Primary Care Update (Mark Ebell)

It's Halloween, and we start with a seasonally appropriate study. That's followed by new recommendations re: BRCA mutations (https://www.ncbi.nlm.nih.gov/pubmed/31429902), Dave Slawson with an Atrium BEAT on the value (?) of Sitz baths, fecal transplant for irritable bowel (https://www.ncbi.nlm.nih.gov/pubmed/30908299), and a quick review of the latest pneumonia guidelines.

This week, an all COVID-19 episode covers 7 new studies in just 24 thrill-packed minutes: 2 phase 2 vaccine trials just out yesterday, outpatient monitoring of patients with COVID-19, hydroxychloroquine in mildly ill patients, and transmission of COVID-19 by children

This week, 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.

Join family physicians Kate Rowland, Mark Ebell and John Hickner this week as they discuss the best NSAID for acute low back pain, a study on masks in schools to reduce COVID incidence, antipsychotics, and the benefits of fluoride varnish and supplements in kids. 

This week, 6 COVID-19 updates: corticosteroids reduce mortality for sickest patients, non-drug approaches to controlling COVID, a review of the multisystem inflammatory syndrome in kids, another study on COVID 19 mortality and race, asymptomatic COVID and a report from the CDC on factors related to hospital and ICU use among patients with COVID-19.

Our mentor, colleague, fellow podcaster, and dear friend John Hickner died peacefully at home on August 22nd at age 72. As we grieve, we want to share some stories about John that exemplify why he was the kindest, most thoughtful, and most decent person we have had the privilege to know. 

Kate is at the Cubs opener today, so you'll have to settle for Mark, Gary and Henry as they discuss reducing seizures in young kids, the best antidepressants for managing pain, and new ACCP guidelines for peri-operative management of anticoagulation and antiplatelet agents.

This week we cover why you should start using automated BP measurement if you're not already (https://www.ncbi.nlm.nih.gov/pubmed/30715088); ablation vs rhythm control for afib (https://www.ncbi.nlm.nih.gov/pubmed/30874766); and the value of early aerobic exercise after sports concussion (https://www.ncbi.nlm.nih.gov/pubmed/30715132). Plus, the value (?) of self-monitoring blood glucose in non-insulin T2DM.

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

This week, Mark reports the first study looking at the duration of symptoms with mild COVID in healthcare workers (more than you think) compared to those without COVID. Then Henry looks at the same thing in hospitalized COVID patients compared to those with other respiratory infections in the US and UK, and John tells us the true rate of anaphylaxis with vaccines.

Happy Holidays... we hope our listeners are getting some downtime. This week, we discuss the benifits (or not) of treating subclinical hypothroidism,  the benefits (or not) of atorvastatin for patients with rheumatoid arthritis, and the best preventive strategy for patients with coronary artery disease and atrial fibrillation.

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. 

This week we tackle caffeine in pregnancy, new onset diabetes and cancer risk; a clinical prediction tool to help rule out acute myocardial infarction and a report on the frequency of COVID reinfection.

This week: how does the yield for FIT testing compare with colonoscopy (https://www.ncbi.nlm.nih.gov/pubmed/29101260); our take on the new ACC/AHA lipid guidelines (https://www.ncbi.nlm.nih.gov/pubmed/30423391); and what works (or doesn't) for subacute cough (https://www.ncbi.nlm.nih.gov/pubmed/30201828).  

This week, Kate leads us on a special Mother's Day edition focused on women's health. Topics discussed by Kate, John and Henry (Mark is in Würzburg busily pontificating) include prevention of preterm delivery, statins during pregnancy, and aromatherapy for postmenopausal symptoms.

This week on Primary Care Update we talk about group PT visits for urinary incontinence in women older than 60, managing uncomplicated forearm fractures in children, a COVID testing strategy for keeping kids in school, and a quadpill for treating hypertension

This week: 3 brief summaries of breaking research on COVID-19 (convalescent sera, hydroxychloroquine, and risk stratification); whether you really need surgery for a mid-clavicular fracture (https://www.ncbi.nlm.nih.gov/pubmed/30835150); and whether acetaminophen does anything (https://www.ncbi.nlm.nih.gov/pubmed/31892511). 

This week 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 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. 

A busy pod today: what patients mean when they say "congestion" (https://www.ncbi.nlm.nih.gov/pubmed/31145430); Dave Slawson on why decongestants are safer than we thought; are personal sound amplifiers any good (https://www.ncbi.nlm.nih.gov/pubmed/31095263); and ongoing overtreatment of asymptomatic bacteriuria (https://www.ncbi.nlm.nih.gov/pubmed/31449295). 

This week we talk about ruling out serious bacterial infection in young infants (https://www.ncbi.nlm.nih.gov/pubmed/30776077), whether exercise can prevent falls in the elderly (https://www.ncbi.nlm.nih.gov/pubmed/30592475), and whether statins and BP meds prevent cognitive decline (https://www.ncbi.nlm.nih.gov/pubmed/30814321).

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

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 John, Henry and Mark discuss interpretation of FIT tests for CRC screening (https://www.ncbi.nlm.nih.gov/pubmed/30802902); diagnosis of appendicitis (https://www.ncbi.nlm.nih.gov/pubmed/30017693); and treatment of neonatal abstinence syndrome (https://www.ncbi.nlm.nih.gov/pubmed/30667476). Plus, a quiz about metformin.

This week, we will discuss the HPV vaccine and whether it actually prevents invasive cervical cancer, diagnosing inflammatory bowel disease in children, and COVID infectivity in households and families. Plus a mythbusting quiz and John's recommendation for what NOT to read. 

This 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/

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/

Special guest Dave Slawson, plus 3 POEMs: 1 vs 12 months of DAPT following PCI; rimegepant for migraine; and the best treatment for clinically suspected gonorrhea and chlamydia.

This week we're joined by special guest Dr. Gary Ferenchick, friend of the pod and professor of Internal Medicine at THE Michigan State University. This week we discuss gabapentin for chronic pelvic pain, cast vs boot (vs surgery) for ruptured achilles tendon, and aspirin for primary prevention.

This week: as needed steroid + LABA for mild asthma (https://www.ncbi.nlm.nih.gov/pubmed/31112386); platelet rich plasma for rotator cuff injury (https://www.ncbi.nlm.nih.gov/pubmed/31000394); and pioglitazone in high risk diabetics who've had a stroke (https://www.ncbi.nlm.nih.gov/pubmed/30734043). 

This week, Kate, Gary, Henry and Mark discuss a new guideline for managing jaundice in babies, treating painful diabetic peripheral neuropathy, acetazolamide for patients hospitalized with CHF, and screening for CVD in older men.

This week Kate, Gary, Henry and Mark talk about bempedoic acid for the prevention of ASCVD, the polypill and cognitive decline in the elderly, post-exposure prophylaxis in persons at high risk of STIs, asymptomatic CAD and subsequent AMI risk. And do you know how long ankle arthroplasties last?

This week we discuss a huge and really important meta-analysis of SGLT-2 inhibitors (flozins) and GLP-1 agonists (tides). Also, a good guideline on Lyme disease diagnosis and treatment, and a novel approach to treating migraine.

This week, Henry, Mark and John discuss: statins for primary prevention in the elderly (https://www.ncbi.nlm.nih.gov/pubmed/30712900); beer before wine or vice versa (https://www.ncbi.nlm.nih.gov/pubmed/30753321); and the impact on control on school performance in kids with T1DM (https://www.ncbi.nlm.nih.gov/pubmed/30721295). Plus a beer themed quiz.

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.

This week, a COVID-19 outbreak in an Israeli high school, the accuracy of antibody studies, denervation to treat hypertension, and identifying low-risk patients with syncope. Plus the quiz, and a recommendation. 

This week, a couple of COVID-19 updates, plus POEMs on breast cancer prevention (https://www.ncbi.nlm.nih.gov/pubmed/31839281) and a cool new (old) way to reduce bad things after an MI (https://www.ncbi.nlm.nih.gov/pubmed/31733140).

We cover 6 COVID-19 studies today, focusing on natural and acquired immunity, the tocilizumab trials, and a fishing story. Also the quiz, and you can get free CME at: https://iafp.mclms.net

This week, 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.

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.

John has the week off, so Kate, Mark and Henry plow forward rudderless and talk about monkeypox (sorry, WHO, we're not calling it hMKPX, buy a vowel), screening for atrial fibrillation, and our new candidate for worst drug ever: aducanumab for Alzheimer dementia.

Join Kate, Mark, Gary and Henry as they discuss 4 new POEMs on treatment of sexual dysfunction, the benefits and harms of GLP-1 agonists, active surveillance vs usual care for ductal carcinoma in situ, and medications to prevent episodic migraine headache.

Henry mentioned AAFP's uncensored resources:

www.aafp.org/family-physician/patient-care/clinical-recommendations.html 

www.aafp.org/family-physician/patient-care/care-resources.html

www.aafp.org/family-physician/patient-care/prevention-wellness/immunizations-vaccines.html

www.aafp.org/family-physician/patient-care/care-resources/sexually-transmitted-infections.html

www.aafp.org/family-physician/patient-care/care-resources/womens-health.html 

www.aafp.org/family-physician/patient-care/care-resources/reproductive-health.html 

Kate's links on sexual dysfunction:

NEJM review:  https://pubmed.ncbi.nlm.nih.gov/39167808/

ED prevalence:  https://pubmed.ncbi.nlm.nih.gov/38410029/

GLP-1s do everything: www.ncbi.nlm.nih.gov/pubmed/39833406

Active monitoring of DCIS:  https://pubmed.ncbi.nlm.nih.gov/39665585/

Episodic migraines: https://pubmed.ncbi.nlm.nih.gov/39899861/ 

https://www.ncbi.nlm.nih.gov/pubmed/39631943

This week, 2 new COVID-19 studies (doi:10.1001/jama.2020.6771 and doi: 10.1001/jama.2020.6775), an effective treatment for irritable bowel syndrome (https://www.ncbi.nlm.nih.gov/pubmed/31852769), and trends in prostate cancer screening (https://www.ncbi.nlm.nih.gov/pubmed/31794057).

This week, 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.

This week: low-carb diets for patients with T2DM, managing patients with chronic back pain, and reinfection rates in patients with COVID. Plus the quiz, and a reality TV recommendation.

Today, and all COVID episode. Does adding baricitinib improve outcomes in patients on remdesivir; convalescent plasma given early in high risk elders; and how common are long-hauler symptoms.

This week 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!

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: salivary testing for COVID, COVID immunity, ACR guidelines for managing patients with degenerative joint disease, and the use of old forms of insulin in managing patients with type 2 diabetes.

This week, Gary, Kate, Henry and Mark discuss 2 new studies and 2 new guidelines: screening for genital herpes infections from the USPSTF, semaglutide injections in obese adolescents, ACG guidelines for acute lower GI bleeding, and invasive vs. noninvasive management of patients with stable CAD. And Henry manages to not talk about baseball!

This week: Dapagliflozin...for heart failure, not T2DM? (https://www.ncbi.nlm.nih.gov/pubmed/31535829) Do muscle relaxants add anything to NSAIDs for back pain? (https://www.ncbi.nlm.nih.gov/pubmed/30955985) And early vs delayed surgery for gallstone pancreatitis (https://www.ncbi.nlm.nih.gov/pubmed/31268184). Plus the quiz and a recommendation. 

Does linagliptin prevent CV events: ttps://www.ncbi.nlm.nih.gov/pubmed/30418475; does Tai Chi prevent falls and fractures: https://www.ncbi.nlm.nih.gov/pubmed/30208396; treatment of endometriosis pain: https://www.ncbi.nlm.nih.gov/pubmed/30396557; and the benefits of sauna: https://www.ncbi.nlm.nih.gov/pubmed/30486813. 

Today we discuss: vitamin D for pain and headache (https://www.ncbi.nlm.nih.gov/pubmed/25261164); chronic diarrhea guidelines (https://www.ncbi.nlm.nih.gov/pubmed/29653941); lorcaserin and T2DM (https://www.ncbi.nlm.nih.gov/pubmed/30293771); and the results of "screening" MRI (https://www.bmj.com/content/363/bmj.k4577).

This week we discuss COVID research on how many are asymptomatic and for how long people are infectious , managing overactive bladder symptoms in men, and perioperative probiotics and synbiotics for patients undergoing abdominal surgery.

This week Kate, Henry, Mark and John are all over the map, with 4 new studies on the safety of Janus Kinase inhibitors, midodrine for recurrent vasovagal syncope, empagliflozin for heart failure (not DM) and peppermint oil for irritable bowel syndrome. 

This week our skeptics discuss the best topical acne treatments, hypoglycemia in nursing home residents, the best antiplatelet therapy after minor stroke or TIA, and whether lockdowns reduced COVID-19 mortality.

This week on Primary Care Update: 2 COVID-19 studies (convalescent plasma RCT and accuracy of patient self-sampling), plus managing pneumothorax, and something that seems to work for infantile colic. 

Kate, Mark, John and Henry discuss the value of three doses of mRNA vaccine for immunocompromised people, Ivermectin for treating persons with COVID-19, the benefits of boosters based on Israeli data, and pregnancy outcomes of women with COVID-19 infection. 

This week, Kate, Mark, John and henry will discuss cannabis use in patients with rheumatologic disorders, platelet-rich plasma injections for persons with plantar fasciitis, epidural steroid injections for sciatica, and COVID mortality and race.

This episode, Henry, Kate, Mark and their colleague Gary Ferenchick from MSU discuss: pharmacogenomic-guided antidepressant therapy, non-drug interventions for children with functional abdominal pain, Vitamin D and fracture risk in the elderly, and NICE guideline for persons with T2DM.

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

Show links:

Essential Evidence Plus: www.essentialevidenceplus.com

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

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

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

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

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

In episode 46 we again cover all things COVID-19: 2 trials of remdesivir, news on viral shedding, COVID mortality, thrombotic events and risk of infection among COVID contacts. You can get all of our research briefs on COVID-19 here: https://www.aafp.org/journals/afp/explore/covid-19-daily-briefs.html

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

Links from today's podcast:

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

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

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

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

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

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

0: 0.5%

1: 3.0%

2: 7.4%

3: 23%

4: 46%

This week Kate, Henry and Mark discuss motivational interviewing for weight loss, intensive vs standard urate lowering in persons with gout, and screening high risk persons for anal cancer.

This week, Kate, Mark, John and Henry discuss a proven strategy to decrease antibiotic prescribing, learn about updated USPSTF recommendations for blood pressure screening, whether vitamin D and fish oil for prevent A fib, and the value of oral steroids for wheezy preschoolers age 2 to 5.

This week, while Gary tries to learn French in of all places France, Kate, Mark and Henry discuss management of non-STEMI in frail older adults, identifying children with secondary hypertension, and RSV vaccination in pregnant women

This week, 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 will discuss a potpourri of COVID studies: a large propensity score matched study of thromboprophylaxis in hospitalized patients, novel use of colchicine for COVID-19, and mortality associated with mutant SARS-CoV-2 strains.

This week Kate, Henry and Mark give John the week off and discuss outcomes after adenotonsillectomy in children with OSA, the effectiveness and safety of DAPT vs ASA for secondary stroke prevention, and the final results of the largest trial of screening for ovarian cancer using CA-125 and ultrasound.

We are really excited to introduce our new co-host, Dr. Kate Rowland, an Associate Professor in the Department of Family Medicine at Rush University in Chicago. We have been teaching with Kate for a long time in our in-person courses, and it's great to have her on board for the podcast. This week we talk about a new study from Oxford University finding a clear benefit for inhaled steroids in patients newly diagnosed with COVID-19. Kate discusses changes (good ones!) in regulations around MAT, Henry has good news about managing 5th metatarsal fractures, and John closes with data on the safety of mRNA vaccines in pregnancy. And the quiz!

This week our intrepid team of primary care physicians (Kate Rowland, Henry Barry, Gary Ferenchick and Mark Ebell) discuss treatment of resistant depression in older adults, recognizing and managing angry and disruptive patients, the best way to settle a cranky infant, and the AAFP 2022 Guideline on BP targets in adults with hypertension.

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.

Today we talk about what to do for patients with both coronary heart disease and afib (https://www.ncbi.nlm.nih.gov/pubmed/30883055); a practice changer for the three of us addressing how patient to be with antidepressants (https://www.ncbi.nlm.nih.gov/pubmed/29952277); and whether early or delayed cardioversion is better for afib (https://www.ncbi.nlm.nih.gov/pubmed/30883054).

Join Kate, Mark, Gary and Henry as they discuss whether we should (or can) use biomarkers to predict mild cognitive impairment or dementia, financial incentives to promote smoking cessation, the efficacy of HP eradication for functional dyspepsia, and results of the glycemic control arm of the GRADE Trial.

This week, 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

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, family physicians Kate, John, Henry and Mark will discuss whether mortality really increases over the holidays, the best way to prep patients for ear wax removal, whether high dose amoxicillin is effective for kids with lower respiratory infection, and how effective vaccines are against omicron. Plus a special Christmas quiz!

Today we talk about the impact of more primary care physicians in a population on health outcomes; whether or not probiotics, prebiotics, and antibiotics are helpful for irritable bowel; and the impact of SGLT-2 inhibitors like empagliflozin on cardiovascular outcomes in diabetics with heart disease or at very high risk.

This week we will discuss treatment of overactive bladder syndrome, a smoking cessation guideline and bone density testing. For free CME, go to https://iafp.mclms.net. 

This week: is it safe to skip breakfast (https://www.ncbi.nlm.nih.gov/pubmed/30700403), reducing fracture risk in women with osteopenia (https://www.ncbi.nlm.nih.gov/pubmed/30575489), drug therapy for anxiety disorder (https://www.ncbi.nlm.nih.gov/pubmed/30712879 ), and antibiotics for serious asthma exacerbations (https://www.ncbi.nlm.nih.gov/pubmed/30688986). 

How long does a new knee or hip last (https://www.ncbi.nlm.nih.gov/pubmed/30782340); does subacromial decompression work for chronic shoulder pain (https://www.ncbi.nlm.nih.gov/pubmed/30728120); fentanyl or ketamine intranasally for extremity injury in kids (https://www.ncbi.nlm.nih.gov/pubmed/30592476); and splint or cast for fibular fracture (https://www.ncbi.nlm.nih.gov/pubmed/30674451). 

A whole lotta diabetes goin' on: linagliptin ($780) vs glimepiride ($3) for T2DM (https://www.ncbi.nlm.nih.gov/pubmed/31536101); semaglutide in T2DM + vascular/CKD (https://www.ncbi.nlm.nih.gov/pubmed/31185157); and whether we should care about pre-diabetes (https://www.ncbi.nlm.nih.gov/pubmed/31076416).

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

A diverse set of POEMs from Kate, John, Henry and Mark: CDC COVID mitigation and vaccination updates, non-opioid post-op pain management, a guideline for managing persons with IBS, and the challenges of communicating risk with words

This week, Gary, Kate, Henry and Mark discuss 4 new studies relevant to primary care practice: the effectiveness of RSV monoclonals in infants, acupuncture for sciatica associated with disk herniation, zoledronate every 5 years for low risk women, and the effect of arm position on blood pressure readings. Plus a quiz! Please see below for show notes and links:

Learn more about Essential Evidence Plus: www.essentialevidenceplus.com

Real world study of nirsevemab for average risk infants: https://pubmed.ncbi.nlm.nih.gov/39257372/

Acupuncture effective for sciatica: https://pubmed.ncbi.nlm.nih.gov/39401008/

Zoledronate every 5 years for average risk women: https://pubmed.ncbi.nlm.nih.gov/39813642/

Importance of correct arm position for BP: https://pubmed.ncbi.nlm.nih.gov/39373998/

A nice infographic for measuring BP correctly from the AMA and Johns Hopkins: https://targetbp.org/wp-content/uploads/2016/10/MAPHypertension_7StepsInOfficeInfographic_Landscape_English_NoCropsNoBleeds-12.pdf

This is an all-COVID-19 week. We discuss the WHO Solidarity trial of remdesivir and other antivirals, banlamivimab for outpatients, and an RCT of convalescent serum. 

This week, we discuss hopefully the last two studies of hydroxychloroquine for patients with COVID (still doesn't work), pulmonary rehab in patients with COPD, and the use of special footwear in patients with knee DJD.

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.

This week, Kate, Mark, Henry and John will discuss penicillin allergy, US-guided steroid injections, psychological therapies for patients with IBS and the natural history of “prediabetes”. Plus the quiz from Kate.

This week, Kate, Mark, 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, John, Henry and Mark for a discussion of pumpkin seed oil for BPH symptoms, open label placebo for post-op pain, muscle relaxants for low back pain, and the implications of universal depression screening. 

This week Kate, Henry, John and Mark discuss whether iron supplementation provides real benefits for anemic infants, IL6 antagonists for COVID, inhaled corticosteroids for COVID, and platelet rich plasma for Achilles tendinopathy. 

Join us this week as Kate, Henry, Gary and Mark discuss: nonpharmacologic sleep interventions in children, crenezumab for treating patients with early Alzheimers, prognosis after knee replacement, and time restricted eating (“intermittent fasting”) for weight loss. Henry and Gary are oxygen deprived and recording in Big Sky, teaching a CME course. You can join all four of us on March 3 and 4 in Scottsdale, AZ for 16 hours of content at the Arizona Academy of Family Physicians annual spring course. Click here to learn more and register.