dyspepsia evaluation Feb 01, 2023

This week, Kate, Henry and Mark discuss vitamin C for sepsis, probiotics for treating halitosis, and new UK guidelines for evaluation of dyspepsia. Plus a quiz: how much time do we primary care docs spend every day delivering preventive services?

Episode 120: sleepy time for kids, crenezumab for Alzheimers, prognosis after TKA, and intermittent fasting Jan 18, 2023

Join us this week as Kate, Henry, Gary and Mark discuss: nonpharmacologic sleep interventions in children, crenezumab for treating patients with early Alzheimers, prognosis after knee replacement, and time restricted eating (“intermittent fasting”) for weight loss. Henry and Gary are oxygen deprived and recording in Big Sky, teaching a CME course. You can join all four of us on March 3 and 4 in Scottsdale, AZ for 16 hours of content at the Arizona Academy of Family Physicians annual spring course. Click here to learn more and register.

Episode 119: insomnia treatment, when to take HTN meds, colonoscopy effectiveness, and chlorthalidone vs HCTZ Jan 04, 2023

An action packed episode with some truly landmark studies to discuss. Join Kate, Henry, Gary and Mark as they discuss drug treatment of insomnia, when to take your anti-hypertensive meds, whether colonoscopy is effectiveness, and chlorthalidone vs HCTZ.

Episode 118: hyperbilirubinemia, diabetic neuropathy, acute heart failure, and screening for CVD Dec 10, 2022

This week, Kate, Gary, Henry and Mark discuss a new guideline for managing jaundice in babies, treating painful diabetic peripheral neuropathy, acetazolamide for patients hospitalized with CHF, and screening for CVD in older men.

Episode 117: the plague, treatment of prediabetes, asymptomatic bacteriuria, and the value of pyuria Nov 27, 2022

This week, Mark, Kate, Henry and Gary discuss black Friday, black Death; long term outcomes of managing patients with impaired glucose tolerance or "pre-diabetes" (Henry hates that term); treating asymptomatic bacteriuria in nursing home residents; and the significance of microscopic pyuria in asymptomatic patients.

Episode 116: Polypills, yoga for migraine, best 2nd drug for DM, and Paxlovid for omicron Nov 09, 2022

Gary, Kate, Henry and Mark discuss 4 POEMs: polypills for secondary prevention of cardiovascular disease, yoga for migraines, the best 2nd drug for type 2 DM, and clinical outcomes with Paxlovid in the omicron wave. Do check out Essential Evidence Plus if you want all of the POEMs each month and a great primary care reference.

Episode 115: bisphosphonates and mortality, COVID rebound, and 2 IBS treatments Oct 29, 2022

This week, join Mark, Kate, Gary and Henry as they discuss 4 studies: mortality reduction from the treatment of osteoporosis, hypnosis for patients with IBS, COVID rebound syndrome, and low FODMAP diets in patients with IBS.

Episode 114: cannabis for chronic pain, scaphoid fractures, and steroids for renal colic Oct 12, 2022

On this week's podcast, our intrepid trio of family physicians discusses cannabis for chronic pain, treatment of scaphoid fractures in adults, and adding dexamethasone to ketorolac for adults with renal colic.

Episode 113: POC respiratory panels, fever in adults, and CV benefits of SGLT-2's Sep 28, 2022

Today Kate, Gary and Henry talk about point of care respiratory panels for children, outcomes of controlling fever in adults, and SGLT2 inhibitors and heart failure. Mark is enjoying Murphy's in Cork but still managed to do the post-production.

Episode 112: buckle fractures, tirzepatide for obesity, and stroke risk with severe carotid stenosis Sep 14, 2022

This week, Henry, Gary and Mark discuss: managing children with torus (buckle) fractures of the distal radius, tirzepatide for treating obesity in adults without T2DM, and stroke risk in patients with asymptomatic severe carotid artery stenosis. Kate couldn't join us this week, but check out her thoughtful essay in the journal Family Medicine

Episode 110: pharmacogenomics, functional abdominal pain in kids, vitamin D and fractures, and a T2DM guideline Sep 03, 2022

This episode, Henry, Kate, Mark and their colleague Gary Ferenchick from MSU discuss: pharmacogenomic-guided antidepressant therapy, non-drug interventions for children with functional abdominal pain, Vitamin D and fracture risk in the elderly, and NICE guideline for persons with T2DM.

Primary Care Update: Remembering John Hickner, MD, MS Sep 02, 2022

Our mentor, colleague, fellow podcaster, and dear friend John Hickner died peacefully at home on August 22nd at age 72. As we grieve, we want to share some stories about John that exemplify why he was the kindest, most thoughtful, and most decent person we have had the privilege to know.

Episode 109: motivational interviewing for weight loss, urate lowering in gout, and screening for anal cancer. Aug 17, 2022

This week Kate, Henry and Mark discuss motivational interviewing for weight loss, intensive vs standard urate lowering in persons with gout, and screening high risk persons for anal cancer.

Episode 108: LDL and mortality, cost-effectiveness of Alzheimer drugs, and surgery for ortho problems Aug 03, 2022

This week, Kate, Henry and Mark discuss how much statins lower mortality, the cost-effectiveness of the new crop of Alzheimer's drugs, and whether surgery is helpful for a range of orthopedic conditions.

Episode 107: TENS for renal colic, secondary HTN in kids, and evaluating chest pain Jul 20, 2022

This week, Kate, Mark and Henry will discuss secondary hypertension in children, TENS for persons with renal colic, and CTA vs angiography in persons with suspected stable CAD.

Episode 106: hMKPX (OK, monkeypox), screening for afib, and aducanumab for Alzheimer dementia Jul 06, 2022

John has the week off, so Kate, Mark and Henry plow forward rudderless and talk about monkeypox (sorry, WHO, we're not calling it hMKPX, buy a vowel), screening for atrial fibrillation, and our new candidate for worst drug ever: aducanumab for Alzheimer dementia.

Episode 105: coronary calcium CT, what happens to prediabetics, an RCT of ketamine, and 1 vs 2 antidepressants Jun 22, 2022

This week, Kate, Mark, Henry and John discuss the added value of coronary calcium scores, the natural history of prediabetes in older adults, using ketamine in suicidal persons, and whether antidepressant combination or monotherapy is better in severe or refractory depression.

Episode 104: stress urinary incontinence, thyroid meds, Achilles tendon rupture, and HEPA for COPD Jun 08, 2022

Kate, John, Henry and Mark (he set his alarm this time) are back to talk about a new treatment for female stress urinary incontinence, air cleaners for preventing COPD exacerbations in smokers, surgery vs non-operative management of Achilles tendon rupture, and whether switching among levothyroxine generics is a problem.

Episode 103: rosacea treatment, Dr. Google, and vitamin D and COVID May 26, 2022

This week Mark slept in, so Kate, John and Henry talk about British guidelines for treatment of rosacea, what to do when Dr. Google comes to the office, and Vitamin D and COVID.

Episode 102: Prevention of preterm delivery, statins during pregnancy, and aromatherapy for postmenopausal symptoms May 10, 2022

This week, Kate leads us on a special Mother's Day edition focused on women's health. Topics discussed by Kate, John and Henry (Mark is in Würzburg busily pontificating) include prevention of preterm delivery, statins during pregnancy, and aromatherapy for postmenopausal symptoms.

Episode 101: new VTE guidelines, weight loss drugs, and increased CV risk post-COVID Apr 29, 2022

This week Kate, Henry and Mark discuss updated guideline recommendations for treatment of VTE, weight loss drugs, and the increased risk of cardiovascular events following COVID-19 infection. John has the week off.

Episode 100: Best of the best of the best! Apr 11, 2022

This week, Kate, Mark, Henry and John pick their 4 favorite POEMs from the first 99 episodes. We'll dig into aspirin, beer before wine or vice versa, chronotherapy for hypertension, and asthma diagnosis. And thanks for being our audience for 100 episodes! Keep listening, and spread the word to friends and colleagues.

Episode 99: NSAIDS for back pain, masks in schools, fluoride, and antipsychotics Mar 16, 2022

Join family physicians Kate Rowland, Mark Ebell and John Hickner this week as they discuss the best NSAID for acute low back pain, a study on masks in schools to reduce COVID incidence, antipsychotics, and the benefits of fluoride varnish and supplements in kids.

Episode 98: COVID, pain management without opioids, irritable bowel, and communicating risk Mar 04, 2022

A diverse set of POEMs from Kate, John, Henry and Mark: CDC COVID mitigation and vaccination updates, non-opioid post-op pain management, a guideline for managing persons with IBS, and the challenges of communicating risk with words

Episode 97: acne, hypoglycemia in the nursing home, DAPT or aspirin after stroke, and lockdowns Feb 16, 2022

This week our skeptics discuss the best topical acne treatments, hypoglycemia in nursing home residents, the best antiplatelet therapy after minor stroke or TIA, and whether lockdowns reduced COVID-19 mortality.

Episode 96: medication safety, midodrine for syncope, empagliflozin for heart failure, and peppermint oil for IBS Feb 02, 2022

This week Kate, Henry, Mark and John are all over the map, with 4 new studies on the safety of Janus Kinase inhibitors, midodrine for recurrent vasovagal syncope, empagliflozin for heart failure (not DM) and peppermint oil for irritable bowel syndrome.

Episode 95: measuring temps, implantable monitors, procalcitonin in primary care, and HPV based cancer screening Jan 19, 2022

This week Kate, Mark, Henry and John talk about measuring temps in kids, implantable monitors to diagnose afib, procalcitonin in primary care, and HPV based cervical cancer screening

Episode 94: overcoming vaccine hesitancy, fluvoxamine and Paxlovid for COVID-19, and tighter BP control in elders Jan 05, 2022

This week family physicians Kate, John, Henry and Mark discuss best practices for vaccine uptake, fluvoxamine for outpatients with COVID, Paxlovid for outpatients with COVID, and the benefits and harms of lowering BP in older persons.

Episode 93: holiday death rates, ear wax, amoxicillin for kids, and vaccines and the omicron variant Dec 22, 2021

This week, family physicians Kate, John, Henry and Mark will discuss whether mortality really increases over the holidays, the best way to prep patients for ear wax removal, whether high dose amoxicillin is effective for kids with lower respiratory infection, and how effective vaccines are against omicron. Plus a special Christmas quiz!

Episode 92: urinary incontinence, forearm fractures in kids, COVID testing in schools, and a novel hypertension strategy Dec 09, 2021

This week on Primary Care Update we talk about group PT visits for urinary incontinence in women older than 60, managing uncomplicated forearm fractures in children, a COVID testing strategy for keeping kids in school, and a quadpill for treating hypertension

Episode 91: iron for anemic infants, IL-6 antagonists and inhaled steroids for COVID, and PRP for Achilles tendinopathy Nov 24, 2021

This week Kate, Henry, John and Mark discuss whether iron supplementation provides real benefits for anemic infants, IL6 antagonists for COVID, inhaled corticosteroids for COVID, and platelet rich plasma for Achilles tendinopathy.

Episode 90: music therapy, lung CA screening, VTE prophylaxis, and a pain guideline Nov 20, 2021

This week, Kate, John, Mark and Henry discuss music to improve sleep and cognition in older adults, lung cancer screening in an organized health system, a comparison of 2 agents for VTE prophylaxis after total knee arthroplasty, and a new pain guideline with a surprising recommendation.

Episode 89: pumpkin seeds, placebo for post-op pain, muscle relaxants, and depression screening Oct 28, 2021

This week, join Kate, John, Henry and Mark for a discussion of pumpkin seed oil for BPH symptoms, open label placebo for post-op pain, muscle relaxants for low back pain, and the implications of universal depression screening.

Episode 88: influenza, stroke prevention, a novel telemedicine use, and T2DM overtreatment Oct 17, 2021

Join Kate, Henry, John and Mark as they discuss antivirals in children hospitalized with influenza, DAPT for secondary stroke prevention, the safety and effectiveness of no-test medical abortions, and harms of overtreating older persons with T2DM.

Episode 87: COVID boosters, ivermectin, and pregnancy outcomes with COVID infection Sep 30, 2021

Kate, Mark, John and Henry discuss the value of three doses of mRNA vaccine for immunocompromised people, Ivermectin for treating persons with COVID-19, the benefits of boosters based on Israeli data, and pregnancy outcomes of women with COVID-19 infection.

Episode 86: dexamethasone post-op, topical terbinafine for toenails, thromboprophylaxis, and vaccine adverse events Sep 15, 2021

This week Kate, Mark, Henry and John (he's back!) discuss dexamethasone after major non-cardiac surgery, topical terbinafine for onychomycosis, thromboprophylaxis during knee replacement, and mRNA COVID vaccine adverse events

Episode 85: aspirin and antidepressant doses, how low to go with BP, and eye drops for migraine Sep 03, 2021

This week, Kate, Henry and Mark discuss comparative efficacy of aspirin doses, blood pressure lowering and health outcomes, dosing of antidepressants, timolol eye drops for acute migraine treatment

Episode 84: adenotonsillectomy in kids with OSA, DAPT vs ASA for stroke prevention, and ovarian cancer screening Aug 19, 2021

This week Kate, Henry and Mark give John the week off and discuss outcomes after adenotonsillectomy in children with OSA, the effectiveness and safety of DAPT vs ASA for secondary stroke prevention, and the final results of the largest trial of screening for ovarian cancer using CA-125 and ultrasound.

Episode 83: TIA risk score, US for frractures, CDC delta variant report, and harms of MRI Aug 03, 2021

This week, Kate, Henry, Mark and John will discuss the Canadian TIA score, ultrasound for diagnosing upper extremity fractures in children, a summary of the leaked CDC report on breakthrough cases and the delta variant, and how MRI reports can cause harm

Episode 82: PCR stool tests in kids, duration of antibiotics for CAP in kids, and an UGI bleed guideline Jul 22, 2021

This week, we give John the episode off, so Kate, Mark and Henry will discuss rapid stool tests in children with community acquired diarrhea, a guideline for managing patients with acute UGI bleeding, and the best duration of antibiotics for ambulatory kids with community-acquired pneumonia

Episode 81: LDL targets, guided antiplatelet therapy, CRC screening, and myocarditis after mRNA vax Jul 08, 2021

This week, we will discuss LDL targets after stroke, guided antiplatelet therapy after PCI, updated CRC screening recommendation from the USPSTF, and the risk of myocarditis after mRNA-based COVID vaccination. For CME credit go to IAFP.com and click on the online education link, and then find our podcast.

Episode 80: Cannabis, PRP for plantar fasciitis, epidural steroids, and COVID mortality and race Jun 24, 2021

This week, Kate, Mark, John and henry will discuss cannabis use in patients with rheumatologic disorders, platelet-rich plasma injections for persons with plantar fasciitis, epidural steroid injections for sciatica, and COVID mortality and race.

Episode 79: caffeine in pregnancy, DM and cancer, ruling out MI, and COVID reinfection Jun 11, 2021

This week we tackle caffeine in pregnancy, new onset diabetes and cancer risk; a clinical prediction tool to help rule out acute myocardial infarction and a report on the frequency of COVID reinfection.

Episode 78: PCN allergy, US guided injections, IBS, and prediabetes prognosis May 27, 2021

This week, Kate, Mark, Henry and John will discuss penicillin allergy, US-guided steroid injections, psychological therapies for patients with IBS and the natural history of “prediabetes”. Plus the quiz from Kate.

Episode 77: deprescribing antibiotics, BP screening recommendations, vit D and fish oil to prevent AF, and steroids for wheeze preschoolers. May 13, 2021

This week, Kate, Mark, John and Henry discuss a proven strategy to decrease antibiotic prescribing, learn about updated USPSTF recommendations for blood pressure screening, whether vitamin D and fish oil for prevent A fib, and the value of oral steroids for wheezy preschoolers age 2 to 5.

Episode 76: inhaled steroids work for early COVID, new opiate rules, managing metatarsal fracture, and mRNA vaccines in pregnancy Apr 29, 2021

We are really excited to introduce our new co-host, Dr. Kate Rowland, an Associate Professor in the Department of Family Medicine at Rush University in Chicago. We have been teaching with Kate for a long time in our in-person courses, and it's great to have her on board for the podcast. This week we talk about a new study from Oxford University finding a clear benefit for inhaled steroids in patients newly diagnosed with COVID-19. Kate discusses changes (good ones!) in regulations around MAT, Henry has good news about managing 5th metatarsal fractures, and John closes with data on the safety of mRNA vaccines in pregnancy. And the quiz!

Episode 75: Duration of symptoms with mild and severe COVID, and true rate of vaccine anaphylaxis Apr 15, 2021

This week, Mark reports the first study looking at the duration of symptoms with mild COVID in healthcare workers (more than you think) compared to those without COVID. Then Henry looks at the same thing in hospitalized COVID patients compared to those with other respiratory infections in the US and UK, and John tells us the true rate of anaphylaxis with vaccines.

Episode 74: More flozins and tides, Lyme disease, and something new for acute migraine Apr 02, 2021

This week we discuss a huge and really important meta-analysis of SGLT-2 inhibitors (flozins) and GLP-1 agonists (tides). Also, a good guideline on Lyme disease diagnosis and treatment, and a novel approach to treating migraine.

Episode 73: low-carb diets for T2DM, chronic back pain, and reinfection with COVID Mar 20, 2021

This week: low-carb diets for patients with T2DM, managing patients with chronic back pain, and reinfection rates in patients with COVID. Plus the quiz, and a reality TV recommendation.

Episode 72: Flozins and tides, new med for migraine, and antidepressants for back pain and DJD Mar 04, 2021

This week, Mark, Henry and guest POET Kate Rowland from Rush Medical College discuss: newer agents to treat diabetes, a new medication for migraine prevention, and antidepressants for pain in patients with back pain or DJD.

Episode 71: thromboprophylaxis for COVID inpatients, colchicine for outpatients with COVID, and COVID variant mortality Feb 18, 2021

This week, we will discuss a potpourri of COVID studies: a large propensity score matched study of thromboprophylaxis in hospitalized patients, novel use of colchicine for COVID-19, and mortality associated with mutant SARS-CoV-2 strains.

Episode 70: colchicine for heart disease, pregnancy after contraception, and prostate CA screening Feb 06, 2021

This week, we will discuss: a novel use for an old-time drug, pregnancy after contraception, and prostate cancer screening.

Episode 69: baricitinib + remdesivir, positive study of convalescent plasma, and long-haulers Jan 22, 2021

Today, and all COVID episode. Does adding baricitinib improve outcomes in patients on remdesivir; convalescent plasma given early in high risk elders; and how common are long-hauler symptoms.

Episode 68: lung cancer screening, preventing celiac disease, and a positive convalescent plasma trial Jan 11, 2021

This week, we will discuss screening for lung cancer, preventing celiac disease with early introduction of wheat, and a positive trial of convalescent plasma for COVID in patients with early infection.

Episode 67: HPV vaccine, a test for IBD in kids, and household transmission of COVID Dec 23, 2020

This week, we will discuss the HPV vaccine and whether it actually prevents invasive cervical cancer, diagnosing inflammatory bowel disease in children, and COVID infectivity in households and families. Plus a mythbusting quiz and John's recommendation for what NOT to read.

Episode 66: repurposed antivirals, banlamivimab for outpatients, and convalescent serum, all for COVID-19 Dec 12, 2020

This is an all-COVID-19 week. We discuss the WHO Solidarity trial of remdesivir and other antivirals, banlamivimab for outpatients, and an RCT of convalescent serum.

Episode 65: gabapentin for chronic pain, achilles tendons, and aspirin for primary prevention Nov 24, 2020

This week we're joined by special guest Dr. Gary Ferenchick, friend of the pod and professor of Internal Medicine at THE Michigan State University. This week we discuss gabapentin for chronic pelvic pain, cast vs boot (vs surgery) for ruptured achilles tendon, and aspirin for primary prevention.

Episode 64: COVID vaccine update, natural immunity, tocilizumab trials, and a fishing story Nov 12, 2020

We cover 6 COVID-19 studies today, focusing on natural and acquired immunity, the tocilizumab trials, and a fishing story. Also the quiz, and you can get free CME at: https://iafp.mclms.net

Episode 63: overactive bladder, smoking cessation, and bone density testing Nov 03, 2020

This week we will discuss treatment of overactive bladder syndrome, a smoking cessation guideline and bone density testing. For free CME, go to https://iafp.mclms.net.

Episode 62: Tests for COVID, kids with COVID, and vaccines. Oct 21, 2020

Since it has been several weeks since we discussed COVID, this week we will discuss tests for diagnosing it, children and adolescents, whether a vaccine will stop the pandemic, and symptom duration after contracting COVID.

Episode 61: Baloxavir, scaphoid fracture, and bariatric surgery Oct 07, 2020

This week, we discuss: influenza prophylaxis, treatment of scaphoid fractures and mortality associated with bariatric surgery. And now you can get free CME (0.5 hour) from the Illinois Academy of Family Physicians for listening. Just go to: iafp.mclms.net, answer a short quiz, and claim your credit.

Episode 60: DAPT after stroke, gout, and HRT after 20 years Sep 18, 2020

This week John, Henry and Mark discuss dual antiplatelet therapy after stroke, updated recommendations for management of gout, and long-term follow up of hormone replacement for post menopausal women.

Episode 59: Top COVID-19 research studies, part deux Sep 05, 2020

We review 9 more of the top COVID-19 research studies to date, including studies on transmission, treatment, and prognosis.

Episode 58: Top COVID studies: 9 of the most important COVID-19 studies Aug 28, 2020

In this episode we summarize 9 top COVID-19 studies in a special episode prepared for the Indiana Academy of Family Physicians.

Episode 57: Our (hopefully) last 2 HCQ studies, rehab for COPD, and funny shoes for knee OA Aug 13, 2020

This week, we discuss hopefully the last two studies of hydroxychloroquine for patients with COVID (still doesn't work), pulmonary rehab in patients with COPD, and the use of special footwear in patients with knee DJD.

Episode 56: Israeli school outbreak, antibody tests, going nerveless for HTN, and syncope Jul 31, 2020

This week, a COVID-19 outbreak in an Israeli high school, the accuracy of antibody studies, denervation to treat hypertension, and identifying low-risk patients with syncope. Plus the quiz, and a recommendation.

Episode 55: COVID-19: vaccines, HCQ for mild illness, and C-19 in kids Jul 22, 2020

This week, an all COVID-19 episode covers 7 new studies in just 24 thrill-packed minutes: 2 phase 2 vaccine trials just out yesterday, outpatient monitoring of patients with COVID-19, hydroxychloroquine in mildly ill patients, and transmission of COVID-19 by children

Episode 54: COVID, overactive bladder, and pro/synbiotics post-op Jul 17, 2020

This week we discuss COVID research on how many are asymptomatic and for how long people are infectious , managing overactive bladder symptoms in men, and perioperative probiotics and synbiotics for patients undergoing abdominal surgery.

Episode 53: COVID prevalence, treating UTI, migraine prophylaxis, and lab values Jul 02, 2020

2 COVID papers on seroprevalence and total vs confirmed cases, treating UTI with telehealth, migraine prophylaxis for kids, and variation in lab values.

Episode 52: COVID-19, 6 studies on steroids, NPI, MIRS in kids, and more Jun 17, 2020

This week, 6 COVID-19 updates: corticosteroids reduce mortality for sickest patients, non-drug approaches to controlling COVID, a review of the multisystem inflammatory syndrome in kids, another study on COVID 19 mortality and race, asymptomatic COVID and a report from the CDC on factors related to hospital and ICU use among patients with COVID-19.

Episode 51: Convalescent plasma, patient self-testing, pneumothorax, and colic Jun 08, 2020

This week on Primary Care Update: 2 COVID-19 studies (convalescent plasma RCT and accuracy of patient self-sampling), plus managing pneumothorax, and something that seems to work for infantile colic.

Episode 50: Last call for HCQ: we cover 6 COVID-19 studies Jun 01, 2020

A lot to cover: remdesivir updates, the effect of cancer treatment on COVID mortality, hypertensive medications, last call for HCQ, and racial disparities.

Episode 49: COVID news, cellulitis diagnosis, and COPD May 27, 2020

This week on primary care update: safety of convalescent sera, two social distancing studies, cellulitis diagnosis, and treating COPD exacerbations. Plus a bonus beer POEM.

Episode 48: Two COVID-19 studies, OA guideline, and choosing insulins May 13, 2020

This week: salivary testing for COVID, COVID immunity, ACR guidelines for managing patients with degenerative joint disease, and the use of old forms of insulin in managing patients with type 2 diabetes.

Episode 46: remdesivir trials, fecal shedding, and more May 04, 2020

In episode 46 we again cover all things COVID-19: 2 trials of remdesivir, news on viral shedding, COVID mortality, thrombotic events and risk of infection among COVID contacts. You can get all of our research briefs on COVID-19 here: https://www.aafp.org/journals/afp/explore/covid-19-daily-briefs.html

Episode 45: 2 COVID studies, IBS and prostate CA screening Apr 27, 2020

This week, 2 new COVID-19 studies (doi:10.1001/jama.2020.6771 and doi: 10.1001/jama.2020.6775), an effective treatment for irritable bowel syndrome (https://www.ncbi.nlm.nih.gov/pubmed/31852769), and trends in prostate cancer screening (https://www.ncbi.nlm.nih.gov/pubmed/31794057).

Episode 44: 6 COVID-19 studies Apr 21, 2020

This week, research updates about COVID-19: the largest trial to date of hydroxychloroquine (https://doi.org/10.1101/2020.04.10.20060558), the first serosurvey results (https://doi.org/10.1101/2020.04.14.20062463), doing telehealth (www.bmj.com/content/368/bmj.m1182), masks (https://doi.org/10.17226/25776), the effect of temperature (https://doi.org/10.1101/2020.04.14.20062463) and viral shedding / infectiousness (https://doi.org/10.1038/s41591-020-0869-5).

Episode 43: 2 COVID-19 studies, breast CA prevention, and post-MI tx Apr 15, 2020

This week, a couple of COVID-19 updates, plus POEMs on breast cancer prevention (https://www.ncbi.nlm.nih.gov/pubmed/31839281) and a cool new (old) way to reduce bad things after an MI (https://www.ncbi.nlm.nih.gov/pubmed/31733140).

Episode 42: COVID-19 edition Apr 07, 2020

All COVID-19 all the time this week with 6 updates: 2 HCQ studies, the new antibody tests, case fatality rates, whether handwashing really works, and an editorial from NEJM. We'll be doing regular podcasts focused on COVID-19, plus our regular podcasts covering all the rest.

Episode 41: COVID-19 briefs, clavicle fractures, and acetaminophen Mar 31, 2020

This week: 3 brief summaries of breaking research on COVID-19 (convalescent sera, hydroxychloroquine, and risk stratification); whether you really need surgery for a mid-clavicular fracture (https://www.ncbi.nlm.nih.gov/pubmed/30835150); and whether acetaminophen does anything (https://www.ncbi.nlm.nih.gov/pubmed/31892511).

Episode 40: food allergies, BP tarbets, and CRC screening Mar 21, 2020

This week: preventing food allergies (https://www.ncbi.nlm.nih.gov/pubmed/31633778), choosing the right BP target long-term after stroke (https://www.ncbi.nlm.nih.gov/pubmed/31355878), and improving uptake of colorectal cancer screening (https://www.ncbi.nlm.nih.gov/pubmed/30915656).

Episode 39: autism, soccer and dementia, and diagnosing hip OA Mar 01, 2020

This week: the results of screening for autism (https://www.ncbi.nlm.nih.gov/pubmed/31562252), does soccer cause dementia (https://www.ncbi.nlm.nih.gov/pubmed/31633894), and the best way to diagnose hip OA on exam (https://www.ncbi.nlm.nih.gov/pubmed/31846019).

Episode 38: Top 20 POEMs of 2019, part 3 Feb 19, 2020

We finish our top 20 from 2019: bleeding risk with different DOACs (https://www.ncbi.nlm.nih.gov/pubmed/30512099), whether higher doses of ibuprofen are better than low (https://www.ncbi.nlm.nih.gov/pubmed/31383385), a comparison of Shingrix with Zostavax (https://www.ncbi.nlm.nih.gov/pubmed/30361202), and whether exercise really prevents falls (https://www.ncbi.nlm.nih.gov/pubmed/30592475). Plus, an update on the COVID-19 epidemic.

Episode 37: Top 20 POEMs of 2019, Part 2 Feb 04, 2020

Part 2 of our review of the top 20 POEMs of 2019. This week infections (ruling out CAP, typical duration of RTI in kids, and 5 vs 10 days for strep throat) and colorectal cancer screening (yield of FIT over 10 years ~ colonoscopy, no need to stop NSAID or anticoagulant, and family history effect on risk).

Episode 36: Top 20 POEMs of 2019, Part 1 Jan 23, 2020

In part 1 this week, we discuss 10 of 2019's top 20 POEMs. POEMs address hypertension, lipid management, behavioral medicine, and aspirin. This is the best of the best of the best for 2019...enjoy!

Episode 35: dapagliflozin for HF, muscle relaxants, and gallstone pancreatitis Jan 08, 2020

This week: Dapagliflozin...for heart failure, not T2DM? (https://www.ncbi.nlm.nih.gov/pubmed/31535829) Do muscle relaxants add anything to NSAIDs for back pain? (https://www.ncbi.nlm.nih.gov/pubmed/30955985) And early vs delayed surgery for gallstone pancreatitis (https://www.ncbi.nlm.nih.gov/pubmed/31268184). Plus the quiz and a recommendation.

Episode 34: subclinical hypothyroidism, RA, and preventing CAD and AF Dec 26, 2019

Happy Holidays... we hope our listeners are getting some downtime. This week, we discuss the benifits (or not) of treating subclinical hypothroidism, the benefits (or not) of atorvastatin for patients with rheumatoid arthritis, and the best preventive strategy for patients with coronary artery disease and atrial fibrillation.

Episode 33: controlling pain, diverticulitis, and when to take BP meds Dec 12, 2019

Happy Holidays! This week we talk about whether adding ibuprofen and codeine improves pain control (https://pubmed.ncbi.nlm.nih.gov/31378383); whether or not a colonoscopy is needed to look for cancer after an episode of diverticultitis (https://pubmed.ncbi.nlm.nih.gov/31260589); and why everyone should take their blood pressure meds at night (https://pubmed.ncbi.nlm.nih.gov/31641769).

Episode 32: ticagrelor for CAD, cough and ACEI, and preventing HIV Nov 26, 2019

Our Thanksgiving episode, we even added theme music! Our 3 POEMs this week address whether to add ticagrelor to ASA in CAD (https://www.ncbi.nlm.nih.gov/pubmed/31475798); how often is a cough caused by an ACE inhibitor (https://www.ncbi.nlm.nih.gov/pubmed/29330882); and how effective is HAART at preventing HIV transmission (https://www.ncbi.nlm.nih.gov/pubmed/31056293)?

Episode 31: T2DM treatment, T2DM with CVD or CKD, and pre-diabetes Nov 14, 2019

A whole lotta diabetes goin' on: linagliptin ($780) vs glimepiride ($3) for T2DM (https://www.ncbi.nlm.nih.gov/pubmed/31536101); semaglutide in T2DM + vascular/CKD (https://www.ncbi.nlm.nih.gov/pubmed/31185157); and whether we should care about pre-diabetes (https://www.ncbi.nlm.nih.gov/pubmed/31076416).

Episode 30: BRCA mutations, Sitz baths, fecal transplant for IBS, and pneumonia guidelines Nov 01, 2019

It's Halloween, and we start with a seasonally appropriate study. That's followed by new recommendations re: BRCA mutations (https://www.ncbi.nlm.nih.gov/pubmed/31429902), Dave Slawson with an Atrium BEAT on the value (?) of Sitz baths, fecal transplant for irritable bowel (https://www.ncbi.nlm.nih.gov/pubmed/30908299), and a quick review of the latest pneumonia guidelines.

Episode 29: congestion, decongestants, personal sound amplifiers, and overtreatment of asymptomatic bacteriuria Oct 15, 2019

A busy pod today: what patients mean when they say "congestion" (https://www.ncbi.nlm.nih.gov/pubmed/31145430); Dave Slawson on why decongestants are safer than we thought; are personal sound amplifiers any good (https://www.ncbi.nlm.nih.gov/pubmed/31095263); and ongoing overtreatment of asymptomatic bacteriuria (https://www.ncbi.nlm.nih.gov/pubmed/31449295).

Episode 28: 2 hour MI rule out, tramadol safety, and steroids for pneumonia Oct 03, 2019

This week, guest host Dr. Dave Slawson joins Henry and Mark. We discuss rapid (< 2 hr) protocols for ruling out MI (https://www.ncbi.nlm.nih.gov/pubmed/31242362); whether tramadol is as safe as it's cracked up to be (https://www.ncbi.nlm.nih.gov/pubmed/31088782); and steroids for pneumonia (https://www.ncbi.nlm.nih.gov/pubmed/29937237). Plus the quiz, and Mark reviews two clinical prediction rules for PE (PERC and YEARS).

Primary Care Update Episode 27 Sep 22, 2019

This week, Dr. Dave Slawson, co-inventor of the POEMs concept, joins us to talk about a new project called "Atrium BEATS" (https://www.iambeats.io). Plus, we discuss new studies in how long to continue dual anti-platelet therapy after PCI, whether rimegapant works for migraine, and a possible alternative to ceftriaxone for gonorrhea.

Primary Care Update Episode 27 Sep 20, 2019

Special guest Dave Slawson, plus 3 POEMs: 1 vs 12 months of DAPT following PCI; rimegepant for migraine; and the best treatment for clinically suspected gonorrhea and chlamydia.

Primary Care Update Episode 26 Sep 06, 2019

This week: how accurate is clinical gestalt (https://www.ncbi.nlm.nih.gov/pubmed/31208974), canagliflozin and renal outcomes in high risk patients (https://www.ncbi.nlm.nih.gov/pubmed/30990260) and whether oral immunotherapy for peanut allergy is safe and effective (https://www.ncbi.nlm.nih.gov/pubmed/31030987).

Primary Care Update Episode 25 Aug 28, 2019

This week: baloxavir (Xofluza) for flu (https://www.ncbi.nlm.nih.gov/pubmed/30184455); a new guideline for subclinical hypothyroidism (https://www.ncbi.nlm.nih.gov/pubmed/31088853); and a great review on treating opioid use disorders in primary care (https://www.ncbi.nlm.nih.gov/pubmed/31088885).

Primary Care Update Episode 24 Aug 09, 2019

This week: as needed steroid + LABA for mild asthma (https://www.ncbi.nlm.nih.gov/pubmed/31112386); platelet rich plasma for rotator cuff injury (https://www.ncbi.nlm.nih.gov/pubmed/31000394); and pioglitazone in high risk diabetics who've had a stroke (https://www.ncbi.nlm.nih.gov/pubmed/30734043).

Primary Care Update Episode 23 Jul 23, 2019

This week, John, Henry and Mark talk about adding ultrasound to mammography for screening (https://www.ncbi.nlm.nih.gov/pubmed/30882843), routine labs for patients on an antifungal (https://www.ncbi.nlm.nih.gov/pubmed/30347032), and podiatry interventions to prevent falls (https://www.ncbi.nlm.nih.gov/pubmed/30615052).

Episode 22: CHD and AF, antidepressant mgmt, and cardioversion for AF Jul 11, 2019

Today we talk about what to do for patients with both coronary heart disease and afib (https://www.ncbi.nlm.nih.gov/pubmed/30883055); a practice changer for the three of us addressing how patient to be with antidepressants (https://www.ncbi.nlm.nih.gov/pubmed/29952277); and whether early or delayed cardioversion is better for afib (https://www.ncbi.nlm.nih.gov/pubmed/30883054).

Primary Care Update Episode 21 Jun 26, 2019

This week we talk about ruling out serious bacterial infection in young infants (https://www.ncbi.nlm.nih.gov/pubmed/30776077), whether exercise can prevent falls in the elderly (https://www.ncbi.nlm.nih.gov/pubmed/30592475), and whether statins and BP meds prevent cognitive decline (https://www.ncbi.nlm.nih.gov/pubmed/30814321).

Primary Care Update Episode 20 Jun 12, 2019

This week we cover why you should start using automated BP measurement if you're not already (https://www.ncbi.nlm.nih.gov/pubmed/30715088); ablation vs rhythm control for afib (https://www.ncbi.nlm.nih.gov/pubmed/30874766); and the value of early aerobic exercise after sports concussion (https://www.ncbi.nlm.nih.gov/pubmed/30715132). Plus, the value (?) of self-monitoring blood glucose in non-insulin T2DM.

Primary Care Update Episode 19 May 28, 2019

This week John, Henry and Mark discuss interpretation of FIT tests for CRC screening (https://www.ncbi.nlm.nih.gov/pubmed/30802902); diagnosis of appendicitis (https://www.ncbi.nlm.nih.gov/pubmed/30017693); and treatment of neonatal abstinence syndrome (https://www.ncbi.nlm.nih.gov/pubmed/30667476). Plus, a quiz about metformin.

Primary Care Update Episode 18 May 14, 2019

Today Mark, John and Henry talk about: how to rule out (and rule in) pneumonia (https://www.ncbi.nlm.nih.gov/pubmed/30850460); an RCT of e-cigarettes for smoking cessation (https://www.ncbi.nlm.nih.gov/pubmed/30699054); and non-drug treatments for IBS (https://www.ncbi.nlm.nih.gov/pubmed/30177784).

Primary Care Update Episode 17 Apr 29, 2019

This week, Henry, Mark and John discuss: statins for primary prevention in the elderly (https://www.ncbi.nlm.nih.gov/pubmed/30712900); beer before wine or vice versa (https://www.ncbi.nlm.nih.gov/pubmed/30753321); and the impact on control on school performance in kids with T1DM (https://www.ncbi.nlm.nih.gov/pubmed/30721295). Plus a beer themed quiz.

Primary Care Update Episode 16 Apr 17, 2019

How long does a new knee or hip last (https://www.ncbi.nlm.nih.gov/pubmed/30782340); does subacromial decompression work for chronic shoulder pain (https://www.ncbi.nlm.nih.gov/pubmed/30728120); fentanyl or ketamine intranasally for extremity injury in kids (https://www.ncbi.nlm.nih.gov/pubmed/30592476); and splint or cast for fibular fracture (https://www.ncbi.nlm.nih.gov/pubmed/30674451).

Primary Care Update Episode 15 Mar 27, 2019

This week: is it safe to skip breakfast (https://www.ncbi.nlm.nih.gov/pubmed/30700403), reducing fracture risk in women with osteopenia (https://www.ncbi.nlm.nih.gov/pubmed/30575489), drug therapy for anxiety disorder (https://www.ncbi.nlm.nih.gov/pubmed/30712879 ), and antibiotics for serious asthma exacerbations (https://www.ncbi.nlm.nih.gov/pubmed/30688986).

Primary Care Update Episode 14 Mar 19, 2019

Today we talk about stem cell injections for osteoarthritis (https://www.ncbi.nlm.nih.gov/pubmed/29099618), a rant about mortality outcomes in cancer screening from Mark, omega-3 oils for primary prevention (https://www.ncbi.nlm.nih.gov/pubmed/30415637), and testosterone for depression in men (https://www.ncbi.nlm.nih.gov/pubmed/30427999).

Primary Care Update Episode 13 Mar 06, 2019

Today we talk about the impact of more primary care physicians in a population on health outcomes; whether or not probiotics, prebiotics, and antibiotics are helpful for irritable bowel; and the impact of SGLT-2 inhibitors like empagliflozin on cardiovascular outcomes in diabetics with heart disease or at very high risk.

Primary Care Update: Episode 12 Feb 12, 2019

Today's topics: what is the safest oral anticoagulant (https://www.ncbi.nlm.nih.gov/pubmed/30512099), new diabetes guidelines (https://www.ncbi.nlm.nih.gov/pubmed/30291106), and the good and the ouch of the new zoster vaccines (https://www.ncbi.nlm.nih.gov/pubmed/30361202).

Primary Care Update - Episode 11 Feb 08, 2019

Today we discuss: vitamin D for pain and headache (https://www.ncbi.nlm.nih.gov/pubmed/25261164); chronic diarrhea guidelines (https://www.ncbi.nlm.nih.gov/pubmed/29653941); lorcaserin and T2DM (https://www.ncbi.nlm.nih.gov/pubmed/30293771); and the results of "screening" MRI (https://www.bmj.com/content/363/bmj.k4577).

Primary Care Update: Episode 10 Jan 18, 2019

Does linagliptin prevent CV events: ttps://www.ncbi.nlm.nih.gov/pubmed/30418475; does Tai Chi prevent falls and fractures: https://www.ncbi.nlm.nih.gov/pubmed/30208396; treatment of endometriosis pain: https://www.ncbi.nlm.nih.gov/pubmed/30396557; and the benefits of sauna: https://www.ncbi.nlm.nih.gov/pubmed/30486813.

Primary Care Update: Episode 9 Jan 04, 2019

This week: how does the yield for FIT testing compare with colonoscopy (https://www.ncbi.nlm.nih.gov/pubmed/29101260); our take on the new ACC/AHA lipid guidelines (https://www.ncbi.nlm.nih.gov/pubmed/30423391); and what works (or doesn't) for subacute cough (https://www.ncbi.nlm.nih.gov/pubmed/30201828).

Primary Care Update: Episode 8, 12/20/18 Dec 20, 2018

This week we talk about the results of the 3 ASPREE aspirin trials, whether omega-3 oil prevents CV events, and a new biologic agent for migraine. Pubmed abstract links: ASPREE: https://www.ncbi.nlm.nih.gov/pubmed/30221596 ; omega-3: https://www.ncbi.nlm.nih.gov/pubmed/30146932 ; and migraine: https://www.ncbi.nlm.nih.gov/pubmed/30360965

Primary Care Update: Episode 7 Dec 05, 2018

Topics: fluids to prevent UTI, deprescribing study, antipsychotics for delitium, and the value of ECG and echo for preparticipation physicals.

Primary Care Update: Episode 6 Nov 20, 2018

This week's topics: whether surgery works for shoulder impingement, framing test results positively for patients, vagus nerve stimulation for frequent migraines, and a commentary on shared decision-making. Study links: Impingement: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734212/ ; Vagus nerve stimulation: https://www.ncbi.nlm.nih.gov/pubmed/29907608 ; and Positive messaging: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495144/

Primary Care Update: Episode 5 Nov 08, 2018

We discuss recent studies on: antibiotics to treat appys, whether gabapentin is any good for back pain, the accuracy of a single BP measurement, and the best approach to smoking cessation.

Primary Care Update: Episode 4 Oct 23, 2018

Mark, John and Henry talk about tamsulosin for helping stones pass (but not all of them), how aspirin and esomoprazole (at the right dose) can reduce mortality in Barrett's esophagus, whether to do HPV only or co-testing in women 30-65 years, and the safety (and effectiveness) of lorcaserin for weight loss.

Primary Care Update: Episode 3 Oct 08, 2018

Mark, John and Henry discuss the new aspiring studies (does it really prevent heart disease), a positive (!) vitamin D trial, and whether procalcitonin can help us avoid antibiotics for patients with lower respiratory infection. Plus, the quiz, and John nerds out about vitamin D. In a good way.

Primary Care Update: Episode 2 Sep 14, 2018

Today's topics include anticoagulation in patients already taking aspirin, asthma treatment, and getting patients on board with advanced directives. Plus the quiz, and Nerd Alert with Henry.

Primary Care Update: Episode 1 Aug 24, 2018

Today's topics: are new basal insulins really any better, the impact of stigmatizing language, the value of adding cytology to HPV testing alone, and the best evidence to date on just how common incidentalomas are with MRI and CT. Plus, the pop quiz, and a segment we call "Preventing Bad Stuff" (today's topic is prostate CA screening).

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