Primary Care Update
By Mark Ebell
Primary Care UpdateMay 25, 2023
Episode 137: amox/mono, hearing aids, stem cells for knee OA, and preventing T2DM
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
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
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
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
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
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
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
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
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
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!
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
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
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
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
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
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
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
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
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
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
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
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
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.