Primary Care Update

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.

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.

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. 

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.

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 

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.

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.

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

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. 

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.

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

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.

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.

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!

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.

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

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").

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.

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.

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.

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.

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.

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.

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.

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.

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

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?

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.

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.

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 

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!

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.

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.  

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?

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.

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?

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.

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. 

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.

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.

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.

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.

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.

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.

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 

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.

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. 

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.

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. 

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.

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.

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. 

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.

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.

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.

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.

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.

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. 

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

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.

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. 

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

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.

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!

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

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. 

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.

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. 

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.

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. 

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

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

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.

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

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

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.

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.

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.

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.

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.

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!

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.

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.

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.

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.

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.

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

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.

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. 

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. 

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. 

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.

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

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. 

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.

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.

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.

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

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

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.

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. 

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

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.

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

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.

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. 

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

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.

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.

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

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).

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).

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).

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.

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). 

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).

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).

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.

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). 

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!

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. 

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.

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). 

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)?

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).

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.

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). 

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). 

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.

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.

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).

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).

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). 

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).

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).

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).

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.

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.

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). 

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.

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). 

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). 

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).

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.

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).

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).

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. 

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).