Primary Care Update

Latest Episodes:

Episode 178: tapering benzos, neuro testing for athletes, vonoprazan for PUD, and zoster-dementia link Apr 08, 2025

Show notes

This week Kate, Gary, Mark and Henry discuss discontinuation of benzodiazepines and treatment of insomnia, the value of baseline cognitive testing of college athletes, vonoprazan vs PPI for preventing and treating ulcers, and whether herpes zoster vaccine reduces dementia risk.

Show links:

Essential Evidence Plus: www.essentialevidenceplus.com

Tapering benzos: https://pubmed.ncbi.nlm.nih.gov/39374004/

Baseline neuro eval for athletes: pubmed.ncbi.nlm.nih.gov/39741470/

David Kaufman, “We Need You in the Locker Room” https://thesagergroup.net/books/in-the-locker-room

Vonoprazan vs PPIs for ulcers: https://pubmed.ncbi.nlm.nih.gov/39294424/

Zoster and dementia: https://pubmed.ncbi.nlm.nih.gov/40175543/

Episode 177: steroids and CV risk, dementia guideline, fezolinetant for VMS, and osteoporosis screening Mar 26, 2025

Show notes

This week Gary, Mark, Kate and Henry discuss: adverse effects from inhaled steroids in asthma, Italian dementia guideline, fezolinetant for treatment of vasomotor symptoms, and updated USPSTF recommendations for osteoporosis screening.

Show notes and links:

Asthma and risk of CV events: https://pubmed.ncbi.nlm.nih.gov/39088770/

GINA 2024 guidelines: https://ginasthma.org/2024-report/

Italian dementia guidelines: https://www.ncbi.nlm.nih.gov/pubmed/39544104 with link to full report in Inglese: https://www.iss.it/documents/d/guest/the-full-guideline-english-version

Fezolinetant for vasomotor symptoms: https://pubmed.ncbi.nlm.nih.gov/39557487/

USPSTF osteoporosis screening guideline: https://pubmed.ncbi.nlm.nih.gov/39808425/

Dietary assessment tool: https://epi.grants.cancer.gov/asa24/

Article on interval for next BMD screening based on initial result: https://pubmed.ncbi.nlm.nih.gov/22256806/

Episode 176: bright lights, fever in kids, new anticoagulant for AF, and antibiotics for appendicitis Mar 12, 2025

Show notes

Join Kate, Gary, Mark and Henry as they discuss 4 new POEMs relevant to primary care: bright light therapy for non-seasonal depression, fever control in children, abelacimab for atrial fibrillation, antibiotics vs surgery in children with nonperforated appendicitis. Get all of the POEMs (a new one every day) by going to Essential Evidence Plus and subscribing.

Links from today's podcast:

Bright lights for non-seasonal depression: https://pubmed.ncbi.nlm.nih.gov/39356500/

Controlling fever in children: https://pubmed.ncbi.nlm.nih.gov/39318339/

Abelacimab for anticoagulation in atrial fib: https://pubmed.ncbi.nlm.nih.gov/39842011/

Antibiotics vs surgery for appendicitis in kids: https://www.ncbi.nlm.nih.gov/pubmed/39826968

Independent predictors of suicidal ideation: https://pubmed.ncbi.nlm.nih.gov/7966924/

Here is the probability of suicidal ideation by # of risk factors:

0: 0.5%

1: 3.0%

2: 7.4%

3: 23%

4: 46%

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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

Show notes

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/