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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/
Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, and Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for articles published from March 8-14, 2025.
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning examines how to prevent adverse publicity by patients on social media. Chapters 00:00 Intro 02:01 Patient-Social Media Interaction 11:56 Lung Cancer Screening Recommendations 15:29 Perc vs Surg Revasc, SWEDEHEART Registry 18:06 Down Syndrome Patient Outcomes 19:20 Nighttime Cardiovascular Staffing Impact 23:42 Samurai Cannulation 28:30 Off-Pump AAD Via Upper Ministernotomy 30:35 Robotic Thoracic Truncal Vagotomy 31:59 Upcoming Events 33:02 Closing He explores the benefits and drawbacks of patient groups on social media, explains how social media impacted the Shanghai Pulmonary Hospital, and provides examples of online patient groups. He also discusses whether surgeons should encourage patients to post on social media, what roles surgeons should have in online patient groups, and discusses his own experience with online patient groups. Joel also reviews recent JANS articles on lung cancer screening and USPSTF recommendations, percutaneous vs. surgical revascularization of non-ST-segment elevation myocardial infarction with multivessel disease, outcomes in adult congenital heart disease patients with Down syndrome undergoing a cardiac surgical procedure, and the impact of nighttime cardiovascular intensive care unit staffing on failure to rescue and revenue. In addition, Joel explores Samurai (the Direct True Lumen Technique) cannulation in acute type I aortic dissection, off-pump aortic arch debranching via upper ministernotomy, and robotic thoracic truncal vagotomy. Before closing, he highlights upcoming events in CT surgery. JANS Items Mentioned 1.) Lung Cancer Screening and USPSTF Recommendations 2.) Percutaneous vs. Surgical Revascularization of Non-ST-Segment Elevation Myocardial Infarction With Multivessel Disease: The SWEDEHEART Registry 3.) Outcomes in Adult Congenital Heart Disease Patients With Down Syndrome Undergoing a Cardiac Surgical Procedure 4.) Impact of Nighttime Cardiovascular Intensive Care Unit Staffing on Failure to Rescue and Revenue CTSNET Content Mentioned 1.) Samurai (the Direct True Lumen Technique) Cannulation in Acute Type I Aortic Dissection 2.) Off-Pump Aortic Arch Debranching Via Upper Ministernotomy 3.) Robotic Thoracic Truncal Vagotomy Other Items Mentioned 1.) Career Center 2.) CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Interview with Tumaini Rucker Coker, MD, MBA, USPSTF member and coauthor of Screening for Food Insecurity: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Preventive Services for Food Insecurity Food Insecurity, Health, and Health Care in the US Navigating the Complexity of Food Insecurity Screening Screening for Food Insecurity US Preventive Services Task Force Recommendations for Screening for Food Insecurity Screening for Food Insecurity
Artigo JAMA Network Open - LinkFolheto Cochrane em Português - Link(80) Dano vs benefício no rastreio do cancro da mama - Link(82) A história da doente com cancro da mama que foi salva - Link---Nova Android & iOS app MGFamiliar - Link---Subscreva o Podcast MGFamiliar para não perder qualquer um dos nossos episódios. Além disso, considere deixar-nos uma revisão ou um comentário no Apple Podcasts ou no Spotify.---MusicCold Funk - Funkorama de Kevin MacLeod está licenciada ao abrigo da Creative Commons – Atribuição 4.0. https://creativecommons.org/licenses/by/4.0/ Origem: http://incompetech.com/music/royalty-free/index.html?isrc=USUAN1100499 Artista: http://incompetech.com/
Episode 183: Colorectal Cancer in Young AdultsFuture Dr. Avila and Dr. Arreaza present evidence-based information about the screening and diagnosis of colorectal cancer and explain the increasing incidence among young adult and the importance to screen early in high risk groups. Written by Jessica Avila, MS4, American University of the Caribbean School of Medicine. Edits and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.IntroductionJessica: Although traditionally considered a disease only affecting older adults, colorectal cancer (CRC) has increasingly impacted younger adults (defined as those under 50) at an alarming rate. According to the American Cancer Society, CRC is now the leading cause of cancer-related death in men under 50 and the second leading cause in women under 50 (American Cancer Society, 2024). Arreaza: Why were you motivated to talk about CRC in younger patients?Jessica: Because despite advancements in early detection and treatment, younger patients are often diagnosed at later stages, resulting in poorer outcomes. We will discuss possible causes, risk factors, common symptoms, and why early screening and prevention are important. Arreaza: This will be a good reminder for everyone to screen for colorectal cancer because 1 out of every 5 cases of colorectal cancer occur in adults between the ages of 20 and 54. The Case of Chadwick BosemanJessica: Many people know Chadwick Boseman from his role as T'Challa in Black Panther. His story highlights the worrying trend of increasing CRC in young adults. He was diagnosed with stage III colorectal cancer at age 39. This diagnosis was not widely known until he passed away at 43. His case shows how silent and aggressive young-onset CRC can be. Like many young adults with CRC, his symptoms may have been missed or thought to be less serious issues. His death drew widespread attention to the rising burden of CRC among young adults and emphasized the critical need for increased awareness and early screening efforts.Arreaza: Black Panther became a hero not only in the movie, but also in real life, because he raised awareness of the problem in young AND in Black adults. EpidemiologyJessica: While rates of CRC in older populations have decreased since the 1990s, adults under 50 have seen an increase in CRC rates of nearly 50%. (Siegel et al., 2023). Currently, one in five new CRC diagnoses occurs in individuals younger than 55 (American Cancer Society, 2024).Arreaza: What did you learn about the incidence by ethnic groups? Are there any trends? Jessica: Yes, certain ethnic groups are shown to have higher rates of CRC. Black Americans, Native Americans, and Alaskan Natives have the highest incidence and mortality rates from CRC (American Cancer Society, 2024). Black Americans have a 20% higher incidence and a 40% higher mortality rate from CRC compared to White Americans, primarily due to disparities in access to screening, healthcare resources, and early diagnosis. Hispanic and Asian American populations are also experiencing increasing CRC rates, though to a lesser extent.Arreaza: It is important to highlight that Black Americans have the highest rate of both diagnoses and deaths of all groups in the United States. Who gets colorectal cancer?Risk FactorsJessica: Anyone can get colorectal cancer, but some are at higher risk. In most cases, environmental and lifestyle factors are to blame, but early-onset CRC are linked to hereditary conditions. Arreaza: There is so much to learn about colorectal cancer risk factors. Tell us more.Jessica: The following are key risk factors:Modifiable risk factors:Diet and processed foods: A diet high in processed meats, red meat, refined sugars, and low fiber is strongly associated with an increased risk of CRC. Fiber is essential for gut health, and its deficiency has been linked to increased colorectal cancer risk (Dekker et al., 2023).Obesity and sedentary lifestyle: Obesity and physical inactivity contribute to CRC risk by promoting chronic inflammation, insulin resistance, and metabolic disturbances that promote tumor growth (Stoffel & Murphy, 2023).Gut microbiome imbalance: Disruptions in gut microbiota, especially an overgrowth of Fusobacterium nucleatum, have been noted in CRC pathogenesis, potentially causing tumor development and progression (Brennan & Garrett, 2023).Arreaza: As a recap, processed foods, obesity, sedentarism, and gut microbiome. We also have to mention smoking and high alcohol consumption as major risks factors, but the strongest risk factor is a family history of the disease.Non-modifiable risk factors:Genetic predisposition: Although only 20% of early-onset CRC cases are linked to hereditary syndromes such as Lynch syndrome and familial adenomatous polyposis (FAP), individuals with a first-degree relative with CRC are at a significantly higher risk and should undergo earlier and more frequent screening (Stoffel & Murphy, 2023).Arreaza: Also, there is a difference in incidence per gender assigned at birth, which is also not modifiable. The rate in the US was 33% higher in men (41.5 per 100,000) than in women (31.2 per 100,000) during 2015-2019. So, if you are a man, your risk for CRC is slightly higher. Protective factors, according to the ACS, are physical activity (no specification about how much and how often) and dairy consumption (400g/day). Jessica, let's talk about how colon cancer presents in our younger patients.Clinical Presentation and Challenges in DiagnosisJessica: Young-onset CRC is often diagnosed at advanced stages due to delayed recognition of symptoms. Common symptoms include:Rectal bleeding (often mistaken for hemorrhoids)Young individuals may ignore it, believe they do not have time to address it, or lack insurance to cover a comprehensive evaluation.Unexplained weight lossFatigue or weaknessChanges in bowel habits (persistent diarrhea or constipation)This may also be rationalized by dietary habits.Abdominal pain or bloatingIron deficiency anemia.Arreaza: All those symptoms can also be explained by benign conditions, and colorectal cancer can often be present without clear symptoms in its early stages. Jessica: Yes, in young adults, symptoms may be dismissed by healthcare providers as benign conditions such as irritable bowel syndrome (IBS), hemorrhoids, or dietary intolerance, leading to significant diagnostic delays. Arreaza: We must keep a low threshold for ordering a colonoscopy, especially in patients with the risks we mentioned previously. Jessica: We may also be concerned about the risk/benefit of colonoscopy or diagnostic methods in younger adults, given the traditional low likelihood of CRC. Approximately 58% of young CRC patients are diagnosed at stage III or IV, compared to 43% of older adults (American Gastroenterological Association, 2024). Early recognition and prompt evaluation of persistent symptoms are crucial for improving outcomes. Empowering and informing young adults about concerning symptoms is the first step in better recognition and better outcomes for these individuals.Arreaza: This is when the word “follow up” becomes relevant. I recommend you leave the door open for patients to return if their common symptoms worsen or persist. Let's talk about screening. Screening and PreventionJessica: Due to the trend of CRC being identified in younger populations, the U.S. Preventive Services Task Force (USPSTF) lowered the recommended screening age for CRC from 50 to 45 in 2021 (USPSTF, 2021). Off the record, some Gastroenterologists also foresee the USPSTF lowering the age to 40. Arreaza: That is correct, it seems like everyone agrees now that the age to start screening for average-risk adults is 45. It took a while until everyone came to an agreement, but since 2017, the US Multi-Society Task Force had recommended screening at age 45, the American Cancer Society recommended the same age (45) in 2018, and the USPSTF recommended the same age in 2021. This podcast is a reminder that the age of onset has been decreased from 50 to 45, for average-risk patients, according to major medical associations.Jessica: For individuals with additional risk factors, including a family history of CRC or chronic gastrointestinal symptoms, screening starts at age 40 or 10 years before the diagnosis of colon cancer in a first-degree relative. Dr. Arreaza, who has the lowest and the highest rate of screening for CRC in the US? Arreaza: The best rate is in Massachusetts (70%) and the lowest is California (53%). Let's review how to screen:Jessica: Recommended Screening Methods:Colonoscopy: Considered the gold standard for CRC detection and prevention, colonoscopy allows for identifying and removing precancerous polyps.Fecal Immunochemical Test (FIT): A non-invasive stool test that detects hidden blood, recommended annually.Stool DNA Testing (e.g., Cologuard): This test detects genetic mutations associated with CRC and is recommended every three years.Arreaza: Computed tomographic colonography (CTC) is another option, it is less common because it is not covered by all insurance plans, it examines the whole colon, it is quick, with no complications. Conclusion:Colorectal cancer is rapidly emerging as a serious health threat for young adults. The increase in cases over the past three decades highlights the urgent need for increased awareness, early symptom detection, and proactive screening. While healthcare providers must weigh the risk/benefit of testing for CRC in younger adults, patients must also be equipped with knowledge of concerning signs so that they may also advocate for themselves. Early detection remains the most effective tool in preventing and treating CRC, emphasizing the importance of screening and risk factor modification.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:American Cancer Society. (2024). Colorectal Cancer Statistics, 2024. Retrieved fromhttps://www.cancer.orgAmerican Gastroenterological Association. (2024). Delays in Diagnosis of Young-Onset Colorectal Cancer: A Systemic Issue. Gastroenterology Today.Brennan, C. A., & Garrett, W. S. (2023). Gut Microbiota and Colorectal Cancer: Advances and Future Directions. Gastroenterology.Dekker, E., et al. (2023). Colorectal Cancer in Adolescents and Young Adults: A Growing Concern. The Lancet Gastroenterology & Hepatology.Siegel, R. L., et al. (2023). Colorectal Cancer Statistics, 2023. CA: A Cancer Journal for Clinicians.Stoffel, E. M., & Murphy, C. C. (2023). Genetic and Environmental Risk Factors in Young-Onset Colorectal Cancer. JAMA Oncology.U.S. Preventive Services Task Force. (2021). Colorectal Cancer Screening Guidelines.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.
How can breast cancer screening guidelines affect women's healthcare access? Dorothy Gibbons discusses recent changes in breast cancer screening recommendations. JAMA confirmed that starting screenings at age 40 improves outcomes. Previously, the USPSTF advised screening starting at age 50, but now they recommend it for women aged 40 to 74, every other year. Dorothy advocates for annual screenings for more effective detection. She differentiates between routine and diagnostic mammograms, emphasizing their importance. USPSTF’s stance on breast density informs whether further tests like MRIs or ultrasounds are necessary. Insurance coverage hinges on these recommendations. The Affordable Care Act mandates insurance to cover preventive services, but legal challenges could affect this provision. Dorothy recalls a case where a woman had to pay out of pocket for an ultrasound, which ultimately saved her life. She urges listeners to understand these issues and their potential impact on women's health. Subscribe to Let's Talk About Your Breasts and consider supporting The Rose at therose.org. Key Questions Answered 1. Why is it important to start breast cancer screening at age 40? 2. What are the differences between screening mammograms and diagnostic mammograms? 3. What were the previous recommendations for the starting age of breast cancer screenings by the USPSTF? 4. What did the recent update from the USPSTF recommend regarding breast cancer screenings? 5. What is the importance of breast density information for women? 6. What does the USPSTF say about supplemental screening for women with dense breasts? 7. How does health insurance typically respond to the USPSTF recommendations? 8. What is the role of the Affordable Care Act (ACA) in preventive services like mammograms? Timestamped Overview 00:00 "Breast Cancer Screening: Start at 40" 03:16 Affordable Care Act: Legal ChallengesSee omnystudio.com/listener for privacy information.
Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, and Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for articles published from January 11-17, 2025.
Interview with Esa M. Davis, MD, MPH, USPSTF member and coauthor of Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Screening for Osteoporosis to Prevent Fractures Screening for Osteoporosis to Prevent Fractures Fracture Risk Assessment as a Component of Osteoporosis Screening—Easier Said Than Done Screening for Osteoporosis to Prevent Fractures
EVERYTHING CHANGES! So true. And now, the USPSTF has changed (UPDATED) their recommendations for cervical cancer screening in regards to HPV primary screening. This is BRAND NEW, within the last 24 hours. Primary HPV screening for cervical cancer has gained a lot of steam and is progressing quickly. The FDA approval of “dual stain” testing of hrHPV positive results, the recent FDA approval for patient self-collection for HPV vaginal samples in a clinical setting, and now this new draft recommendation from the USPSTF. What did they update? How is that controversial? Listen in for details!
In November 2013, ACOG issued the Hypertension in Pregnancy Task Force Report recommending daily low-dose aspirin (81mg) beginning in the late 1st trimester for women with a history of early-onset preeclampsia and preterm delivery at less than 34 0/7 weeks, or for women with more than one prior pregnancy complicated by preeclampsia. The following year, the USPSTF published a similar guideline, although the list of indications for low-dose aspirin use was more expansive. Since then, the ACOG has issued new guidance on low-dose aspirin, in 2018 and 2021. Nonetheless, while criteria for use has evolved, the dosage recommended has remained as 81 mg. But MEDICINE MOVES FAST, and a new Expert Review in the AJOG MFM is making a case for 162mg. Are we underdosing low-dose aspirin for prevention of preeclampsia? A litany of data says YES. Listen in for details.
Osteoporosis significantly impacts morbidity and mortality in the U.S., with approximately 12.3 million adults (USPSTF) in the United States aged 50 and over expected to be living with the disease. Osteoporotic fractures result in severe consequences such as functional impairment, chronic pain, reduced quality of life, and loss of independence. Furthermore, the clinical and economic burden of osteoporosis is substantial, with annual costs projected to be $25.3 billion by 2025 (AJMC).The U.S. Preventative Task Force (USPSTF) recommends screening and treatment of osteoporosis in adults. Accordingly, CommonSpirit Health, Physician Enterprise has adopted the evidence based guidelines of professional societies, including American College of Physicians (ACP), American Association of Clinical Endocrinologists (AACE), and Endocrine Society, on screening and treatment to prevent osteoporotic fractures. Speakers:Kavita Chawla, MD, MHA, FACP, Primary Care Physician, Kirkland Medical Center, Virginia Mason Franciscan HealthBryan C Jiang, MD, Internal Medicine Endocrinology, Diabetes and Metabolism, Baylor College of Medicine Houston, TexasPanelist:Anne Wright, DMSc, MPAS, PA-C, DFAAPA, System Director Advanced Practice Ambulatory Care, CommonSpirit Health
Episode 175: Alcohol Use Disorder Basics Future Dr. Sangha explains the clinical presentation, diagnosis, and fundamentals of the treatment of alcohol use disorder (AUD). Dr. Arreaza offers insights about the human aspect of the treatment of AUD. Written by Darshpreet Sangha, MS4, Ross University School of Medicine. Editing and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is Alcohol Use Disorder?AUD is characterized as the inability to stop or control alcohol use despite adverse physical, social and occupational consequences. According to DSM-5, it is a pattern of alcohol use that, over 12 months, results in at least two of the following symptoms, indicating clinically substantial impairment or distress: Alcohol is frequently used in higher quantities or for longer periods than planned.There is a persistent desire or unsuccessful attempt to reduce or manage alcohol use.Activities that are required to get alcohol, consume alcohol, or recuperate from its effects take up a lot of time.A strong need or desire to consume alcohol—a craving.A pattern of drinking alcohol that prevents one from carrying out important responsibilities at work, school, or home.Sustained alcohol consumption despite ongoing or recurring interpersonal or social issues brought on by or made worse by alcohol's effects.Alcohol usage results in the reduction or cessation of important social, professional, or leisure activities.Frequent consumption of alcohol under risky physical circumstances.Continuing to drink even when one is aware of a chronic or recurrent health or psychological issue that may have been brought on by or made worse by alcoholTolerance: requiring significantly higher alcohol intake to produce the same intended effect. Withdrawal: Characterized by the typical withdrawal symptoms or a noticing relief after taking alcohol or a closely related substance, such as benzodiazepine.How can we determine the severity of AUD? Mild: 2–3 symptomsModerate: 4–5 symptomsSevere: >/= 6 symptomsWho is at risk for AUD?Note: Ancestry offers a DNA analysis to find out about your heritage. You can also send that DNA to a third party to learn about your risks for diseases and conditions (for example, Prometheus.) Anyone can find out about their risk for alcoholism by doing a DNA test. The risk factors for AUD are: Male genderAges 18-29Native American and White ethnicitiesHaving Significant disabilityHaving other substance use disorderMood disorder (MDD, Bipolar)Personality disorder (borderline, antisocial personality)What is heavy drinking?According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), heavy alcohol use is characterized as: Males who drink > 4 drinks daily or > 14 drinks per week Females who drink > 3 drinks on any given day or > 7 drinks per weekPathophysiology of AUD.The pathogenesis of AUD is not well understood, but factors that may play a role are genetics, environmental influences, personality traits, and cognitive functioning. Also, genetic factors may decrease the risk of AUD, i.e., the flushing reaction, seen in individuals who are homozygous for the gene that encodes for aldehyde dehydrogenase, which breaks down acetaldehyde. Who should be screened?A person with AUD may not be easy to diagnose in a simple office visit, but some clues may point you in that direction. First of all, patients with AUD may present to you during their sober state, that´s why ALL adults (including pregnant patients) must be screened for AUD in primary care )Grade B recommendation). The frequency has not been determined but as a general rule, at least in Clinica Sierra Vista, we screen once a year. The USPSTF has concluded that there is insufficient evidence to recommend screening adolescents between 12-17 years old. What are the clinical manifestations of AUD?Some symptoms may be subtle, including sleep disturbance, GERD, HTN, but some may be obvious, such as signs of advanced liver disease (ascites, jaundice, bleeding disorders, etc.)If you draw routine labs, you may find abnormal LFTs (AST:ALT ratio >2:1), macrocytic anemia (MCV >100 fL), and elevated Gamma-glutamyl transferase (GGT). All these findings are highly suggestive of AUD. Patients with AUD may present in either an intoxication or withdrawal state. Signs and symptoms of acute intoxication may include “slurred speech, nystagmus, disinhibited behavior, incoordination, unsteady gait, hypotension, tachycardia, memory impairment, stupor, or coma.” Signs and symptoms of withdrawal range from tremulousness to hallucinations, seizures, and death. They are seen between 4 and 72 hours after the last drink, peaking at 48 hours, and can last up to 5 days. Alcohol withdrawal is one of the few fatal withdrawal syndromes that we know in medicine, and the symptoms can be assessed using a CIWA assessment. Treatment of AUD.There are factors to consider before starting treatment: Evaluating the severity of AUD Establishing clear treatment goals is associated with better treatment outcomesAssessing readiness to change: It can be done by motivational interviewing and using the stages of change model, which are, Pre-contemplation, contemplation, preparation, action, maintenance, and relapse.Discussing treatment of withdrawal.Treatment may be done as outpatient or it may require hospitalization. Dr. Beare sent an email with this information: “The approach to treating patients with AUD can be broken into two parts - the first is withdrawal management and the second is the long-term maintenance part. You MUST have a good plan for withdrawal treatment as it can be fatal if it's not addressed properly.” “Patients with any history of seizures due to withdrawal or a history of delirium tremens need inpatient management. If their withdrawal symptoms are typically mild (agitation, tremors, sleeplessness, anxiety) then outpatient management may be appropriate, typically with a long-acting benzodiazepine such as Librium or Ativan.”According to Dr. Beare, “the human aspect isa key element in treating alcohol use disorder. These patients arrive with tremendous amounts of suffering, shame, guilt, and fear. The relationship between the patient and provider needs to be built with compassion and understanding that this disease is horrible from the patient's perspective and using an algorithmic and calculated approach can cause significant harm to the rapport-building process, leading to lower success rates.”Treatment requires a lot of motivation and willpower. Hopefully, we can use some tools to assist our patients to be successful.-For mild disorder, Psychosocial interventions like motivational interviewing and mutual help groups like AA meetings may be enough to help our patient quit drinking.-For moderate or severe disorder: 1st line treatment is Meditation and structured, evidence-based psychosocial interventions (CBT, 12-step facilitation); which leads to better outcomesFor patients who lack motivation, motivational interviewing can be a useful initial interventionFor motivated patients: medical management, combined behavioral intervention, or a combination of both can be utilizedFor patients with limited cognitive abilities, 12-step facilitation, or contingency management can be helpful For patients who have an involved partner: Behavioral couples therapy can be utilizedMedications for AUD.The first-line pharmacological treatment is Naltrexone. It is given as a daily single dose and can be started while the patient is still actively drinking. There is a monthly dose of long-acting injectable naltrexone as well. Naltrexone is contraindicated in individuals taking opioids, and patients with acute hepatitis or hepatic failure. Alternative 1st line treatment is Acamprosate which can be used in people with contraindications to Naltrexone.AUD is a chronic problem and requires a close follow-up to evaluate response to treatment and complications. Medications need to be used along with psychotherapy and support, and medications may need to be changed or adjusted depending on the patient. It is an individualized therapy that requires full engagement of the doctor, the patient, and their families or social support. In conclusion, I would just like to add that, be compassionate because AUD is not a choice. AUD is a chronic problem like diabetes and HTN and may require a long road to recovery. Treatment includes psychotherapy, medications, and regular follow-up.Thank you for listening!Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Risky drinking and alcohol use disorder: Epidemiology, clinical features, adverse consequences, screening, and assessment, https://www.uptodate.com/contents/risky-drinking-and-alcohol-use-disorder-epidemiology-clinical-features-adverse-consequences-screening-and-assessment, accessed on August 18, 2024.Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry, Accessed on August 18, 2024.Alcohol use disorder: Treatment overview, https://www.uptodate.com/contents/alcohol-use-disorder-treatment-overview, assessed on August 18, 2024. Royalty-free music used for this episode, Grande Hip-Hop by Gushito, downloaded on Nov 06, 2023, from https://www.videvo.net
Interview with Esa M. Davis, MD, MPH, USPSTF member and coauthor of Screening and Supplementation for Iron Deficiency and Iron Deficiency Anemia During Pregnancy: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Screening and Supplementation for Iron Deficiency and Iron Deficiency Anemia During Pregnancy Screening and Supplementation for Iron Deficiency and Iron Deficiency Anemia During Pregnancy Anemic Data for Preventive Screening and Supplementation to Address Iron Deficiency Anemia in Pregnancy Screening for Iron Deficiency and Iron Deficiency Anemia During Pregnancy Iron Deficiency and Iron Deficiency Anemia During Pregnancy—Opportunities to Optimize Perinatal Health and Health Equity
Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Jessie Hsieh, MD Guest: David Isaacson, MD About 70 percent of all cancer-related deaths are associated with cancers that don't have recommended USPSTF screening modalities.1 But the good news is that adding multicancer early detection (MCED) testing to usual care screenings could help address this gap and potentially improve outcomes by screening for more cancer types. Joining Dr. Charles Turck to share their experiences with MCED testing and a real-world patient case are Drs. Jesse Hsieh and David Isaacson. Dr. Hsieh is the Chairman of the Board of Beacon Health System in Indiana, and Dr. Isaacson is an Assistant Professor of Otolaryngology at the Indiana University School of Medicine. Reference: Estimated deaths per year in 2022 from American Cancer Society Cancer Facts and Figures 2022. Available at: http://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2022/cancer-facts-and-figures-2022.pdf. Data on file GA-2021-0065
Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Jessie Hsieh, MD Guest: David Isaacson, MD About 70 percent of all cancer-related deaths are associated with cancers that don't have recommended USPSTF screening modalities.1 But the good news is that adding multicancer early detection (MCED) testing to usual care screenings could help address this gap and potentially improve outcomes by screening for more cancer types. Joining Dr. Charles Turck to share their experiences with MCED testing and a real-world patient case are Drs. Jesse Hsieh and David Isaacson. Dr. Hsieh is the Chairman of the Board of Beacon Health System in Indiana, and Dr. Isaacson is an Assistant Professor of Otolaryngology at the Indiana University School of Medicine. Reference: Estimated deaths per year in 2022 from American Cancer Society Cancer Facts and Figures 2022. Available at: http://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2022/cancer-facts-and-figures-2022.pdf. Data on file GA-2021-0065
Editor's Summary by Anne Rentoumis Cappola, MD, ScM, Associate Editor of JAMA, the Journal of the American Medical Association, for the July 16, 2024, issue.
In this episode of The Curbsiders Podcast, the team delves into the recently updated breast cancer screening recommendations from the U.S. Preventive Services Task Force (USPSTF) with Dr. Wanda Nicholson (@wnicholsonobgyn), an expert in preventive medicine, diversity, equity and inclusion, and women's health and the Chair of the Task Force. Join us as we review the newest screening mammography recommendations, evidence for earlier screening for all women, the challenge of dense breast findings, and more. Importantly, we discuss disparities in breast cancer outcomes and the need to better understand and address them. Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro and Guest Background Case Updated Breast Cancer Screening Recommendations Rationale for screening age Considerations for findings of dense breasts Balancing benefits and harms Racial disparities Research Gaps Outro Credits Producer, writer, show notes, infographic, and cover art: Fatima Syed MD Hosts: Paul Williams MD, FACP and Fatima Syed MD Reviewer: Emi Okamoto MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Wanda Nicholson MD, MBA, MPH
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.
Editor's Summary by Kristin Walter, MD, MS, Deputy Editor of JAMA, the Journal of the American Medical Association, for the July 2, 2024, issue.
Episode 171: Postpartum Blues, Depression, and PsychosisFuture Dr. Nguyen defines and explains the difference between baby blues, depression, and psychosis. Dr. Arreaza added comments about screening and management of these conditions. Written by Vy Nguyen, OMSIII, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Introduction.Pregnancy is one of the most well-celebrated milestones in one's life. However, once the baby is born, the focus of the family and society quickly shifts to the new member. It is important to continue to care for our mothers and offer them support physically and mentally as they begin their transition into their role. Peripartum mood disorders affect both new and experienced mothers as they navigate through the challenges of motherhood. The challenges of motherhood are not easy to spot, and they include sleep deprivation, physical exhaustion, dealing with pain, social isolation, and financial pressures, among other challenges. Let's focus on 3 aspects of the postpartum period: Postpartum Blues (PPB), Post-partum Depression (PPD) and Post-partum Psychosis (PPP). By the way, we briefly touched on this topic in episode 20, a long time ago. Postpartum blues (PPB) present as transient and self-limiting low mood and mild depressive symptoms that affect more than 50% of women within two or three days of childbirth and resolve within two weeks of onset. Symptoms vary from crying, exhaustion, irritability, anxiety, appetite changes, and decreased sleep or concentration to mood lability. Women are at risk for PPB.Several factors are thought to contribute to the increased risk of postpartum blues including a history of menstrual cycle-related mood changes, mood changes associated with pregnancy, history of major depression, number of lifetime pregnancies, or family history of postpartum depression. Pathogenesis of PPB: While pathogenesis remains unknown, hormonal changes such as a dramatic decrease in estradiol, progesterone, and prolactin have been associated with the development of postpartum blues. In summary, PPB is equivalent to a brief, transient “sad feeling” after the delivery. Peripartum depression (PPD) occurs in 20% of women and is classified as depressive symptoms that appear within six weeks to 1 year after childbirth. Those with baby blues have an increased risk of developing postpartum depression. About 50% of “postpartum” major depressive episodes begin before delivery, thus the term has been updated from “postpartum” to “peripartum” depressive episodes. Some risk factors include adolescent patients, mothers who deliver premature infants, and women living in urban areas. Interestingly, African American and Hispanic mothers are reported to have onset of symptoms within two weeks of delivery instead of six like their Caucasian counterparts. Additional risks include psychological risks such as a personal history of depression, anxiety, premenstrual syndrome, and sexual abuse; obstetric risks such as emergency c-sections and hospitalizations, preterm or low birth infant, and low hemoglobin; social risks such as lack of social support, domestic violence in form of spousal physical/sexual/verbal abuse; lifestyle risks such as smoking, eating sleep patterns and physical activities. Peripartum depression can present with or without psychotic features, which may appear between 1 in 500 or 1 in 1,000 deliveries, more common in primiparous women. Pathogenesis of PPD: Much like postpartum blues, the pathogenesis of postpartum depression is unknown. However, it is known that hormones can interfere with the hypothalamic-pituitary-adrenal axis (HPA) and lactogenic hormones. HPA-releasing hormones increase during pregnancy and remain elevated up to 12 weeks postpartum. The body receptors in postpartum depression are susceptible to the drastic hormonal changes following childbirth which can trigger depressive symptoms. Low levels of oxytocin and prolactin also play a role in postpartum depression causing moms to have trouble with lactation around the onset of symptoms. The USPSTF recommends screening for depression in the adult population, including pregnant and postpartum persons, as well as older adults. Edinburgh Postnatal Depression Scale (EPDS) can be used in postpartum and pregnant persons (Grade B recommendation).Postpartum psychosis (PPP) is a psychiatric emergency that often presents with confusion, paranoia, delusions, disorganized thoughts, and hallucinations. Around 1-2 out of 1,000 new moms experience postpartum psychosis with the onset of symptoms as quickly as several days and as late as six weeks after childbirth. Given the high risk of suicide and harm, individuals with postpartum psychosis require immediate evaluation and treatment. Postpartum psychosis is considered multifactorial, and the single most important risk factor is first pregnancy with family or personal history of bipolar 1 disorder. Other risk factors include a prior history of postpartum psychosis, family history of psychosis, history of schizoaffective disorder or schizophrenia, or discontinuation of psychiatric medications. Studies show that patients with a history of decreased sleep due to manic episodes are twice as likely to have postpartum psychosis at some point in their lives. However, approximately 50% of mothers who experience psychosis for the first time do not have a history of psychiatric disorder or hospitalization. Evaluation.Symptoms of postpartum blues should not meet the criteria for a major depressive episode and should resolve in 2 weeks. The Edinburg Postpartum Depression Scale which is a useful tool for assessing new moms with depressive symptoms. Postpartum depression is diagnosed when the patient presents with at least five depressive symptoms for at least 2 weeks. According to the DSM5, postpartum depression is defined as a major depressive episode with peripartum onset of mood symptoms during pregnancy or in the 4 weeks following delivery. Symptoms for diagnosis include changes in sleep, interest, energy, concentration, appetite, psychomotor retardation or agitation, feeling of guilt or worthlessness, and suicidal ideation or attempt. These symptoms are not associated with a manic or hypomanic episode and can often lead to significant impediments in daily activities. Peripartum-onset mood episodes can present with or without psychotic features. The depression can be so severe that the mother commits infanticide. Infanticide can happen, for example, with command hallucinations or delusions that the infant is possessed.While there are no standard screening criteria in place of postpartum psychosis, questionnaires mentioned earlier such as the Edinburg Postpartum Depression Scale can assess a patient's mood and identify signs of depression and mania. It is important after a thorough history and physical examination to order labs to rule out other medical conditions that can cause depressive and psychotic symptoms. Disorders like electrolyte imbalance, hepatic encephalopathy, thyroid storm, uremia, substance use, infections, and even stroke can mimic a psychiatric disorder. So, How can we treat patients who are diagnosed with a peripartum mood disorder?Management.On the spectrum of peripartum mood disorders, postpartum blues are the least severe and should be self-limiting by week 2. However, patients should be screened for suicidal ideation, paranoia, and homicidal ideation towards the newborn. Physicians should provide validation, education, and resources especially support with sleep and cognitive therapy and/or pharmacotherapy can be recommended if insomnia persists. Regarding postpartum depression, the first-line treatment includes psychotherapy and antidepressants. For those with mild to moderate depression or hesitant to start on medications, psychosocial and psychotherapy alone should be sufficient. However, for those with moderate to severe symptoms, a combination of therapy and antidepressants, such as selective serotonin reuptake inhibitors, is recommended. Once an effective dose is reached, patients should be treated for an additional 6 to 12 months to prevent relapse. In severe cases, patients may need to be hospitalized to treat their symptoms and prevent complications such as self-harm or infanticide.Most SSRIs can be detected in breast milk, but only 10 percent of the maternal level. Thus, they are considered safe during breastfeeding of healthy, full-term infants. So, you mentioned SSRIs, but also SNRIs, bupropion, and mirtazapine are reasonable options for treatment. In patients who have never been treated with antidepressants, zuranolone (a neuroactive steroid) is recommended. Zuranolone is easy to take, works fast, and is well tolerated. Treatment with zuranolone is consistent with practice guidelines from the American College of Obstetricians and Gynecologists.While there are no current guidelines to manage postpartum psychosis, immediate hospitalization is necessary in severe cases. Patients can be started on mood stabilizers such as lithium, valproate, and lamotrigine, and atypical antipsychotics such as quetiapine, and olanzapine, to name a few. Medications like lithium can be eliminated through breast milk and can expose infants to toxicity.The use of medications such as SSRIs, carbamazepine, valproate, and short-acting benzodiazepines are relatively safe and can be considered in those with plans to breastfeed. Ultimately, it is a decision that the patient can make after carefully discussing and weighing the pros and cons of the available medical management. While the prognosis of peripartum mood disorders is relatively good with many patients responding well to treatments, these disorders can have various negative consequences. Individuals with a history of postpartum blues are at increased risk of developing postpartum depression. Similarly, those with a history of postpartum psychosis are at risk of experiencing another episode of psychosis in future pregnancies. Additionally, postpartum depression can have a detrimental effect on mother-infant bonding and affect the growth and development of the infant. These children may have difficulties with social interactions, cognitive development, and depression. In summary, following the birth of a baby can pose new challenges and often is a stressful time for not only the mother but also other family members. Validation and reassurance from primary care physicians in an empathetic and understanding manner may offer support that many mothers may not have in their close social circle. As the first contact, primary care physicians can identify cues and offer support promptly that will not only improve the mental well-being of mothers but also that of the growing children.___________________________Conclusion: Now we conclude episode number 171, “Postpartum blues, depression, and psychosis.” These conditions may be more common than you think. So, be alert during your prenatal and postpartum visits and start management as needed. Psychotherapy and psychosocial therapy alone may be effective but do not hesitate to start antidepressants or antipsychotics when necessary. Make sure you involve the family and the patient in the decision-making process to implement an effective treatment.This week we thank Hector Arreaza and Vy Nguyen. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Raza, Sehar K. and Raza, Syed. Postpartum Psychosis. National Library of Medicine. Last updated Jun 26, 2023. https://www.ncbi.nlm.nih.gov/books/NBK544304/Balaram, Kripa and Marwaha, Raman. Postpartum Blues. National Library of Medicine. Last updated Mar 6, 2023. https://www.ncbi.nlm.nih.gov/books/NBK554546/Mughal, Saba, Azhar, Yusra, Siddiqui, Waquar. Postpartum Depression. National Library of Medicine. Last updated Oct 7, 2022. https://www.ncbi.nlm.nih.gov/books/NBK519070/Royalty-free music used for this episode: Good Vibes by Simon Pettersson, downloaded on July 20, 2023, from https://www.videvo.net/royalty-free-music/.
Interview with John M. Ruiz, PhD, USPSTF member and coauthor of Management of BMI in Children: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Interventions for Weight Management in Children and Adolescents Interventions for High Body Mass Index in Children and Adolescents Interventions for High BMI in Children and Teenagers Treatment Interventions for Child and Adolescent Obesity
Editor's Summary by Mary McGrae McDermott, MD, Deputy Editor of JAMA, the Journal of the American Medical Association, for the June 11, 2024, issue.
Host Andrew Bellavia explores crucial aspects of hearing health policy and coverage with guest Bridget Dobyan, Executive Director of the Hearing Industries Association. The discussion begins with an introduction and a policy discussion on the Medicare Audiologist Access Improvement Act (MAAIA). The focus then shifts to the current state of Medicare coverage for hearing aids and the gaps in accessibility, especially within Medicare Advantage plans. Bridget highlights ongoing legislative efforts, such as Ally's Act, which aims to ensure private insurance coverage for bone anchored auditory implants and services. The U.S. Preventive Services Task Force (USPSTF) decision on hearing screenings by doctors is also examined, with an emphasis on the need for more research to develop effective hearing screeners. They also discuss the future of MarkeTrak, an ongoing and essential market research tool for the hearing industry, and the significant role of the Hearing Industries Association (HIA) in education and advocacy. The episode concludes with insights into the Hear Well campaign, aiming to raise awareness and promote hearing health across the community, and the collaborative efforts needed to bring about positive change in hearing health. Resources: ADA statement on MAAIA legislation: Ear Community, the group behind the Ally's Act bill: USPSTF recommendation on hearing screening in older adults referenced in discussion HIA's comments on the draft USPSTF recommendation Andy's PSA video for HIA's Hear Well campaign Be sure to subscribe to our YouTube channel for the latest episodes each week, and follow This Week in Hearing on LinkedIn and X (formerly Twitter): https://www.linkedin.com/company/this-week-in-hearing/ https://twitter.com/WeekinHearing
Interview with Li Li, MD, PhD, MPH, USPSTF member and coauthor of Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Interventions to Prevent Falls in Community-Dwelling Older Adults Interventions to Prevent Falls in Older Adults Preventing Falls in Older Persons Prevention of Falls in Older Adults
In this episode, Dr. Shawn Tassone discusses the recent recommendations from the United States Preventive Services Task Force (USPSTF) regarding mammography guidelines. The USPSTF recommends biennial screening mammography for women aged 40 to 74, with a B recommendation. Dr. Tassone explains the incidence and mortality rates of breast cancer, particularly among non-Hispanic white and non-Hispanic black women. He also addresses the potential harms of mammography, such as false positive results and overdiagnosis. Dr. Tassone discusses thermography as an alternative to mammography and emphasizes the importance of individualized screening based on risk factors. Episode Highlights The USPSTF recommends biennial screening mammography for women aged 40 to 74, with a B recommendation. Breast cancer is the second most common cancer and cause of death among women in the US. Mammography has potential harms, including false positive results and overdiagnosis. Thermography is not currently considered an alternative to mammography. Screening should be individualized based on risk factors. Resources Dr. Shawn Tassone's Practice | Tassone Advanced Gynecology Dr. Shawn Tassone's Book | The Hormone Balance Bible Dr. Shawn Tassone's Integrative Hormonal Mapping System | Hormone Archetype Quiz Medical Disclaimer This podcast and website represent the opinions of Dr. Shawn Tassone and his guests. The content here should not be taken as medical advice and is for informational purposes only. Because each person is so unique, please consult your healthcare professional for any medical questions.
When should women begin receiving biennial screening for breast cancer? Find out about this and more in today's PeerDirect Medical News Podcast.
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Amidst rising breast cancer rates among younger Americans, a new guideline about breast cancer screening emerges from the US Preventive Services Task Force. The USPSTF now recommends women beginning at 40 years old should receive a mammogram every other year. The previous recommendation was that women should begin receiving biannual screenings at age 50. Candy O'Terry, radio personality and breast cancer survivor, joined Dan to discuss the new guideline and share her story.Ask Alexa to play WBZ NewsRadio on #iHeartRadio
Interview with Wanda K. Nicholson, MD, MPH, MBA, USPSTF Chair and coauthor of Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Collaborative Modeling to Compare Different Breast Cancer Screening Strategies Screening for Breast Cancer Screening for Breast Cancer Screening for Breast Cancer Toward More Equitable Breast Cancer Outcomes
Well, once again… Late breaking news! Today, April 30, 2024, the USPSTF released its updated recommendations for breast cancer screening (mammography) in average risk patients. This follows a firestorm of controversy and backlash over the last 1 to 2 years as the USPSTF continued to recommend initiation of mammogram at age 50, despite the increased incidence of breast cancer in women in their 40s. In this episode, we will review this brand new recommendation and summarize the ACOG response from ACOG President, Dr. Hicks.
PART 2 of our coverage of young-onset colorectal cancer! This week our guest is an Oncology expert, here to give us in-depth information about colorectal cancer, with actionable items on how we can protect ourselves. Colorectal cancer in younger folks (under 50 years old) is unfortunately on the rise. According to the Colorectal Cancer Alliance, in the US, about 10% of colorectal cancer cases are diagnosed in people under 50. Did you know that in 2021, the USPSTF (the federal task force that creates and implements screening guidelines in the US) changed their colorectal cancer screening guidelines? Instead of average-risk folks getting their first screening colonoscopy at 50 (the previous standard), the recommendation is now to start at 45! Your Doctor Friends are happy to present a physician expert in colorectal cancer to provide even more helpful information about why this disease may be targeting younger people, and what we can do as individuals to protect ourselves and those we care about :) Welcome, Meena Sadaps, MD! Dr. Sadaps is a board certified oncologist and assistant professor with Your Doctor Friends at Rush, and practices at the RUSH MD Anderson Cancer Center. She attended Sidney Kimmel Medical College at Thomas Jefferson University before completing residency and fellowship at Cleveland Clinic. HEADS UP! The Colorectal Cancer Alliance Blue Hope Bash annual fundraising event in Chicago is Friday, May 3rd, 2024, at Galleria Marchetti (where Jeremy got married!) and Your Doctor Friends plan to attend! If you can't attend the Blue Hope Bash, PLEASE CONSIDER DONATING to the Colorectal Cancer Alliance! Resources for this episode include: A 2021 review article from the World Journal of Gastrointestinal Oncology regarding young-onset colorectal cancer. The National Cancer Institute's website re: warning signs of young-onset colorectal cancer. A CNN article about the rise of young-onset colorectal cancer. Thanks for tuning in, folks! Please sign up for our "PULSE CHECK" monthly newsletter! Signup is easy, right on our website page, and we PROMISE we will not spam you! We just want to send you cool articles, videos and thoughts :) For more episodes, limited edition merch, or to become a Friend of Your Doctor Friends (and more), follow this link! Find us at: Website: yourdoctorfriendspodcast.com Email: yourdoctorfriendspodcast@gmail.com Connect with us: @your_doctor_friends (IG) Send/DM us a voice memo/question and we might play it on the show! @yourdoctorfriendspodcast1013 (YouTube) @JeremyAllandMD (IG, FB, Twitter) @JuliaBrueneMD (IG) @HealthPodNet (IG)
Colorectal cancer in younger folks (under 50 years old) is unfortunately on the rise. According to the Colorectal Cancer Alliance, in the US, about 10% of colorectal cancer cases are diagnosed in people under 50. Those numbers are rising about 1-2% percent each year, and researchers are still finding out why. Young adults are the only population group experiencing an increase in colorectal cancer Colorectal cancer is currently the deadliest cancer among young men and the second deadliest among young women. In August 2020, the world lost amazing actor, Black Panther himself, Chadwick Boseman, to colorectal cancer at the age of 43. Did you know that in 2021, the USPSTF (the federal task force that creates and implements screening guidelines in the US) changed their colorectal cancer screening guidelines? Instead of average-risk folks getting their first screening colonoscopy at 50 (the previous standard), the recommendation is now to start at 45! Sharing personal experiences, and highlighting the stories of people touched by colorectal cancer is POWERFUL, and the ripple effects flow far. Your Doctor Friends are SO HONORED to highlight two wonderful individuals on this episode- Ashley Bowman, MHA and Dawn Schneider, PhD, MBA. Ashley and Dawn have quite a bit in common- they are both advocate volunteers at the Colorectal Cancer Alliance, members of the Never Too Young Taskforce Advisory Board, and unfortunately both lost sisters to young-onset colorectal cancer. Ashley and Dawn share their amazing, heartbreaking, and inspiring personal stories in this episode. We are so grateful! We will follow up next week with a physician expert in colorectal cancer to provide even more helpful information about why this disease may be targeting younger people, and what we can do as individuals to protect ourselves and those we care about :) HEADS UP! The Blue Hope Bash annual fundraising event in Chicago is Friday, May 3rd, 2024, at Galleria Marchetti (where Jeremy got married!) and Your Doctor Friends plan to attend! (Julie is already shopping for a fancy blue outfit :) COME JOIN US! Opportunities to register for the event CLOSE ON TUESDAY 4/23/24 (the day THIS EPISODE DROPS)! If you can't attend the Blue Hope Bash, PLEASE CONSIDER DONATING to the Colorectal Cancer Alliance! Resources for this episode include: A 2021 review article from the World Journal of Gastrointestinal Oncology regarding young-onset colorectal cancer. The National Cancer Institute's website re: warning signs of young-onset colorectal cancer. A CNN article about the rise of young-onset colorectal cancer. A CC Alliance article highlighting our guest, Ashley Bowman! A CC Alliance article highlighting our guest, Dawn Schneider! Thanks for tuning in, folks! Please sign up for our "PULSE CHECK" monthly newsletter! Signup is easy, right on our website page, and we PROMISE we will not spam you! We just want to send you cool articles, videos and thoughts :) For more episodes, limited edition merch, or to become a Friend of Your Doctor Friends (and more), follow this link! Find us at: Website: yourdoctorfriendspodcast.com Email: yourdoctorfriendspodcast@gmail.com Connect with us: @your_doctor_friends (IG) Send/DM us a voice memo/question and we might play it on the show! @yourdoctorfriendspodcast1013 (YouTube) @JeremyAllandMD (IG, FB, Twitter) @JuliaBrueneMD (IG) @HealthPodNet (IG)
What happens when you turn 40 (and you also have boobs)? Well, since May 2023, the USPSTF has recommended that women at average risk for breast cancer start screening with mammograms beginning at age 40, and undergo mammography every other year. These updated recommendations are still “in progress” and the USPSTF cites the urgent need for more research on: breast cancer screening for people with dense breasts (nearly half of all women), how to particularly protect women of color In the US, there exists a long history of health disparities across screening and treatment for breast cancer. The Task Force discusses, for example, that Black women are 40% more likely to die than White women, and too often get aggressive cancers at young ages. So, Your Doctor Friends are taking a page from America's Sweetheart (and breast cancer survivor herself) Katie Couric. You may remember Katie both underwent a colonoscopy AND a mammogram on the Today Show, and YDF Julie wants to do the next best thing- consult with a breast cancer expert before she gets her FIRST EVER MAMMOGRAM! Your Doctor Friends have the absolute honor to present our guest today, a consummate badass, breast cancer survivor and breast surgeon, to walk Julie through her own personal risk assessment and screening process for breast cancer. Finally, we want to take some time at the end of this episode to share the story of a dear friend and colleague, a fellow sports medicine doctor, and absolute amazing human being, who very recently lost her life to breast cancer. She is the inspiration for this episode and Your Doctor Friends think it's important to talk about her, and are so grateful to her family for their consent to share her story. Learn more about Dr. Kristin Abbott here. Alright, let's get on with it, can we answer the question: Can I protect myself from breast cancer? ENTER Dr. Liz O'Riordan to help us find out! Dr O'Riordan is an expert breast surgeon who has had breast cancer three times. She's a best-selling author, speaker, broadcaster and podcaster and is a trusted source of reliable information. She shares helpful, approachable, valid breast cancer information online, we found her via her IG account @oriordanliz, she also has a podcast called “So Now I've Got Breast Cancer”, and she's published tons of helpful work, including her book “The Complete Guide to Breast Cancer” and her memoir “Under the Knife”. She also has her own wikipedia page, which is pretty rad :) Resources for today's episode include: Dr. O'Riordan's website. Link to the Tyrer-Cuzick Risk Assessment Calculator for breast cancer. The USPSTF's "In Progress" updated guidelines for breast cancer screening. The Breast Cancer Research Foundation's info page on updated USPSTF Breast Cancer Screening Guidelines. Thanks for tuning in, folks! Please sign up for our "PULSE CHECK" monthly newsletter! Signup is easy, right on our website page, and we PROMISE we will not spam you! We just want to send you cool articles, videos and thoughts :) For more episodes, limited edition merch, or to become a Friend of Your Doctor Friends (and more), follow this link! Find us at: Website: yourdoctorfriendspodcast.com Email: yourdoctorfriendspodcast@gmail.com Connect with us: @your_doctor_friends (IG) Send/DM us a voice memo/question and we might play it on the show! @yourdoctorfriendspodcast1013 (YouTube) @JeremyAllandMD (IG, FB, Twitter) @JuliaBrueneMD (IG) @HealthPodNet (IG)
Crowd favorite Dr. Raz joins Dorothy for a new spinoff series called “Mammograms and More.” During this conversation, Dr. Raz sheds light on the importance of mammograms in detecting breast cancer early. He gets granular by explaining what a mammogram is and why it's important to have one every year. Changing guidelines have left many women confused over the year, and Dr. Raz's insights clear the air. He emphasizes the need for consistency and punctuality in mammogram screenings to catch cancer early and improve survivability. Please consider sharing this episode with your family and friends at therose.org. Your action may save the life of an uninsured woman. Key Questions Answered 1.) What's a mammogram? 2.) Why should women get them done early? 3.) What are the different kinds of mammograms? 4.) How have changing guidelines had an impact on women's health? 5.) Why is it important to get screened every year? Chapters 00:00 What is a mammogram? 01:23 Importance of annual mammograms 04:01 Role of USPSTF in setting guidelines 04:58 Impact of changing guidelines on insurance coverage 05:24 Difference between screening and diagnostic mammograms 08:10 What women need to know about mammogramsSee omnystudio.com/listener for privacy information.
Interview with James Stevermer, MD, MSPH, USPSTF member and coauthor of Primary Care Interventions to Prevent Child Maltreatment: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Primary Care Interventions to Prevent Child Maltreatment Primary Care Interventions to Prevent Child Maltreatment Interventions to Prevent Child Maltreatment Struggling to Stem the Tide of Child Maltreatment
Editor's Summary by Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for the March 19, 2024, issue.
What is a preventive screening? Does USPSTF screen for mental health? What are the best preventive screenings? Plus, why an anxiety screening for adults is now recommended. Our guest is Michael Barry, MD, chair of the U.S. Preventive Services Task Force. American Medical Association CXO Todd Unger hosts.
It's very important to stay up-to-date and current with new data. But sometimes you read something that is hot-off-the press and it makes you just stop and say, “hmmm”. In this episode, we will discuss the new USPSTF position statement on screening/treating iron deficiency anemia in pregnancy. We will also review the ACOG August 2023 clinical consensus #4 regarding UTI in pregnancy. In doing so, we present 2 things that “make you go hmmm”.
Episode 161: Depression FundamentalsFuture doctors Madeline Tena and Jane Park define depression and explain different methods to diagnose it. Non-pharmacologic and pharmacologic treatment is mentioned briefly at the end. Written by Madeline Tena, MSIII, and Jane Park, MSIII. Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition. Per the language of Mental Health, depression can be defined as a mood, a symptom, a syndrome of associated disorders, or a specific mental disorder. As a state of mood, depression is associated with feelings of sadness, despair, emptiness, discouragement, and hopelessness. The sense of having no feelings or appearing tearful can also be a form of depressed mood. A depressed mood also can be a part of a collection of symptoms that explain a syndrome. Depression as a mental disorder can encompass depressive syndromes. Per the American Psychiatric Association DSM-5-TR, depressive disorders commonly include sad, empty, irritable mood, accompanied by changes in one's functional capacity. They can be classified by severity and recurrence, and associated with hypomania, mania, or psychosis. Depressive disorders include major depressive disorder (including major depressive episodes), persistent depressive disorder, premenstrual dysphoric disorder, substance-induced depressive disorder, depressive disorder due to medical condition, other specified depressive disorder, and unspecified depressive disorder.Today, we will cover unipolar depressive disorder, also known as major depressive disorder. MDD.Major depressive disorder is a mood disorder primarily characterized by at least one major depressive episode without manic or hypomanic episodes. Depressive episode is a period of at least 2 weeks of depressed mood or anhedonia in nearly all activities for most of the day nearly every day, with four or more associated symptoms in the same 2 weeks. We will discuss specific symptoms for diagnosis further on. Epidemiology of depression.Nationally or regionally representative surveys in 21 countries estimate that the 12-month prevalence of major depressive disorder across all countries is 5 percent. Furthermore, the prevalence of major depressive disorder plus persistent depressive disorder in developed countries (United States and Europe) is approximately 18 percent. Multiple studies consistently indicate that in the general population of the United States, the average age of onset for unipolar major depression and for persistent depressive disorder (dysthymia) is approximately 30 years old. During 2020, approximately ⅕ US adults have reported receiving a diagnosis by a healthcare provider, with the highest prevalence found among young adults age (18-24 year age… generation Z). Within the US there was considerable geographic variation in the prevalence of depression, with the highest state and county estimates of depression observed along the Appalachian and southern Mississippi Valley regions. Why do we care about depression?Because depression is associated with impaired life quality. It can impair a patient's social, physical, and psychological functioning. Also, depression is associated with mortality. A study done by UPenn Family Practice and Community Medicine in 2005 showed that among older, primary-care patients over a 2-year follow-up interval, depression contributed as much to mortality as did myocardial infarction or diabetes. A prospective study from 2005-2017 that followed 186 patients for up to 38 years further showed that patients with major depressive disorder had 27 times higher incidence rate of suicide than the general population. (1, 2). Also, patients dying by suicide visit primary care physicians more than twice as often as mental health clinicians. It is estimated that 45% of patients who died by suicide saw their primary care physician in the month before their death. Only 20% saw a mental health professional a month before their death. (3)Suicidality in depression.It seems that primary care physicians often do not ask about suicidal symptoms in depressive patients. A 2007 study by Mitchell Feldman at the University of California San Francisco showed that 152 family physicians and internists who participated in a standardized patient with antidepressants, suicide was explored in only 36% of the encounters. (4)Physicians, including primary care physicians, should ask patients with depression about suicidality with questions such as: Do you wish you were dead? In the past few weeks, have you been thinking about killing yourself? Do you have a plan to kill yourself? Have you ever tried to kill yourself? (5) Screening for depression.The USPSTF recommends screening for depression in all adults: 18 years old and over regardless of risk factors. Some factors increase the risk of positive screening, such as temperament (negative affectivity/neuroticism), general medical illness, and family history. First-degree family members of people with MDD have a 2-4 times higher risk of MDD than the general population. Furthermore, social history can increase risk as well: sexual abuse, racism, and other forms of discrimination.It is important to highlight the risk in women because they may also be at risk related to specific reproductive life stages (premenstrual period, postpartum, perimenopause). The USPSTF includes pregnant individuals and patients in the postpartum period to be screened for depression. Screening tools. The US Preventive Services Task Force recommends depression screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years (grade B). Similarly, the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) has also recommended annual screening for depression in children aged 12 and older. (6) Some tools used for screening in this age group are the Patient Health Questionnaire for Adolescents (PHQ-A) and the primary care version of the Beck Depression Inventory (BDI). For the general adult population, it is recommended that all patients not currently receiving treatment for depression be screened using the Patient Health Questionnaire-2 (PHQ-2) (7)PHQ 2 is a survey scored 0-6. The survey asks two questions: Over the last 2 weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing things.Feeling down, depressed, or hopeless.Answers should be given in a numerical rating. 0=Not at all; 1=Several days; 2=More than half the days; 3=Nearly every day. A score ≥ 3 is considered positive, and a follow-up full clinical assessment is recommended. The PHQ-2 has a sensitivity of 91% and a specificity of 67% when compared to a semi-structured interview. Keep in mind that the PHQ-2 may be slightly less sensitive to older individuals. Individuals who screen positive with PHQ-2 should have additional screening with the PHQ-9, which is a nine-item, self or clinician-administered, brief questionnaire that is specific to depression. (8) Its content maps directly to the DSM-5 criteria for major depression. (9)The PHQ-9 is a set of 9 questions. The answers are scored similarly to PHQ-2, with a numerical scoring between 0 and 3. (0=Not at all; 1=Several days; 2=More than half the days; 3=Nearly every day). Dr. Arreaza, you will be my patient today, are you ready? It's important that you think about the last 2 weeks.Over the last 2 weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing things. [Dr. Arreaza answers, “sometimes”. Jane asks, “is it several days or nearly every day?”. Dr. Arreaza answers, “nearly every day” 3]Feeling down, depressed or hopeless [Dr. Arreaza: every day 3]Trouble falling or staying asleep, or sleeping too much [Dr. Arreaza: not at all 0]Feeling tired or having little energy [Dr. Arreaza: not at all 0]Poor appetite or overeating [Dr. Arreaza: every day 3]Feeling bad about yourself- or that you are a failure or have let yourself or your family down [Dr. Arreaza: several days 1]Trouble concentrating on things, such as reading the newspaper or watching television [Dr. Arreaza: Several days 2]Moving or speaking so slowly that other people could have noticed. Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual. [Dr. Arreaza: Not at all 0]Thoughts that you would be better off dead, or of hurting yourself [Not at all 0]Jane: Your score is 12.Maddy: Regarding severity, a total score of 1-4 suggests minimal depression. 5-9 suggests mild, 10-14 moderate, 15-19 moderately severe, and 20-27 severe depression. PHQ-9 with patients' scores over 10 had a specificity of 88% and sensitivity of 88% for MDD. (10)But if there are at least 4 non-zero items, including question #1 or #2, consider a depressive disorder and add up the scores. If there are at least 5 non-zero items including questions #1 or #2, consider major depressive disorder specifically. The questionnaire is the starting point for a conversation about depression.A couple of things to note: 1. Physicians should make sure to verify patient responses given the questionnaire can be self-administered. Diagnosis also requires impairment in the patient's job, social, or other important areas of functioning. 2. Diagnosis requires a ruling-out of normal bereavement, histories of manic episodes, depressive episodes better explained by schizoaffective disorder, any superimposed schizophrenia, a physical disorder, medication, or other biological cause of depressive symptoms.Once a patient is newly diagnosed and/or started on treatment, a regular interval administration (e.g. 2 weeks or at every appointment) of PHQ-9 is recommended. The PHQ-9 has good reliability, validity, and high adaptability for MDD patients in psychiatric hospitals for screening and evaluation of depression severity. (12) Other than PHQ-9, there is also Geriatric Depression Scale-15 for older patients with mini mental status exam (MMSE) that scored over 10. (13)For postpartum depression, the preferred screening tool is the Edinburgh postnatal depression scale[Click here (stanford.edu)].Non-pharmacologic and pharmacologic treatment.Now that we have diagnosed the patient, we have to start management. Patients can consider non-pharmacologic treatment such as lifestyle modifications. This can include sleep hygiene, reduction in drug use, increased social support, regular aerobic exercise, finding time for relaxation, and improved nutrition. Furthermore, based on severity, patients can start psychotherapy alone or psychotherapy + pharmacotherapy. Admission is required for pts with complex/severe depression or suicidality. There should be an assessment of efficacy at 6 weeks.There is a warning about patients aged 18-24 who are at increased risk of suicide when taking SSRI within the first couple weeks of treatment. Mediations: SSRI, SNRI, tricyclic antidepressants, MAOIs, and Atypical antidepressants: including trazodone, mirtazapine (Remeron), bupropion (Wellbutrin SR). More research is being done on psychedelic drugs such as ketamine and psilocybin as possible treatments. There are therapies such as ECT available too.Potential Harm of Tx: Potential harms of pharmacotherapy: -SNRI: initial increases in anxiety, insomnia, and restlessness, and possible sexual dysfunction and headaches as well. Compared with the SSRI class, the SNRI class tends to induce more nausea, insomnia, dry mouth, and in rare cases hypertension.-Tricyclic: Cause of numerous side effects, very infrequently prescribed unless the patient is not responding to other forms of treatment. Side effects that are included are: dry mouth. slight blurring of vision, constipation, problems passing urine, drowsiness, dizziness, weight gain, excessive sweating (especially at night). Avoid TCAs in elderly patients.-MAOIS: MAO-IS can cause side effects too, including dizziness or lightheadedness, dry mouth, nausea, diarrhea or constipation, drowsiness, and insomnia. Furthermore, other less common side effects can include involuntary muscle jerks, hypotension, reduced sexual desire/ ability to orgasm, weight gain, difficulty starting urine flow, muscle cramps, and paresthesia.Remember to screen your patients. In case you establish a diagnosis, discuss treatments, including non-pharmacologic and pharmacologic options. Warn your patients about side effects and the timing to see the benefits of the medication, usually after 6 weeks. __________________Conclusion: Now we conclude episode number 161, “Depression Fundamentals.” Future doctors Park and Tena discussed depression and its risk factors, screening, and treatment. They went through the PHQ2 and PHQ9 as screening tools, as well as commonly used treatments and their side effects, such as SSRIs. Dr. Arreaza also highlighted the importance of asking about suicidality in your depressed patients, there is a lot of room for improvement in that aspect. This week we thank Hector Arreaza, Madeline Tena, and Jane Park. Audio editing by Adrianne Silva.Talk_OutroEven without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Angst F, Stassen HH, Clayton PJ, Angst J. Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord. 2002;68(2-3):167-181. doi:10.1016/s0165-0327(01)00377-9. https://pubmed.ncbi.nlm.nih.gov/12063145/Miron O, Yu KH, Wilf-Miron R, Kohane IS. Suicide Rates Among Adolescents and Young Adults in the United States, 2000-2017. JAMA. 2019;321(23):2362-2364. doi:10.1001/jama.2019.5054. https://pubmed.ncbi.nlm.nih.gov/31211337/ Feldman MD, Franks P, Duberstein PR, Vannoy S, Epstein R, Kravitz RL. Let's not talk about it: suicide inquiry in primary care. Ann Fam Med. 2007;5(5):412-418. doi:10.1370/afm.719. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2000302/.Brief Suicide Safety Assessment,National Institute of Mental Health (NIMH), July 11, 2020. https://www.nimh.nih.gov/sites/default/files/documents/research/research-conducted-at-nimh/asq-toolkit-materials/adult-outpatient/bssa_outpatient_adult_asq_nimh_toolkit.pdfBeck A, LeBlanc JC, Morissette K, et al. Screening for depression in children and adolescents: a protocol for a systematic review update. Syst Rev. 2021;10(1):24. Published 2021 Jan 12. doi:10.1186/s13643-020-01568-3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802305/Williams, John; Nieuwsma, Jason. Screening for depression in adults, UpToDate, updated on November 30, 2023. https://www.uptodate.com/contents/screening-for-depression-in-adults.Instrument: Patient Health Questionnaire-9 (PHQ-9), National Institute on Drug Abuse, https://cde.nida.nih.gov/instrument/f226b1a0-897c-de2a-e040-bb89ad4338b9.Lowe B, et al. Monitoring depression-treatment outcomes with the Patient Health Questionnaire-9 (PHQ-9). Med Care, 42, 1194-1201, 2004.Sun, Y., Fu, Z., Bo, Q. et al.The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC Psychiatry20, 474 (2020). https://doi.org/10.1186/s12888-020-02885-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701937/Conradsson M, Rosendahl E, Littbrand H, Gustafson Y, Olofsson B, Lövheim H. Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment. Aging Ment Health. 2013;17(5):638-645. doi:10.1080/13607863.2012.758231. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701937/.Royalty-free music used for this episode: Old Mexican Sunset by Videvo, downloaded on Nov 06, 2023 from https://www.videvo.net
Interview with Tumaini Rucker Coker, MD, MBA, USPSTF member and coauthor of Screening for Speech and Language Delay and Disorders in Children: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Screening for Speech and Language Problems in Young Children Recommendations for Speech and Language Screenings Screening for Speech and Language Delay and Disorders in Children Screening for Speech and Language Delay and Disorders in Children 5 Years or Younger
Become a pro on pre-exposure prophylaxis! Review the updated 2023 United States Preventive Task Force (USPSTF) guidelines on PrEP for HIV Prevention with Dr. John Wong. Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro What is PrEP? USPSTF PrEP for HIV Prophylaxis recommendations Defining Increased Risk for HIV Counseling pearls Types of PrEP, considerations about choice of PrEP Talking about Safer Sex practices, HIV and STI screening on PrEP Recap; outro Credits Producer, Writer, Show Notes, Infographic/Cover Art: Beth Garbitelli MD Hosts: Paul Williams MD, FACP, Beth Garbitelli MD Reviewer:Leah Witt MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: John Wong MD
Interview with John M. Ruiz, PhD, USPSTF member and coauthor of Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years, and Screening and Preventive Interventions for Oral Health in Adults: US Preventive Services Task Force Recommendation Statements. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years Screening and Preventive Interventions for Oral Health in Adults A Call for More Oral Health Research in Primary Care Dental Caries in Adults, Adolescents, and Children Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Adults
On June 27, 2023, researchers published a population based analysis of the prevalence of Iron Deficiency and Iron-Deficiency Anemia in Females in the US who were aged 12-21 Years. This study spanned from 2003 to 2020. What they found was staggering: Almost 40% of American teenage girls and young women had iron deficiency. This was published in JAMA. It's the first research to look at iron deficiency in young women and adolescent girls. Iron deficiency and iron-deficiency anemia are both common, underappreciated conditions with significant morbidity and mortality despite widespread availability of effective treatment. Iron deficiency is the most common micronutrient deficiency worldwide and is the most frequent cause of anaemia. Historically, the focus of screening has been preschool-aged and pregnant females. The CDC-P recommends anemia screening for nonpregnant female adolescents and women every 5 to 10 years, whereas the USPSTF does not address screening for these populations. Oh, and that CDC recommendation is from 1998! That's right, no update since 1998. Also, guidelines from the ACOG focus only on anemia during pregnancy. But now, and here's a clinical pearls: This year, for the first time in its history, the International Federation of Gynecology and Obstetrics issued a recommendation that all women and girls who menstruate should regularly be screened for iron deficiency, not just for anemia and not just during pregnancy. This was recently picked up as a story in the New York Times, being published on October 17, 2023. And here's another clinical pearl… It is completely possible for someone with normal hemoglobin levels to still have iron deficiency. So in this episode, we're going to address the new FIGO guidelines and review why a “screening CBC“ just does not have the sensitivity to detect iron deficiency in reproductive age women. We will also review the appropriate screening test for this condition, as well as review basic iron physiology.
Featuring articles on semaglutide for heart failure in patients with obesity, inhaled fluticasone furoate for treatment of Covid-19, a trial of solanezumab in preclinical Alzheimer's disease, and targeting the BRAF pathway in pediatric glioma; a review article on the prevention of central line–associated bloodstream infections; a case report of a woman with abdominal distention and acute kidney injury; and Perspective articles on the new USPSTF mammography recommendations, on the ethics of abortion care advocacy, and on reducing the risks of nuclear war.
Interview with Esa M. Davis, MD, MPH, USPSTF member and coauthor of Screening for Hypertensive Disorders of Pregnancy: US Preventive Services Task Force Final Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Screening for Hypertensive Disorders of Pregnancy Screening for Hypertensive Disorders of Pregnancy Hypertension Screening in Pregnancy Screening for High Blood Pressure Disorders During Pregnancy
Interview with John B. Wong, MD, USPSTF member and coauthor of Preexposure Prophylaxis to Prevent Acquisition of HIV: US Preventive Services Task Force Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Preexposure Prophylaxis for the Prevention of HIV New USPSTF Guidelines for HIV Preexposure Prophylaxis Preexposure Prophylaxis to Prevent Acquisition of HIV Preventing HIV With PrEP
Interview with Katrina E. Donahue, MD, MPH, USPSTF member and coauthor of Folic Acid Supplementation for the Prevention of Neural Tube Defects: US Preventive Services Task Force Reaffirmation Recommendation Statement. Hosted by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Folic Acid Supplementation to Prevent Neural Tube Defects Folic Acid Supplementation to Prevent Neural Tube Defects Fully Effective Folic Acid Fortification Reaffirming Recommendations for Folic Acid Supplementation Folic Acid to Prevent Neural Tube Defects
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