Primary Care Update

This week, Kate, Mark, Gary and Henry discuss 4 great new POEMs: foot care wipes for patients at risk of diabetic foot infection, resuming DOACS following intracerebral hemorrhage in adults with a fib, treating prediabetes with tirzepatide, and more on intermittent fasting.Show linksBMJ Magic Evidence interactive review of diabetes medications. A great practice and teaching tool: https://matchit.magicevidence.org/230125dist-diabetes/#!/https://www.ncbi.nlm.nih.gov/pubmed/31574019https://pubmed.ncbi.nlm.nih.gov/39964684/ https://pubmed.ncbi.nlm.nih.gov/40023176/ttps://pubmed.ncbi.nlm.nih.gov/39536238/https://pubmed.ncbi.nlm.nih.gov/40163873/

This week, Kate, Gary, Mark and Henry chat about the health effects of dance for older adults, POCUS for diagnosing clavicular fractures, treating male partners of women with BV, and prehabilitation  before elective surgery .Links:Dance for older adults: https://pubmed.ncbi.nlm.nih.gov/39480190/POCUS for clavicle fractures: https://pubmed.ncbi.nlm.nih.gov/39626455/ Oral + topical treatment of male partners for BV: https://pubmed.ncbi.nlm.nih.gov/40043236/ Prehabilitation before elective surgery: https://pubmed.ncbi.nlm.nih.gov/39843215/Case series of avian flu patients: https://www.nejm.org/doi/full/10.1056/NEJMoa2414610

This week join our intrepid primary care physicians Kate, Gary, Henry and Mark as they discuss 4 new studies: an experimental treatment for chronic migraines, safety of albuterol in wheezy kids under 2, oral gepotidacin for uncomplicated UTI, and vitamin K2 and Leg Cramps.Here are the links:Lukas' Fund supporting the Piedmont Athens and Grady Atlanta NICUs: https://www.lukasfund.org Essential Evidence Plus: http://www.essentialevidenceplus.comVibrating intranasal balloons for migraine: https://pubmed.ncbi.nlm.nih.gov/39787477/ and OziliaSafety of albuterol in infants: https://www.ncbi.nlm.nih.gov/pubmed/39266286Oral gepotidacin for uncomplicated UTI: https://www.ncbi.nlm.nih.gov/pubmed/38342126 Vitamin K2 for nocturnal leg cramps: https://pmc.ncbi.nlm.nih.gov/articles/PMC11581596/

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.comTapering 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/ 

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/

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/39826968Independent 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%

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.comReal 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

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.

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

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.

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

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

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/

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

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/

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.

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.

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!

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.

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

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

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.

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

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.

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.

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

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