Primary Care Pod

A New Pandemic? PICKLEBALL INJURIES ON THE RISE!

Fun, quick episode this week.    https://pubmed.ncbi.nlm.nih.gov/33934725/   Non-fatal senior pickleball and tennis-related injuries treated in United States emergency departments, 2010-2019   Harold Weiss 1, Jacob Dougherty 2, Charles DiMaggio 3

First Unprovoked VTE, Cause for Lifelong Blood Thinners?

Today's episode is a very complicated topic without clear cut benefits. Expert opinions and modeling data to address a dangerous and serious topic. Let's look at 2 sources: a new study from the Annals of Internal Medicine and an expert opinion from Uptodate.   https://www.uptodate.com/contents/selecting-adult-patients-with-lower-extremity-deep-venous-thrombosis-and-pulmonary-embolism-for-indefinite-anticoagulation?search=unprovoked%20dvt&sectionRank=1&usage_type=default&anchor=H648618&sour...

Intermittent Fasting vs. Caloric Restriction, Head to Head!

Time restricted eating vs. caloric restriction. Is there a winner in this 1:1:1 12-month trial from Chicago?   https://pubmed.ncbi.nlm.nih.gov/37364268/ Time-Restricted Eating Without Calorie Counting for Weight Loss in a Racially Diverse Population : A Randomized Controlled Trial Shuhao Lin 1, Sofia Cienfuegos 1, Mark Ezpeleta 1, Kelsey Gabel 1, Vasiliki Pavlou 1, Andrea Mulas 1, Kaitie Chakos 1, Mara McStay 1, Jackie Wu 1, Lisa Tussing-Humphreys 2, Shaina J Alexandria 3, Julienne Sanch...

New RSV Vaccine Studies!

Talking about 2 studies released last month:   1. Giving it to 3rd trimester moms and seeing what happens in newborns: https://pubmed.ncbi.nlm.nih.gov/37018474/   2. Giving it to 60+ yo adults and seeing what happens: https://pubmed.ncbi.nlm.nih.gov/37018468/   What happens when I review these? Listen to find out!   Helpful table (Not sure if this will reproduce well or not):   NNT Vaccine Efficacy Severe LRI     first 90 d 142 81% In 6 mo 75 69% ADULTS 1428 85%       non-severe L...

Personalization - A New Treatment Algorithm for Blood Pressure Management

Hey everyone, on today's episode we are talking about a recent JAMA article on Heterogeneity in Blood Pressure Response to various blood pressure medicines and the idea of individualizing antihypertensive algorithms.   https://jamanetwork.com/journals/jama/article-abstract/2803518

Treating Resistant Depression in Elders - Add or Switch Meds?

Today's episode we look at a study of 60+ year olds who have poorly controlled depression.  Is it better to add on medications? Switch medications? Does it matter?    Study link: https://pubmed.ncbi.nlm.nih.gov/36867173/

New(ish) Drug for MACE Prevention

Bempedoic Acid aka Nexletol has a new trial in NEJM that shows MACE reduction in very high risk patients (mostly secondary but some primary prevention).  NNT? NNH? Other trials on Bempedoic acid? Tune in and find out.    

Asthma Management: Less is More?

Interesting study today that looks at High dose ICS inhalers possibly have worse outcomes in patients than medium dose ICS inhalers, leading to more exacerbations and need for antibiotics. Plausible? Let's discuss!

Low Serum Creatinine Can Be Dangerous

We take a Pre-operative study from the Annals of Surgery and talk about perioperative risk management for patients with low serum creatinine.

Guideline Update: COPD - GOLD 2023

Minor changes, but enough that it's probably useful for an update!

AI is Coming for Your Job: ChatGPT Passes Board Exams

Fun episode today!

Guideline Update: CKD Management!

Words go here

Can Medical Cannabis Actually Reduce Opioid Use in Chronic Pain Patients?

Let's review a clinical trial of medical cannabis use in chronic pain patients with the goal of reducing daily MME dose.

Documentation Efficiency: Typing Speeds and Digital Disparities

Interesting Study out of the Netherlands on different typing speeds in clinical practice by age, gender, medical role, and specialty.    Take home - You aren't as fast as a typer as you think!

No Zero Days: Motivational Interviews for 2023

Kicking 2023 year off with a topic on Motivational Interviewing, and what I'm focusing on to help patients make healthy choices and beneficial lifestyle changes for this year.

Osteoporosis for Dummies

Thanks to Dr. Leah Prestbo, you the MVP.

IM Steroids for Knee Arthritis? Really?

Today we discuss a recent study looking at intra-articular steroid injections for knee arthritis vs. IM steroid injections in the glute.  Non-inferior???

HDL is Racist

Apparently, the relationship between HDL and coronary artery disease is much more complicated than previously thought. Low HDL doesn't matter if you are black? Let's read about a November 2022 study from JACC.

Always Rx BP Meds at Night? Not so fast!

Last decade, data has pointed us to prescribe BP meds at night, new study says, maybe it doesn't matter?

DoxyPEP, the Future of STD Care?

words go here

Colonoscopy Fails an RCT??!?

SHOCKING! DRAMA! Not really, so let's dig into the details from NEJM October article on colonoscopy RCT in Europe.

Practice Efficiency: For Clinic Visits, Less is More

I HAVE NOTHING TO PUT IN HERE, JUST LISTEN OK.

Semaglutide for Weight Loss, How Good is it in Real Life?

Works!  How Well? Well, pretty good. Let's get more details!

Guideline Update! Heart Failure Management

1. New classifications for your documentation - HFrEF, HFmrEF, HFpEf, HFiEF 2. Medications for HFrEF, HFmrEF 3. Medications for HFpEF. 4. MEMORIZE ALL THE ACRONYMS

Sitting Cessation Counseling?

Not smoking cessation, but SITTING CESSATION? How a British RCT showed that PCPs can improved hours of sedentary sitting per day, and make changes to patient's overall wellbeing and ? health?  Let's discuss!

Treating Painful Neuropathy: Is More Better?

WELCOME BACK.   Let's talk about a recent study last month on treatment options for painful neuropathy in diabetes. Monotherapy or dual therapy? Is More Better? Is this practice changing? Do I like typing questions in here? Find out in this episode!

The Future is Here! The Cancer Blood Test

Let's talk about cfDNA and how a new test is soon to be coming to a PCP office near you to screen healthy patients for all cancers in a single blood test.

Practice Changes? Hyperkalemia Management on ACE/ARBs

On today's episode: Standard opening and joke, but with a new sponsorship from Panacea Financial!   Pod Episode is on an interesting study from last month on management of hyperkalemia with patients on ACE/ARBs that I thought was super interesting and very relevant to primary care.  Hope you agree!

Combatting Burnout by Accepting Uncertainty

Why You Will Hear A Lot About LipoproteinA in 2023

Let's talk and review research (and future treatments of LpA) on today's episode of the PCP.

The SAD Reality of AD management

*sigh* Alzheimer's disease is awful.    Let's talk about management, or at least how best to handle it.

Guideline Update! Anticoagulation and Endoscopy

We're back!   Let's talk what to do with Warfarin/coumadin, DOACs, antiplatelets/aspirin at the time of EGDs and Colonoscopy based on the most recent guidelines in the spring

COPD Management

Let's review an important topic for Primary Care - COPD! Because it's actually easier than we make it out to be, and can be managed by PCPs in the clinic.  Let's review the 2020 GOLD recommendations.

To Use or Not to Use - PCSK9 and Ezetimibe.

Let's have a talk based on a very recent meta-analysis from the BMJ about PCSK9 and ezetimibe use in prevention of ASCVD/MACEvents.

Common Abdominal Symptoms that Should Alarm You

TITLE.     POEM FROM AFP   IS GOOD TO REVIEW.   BYE.  

Does the White Coat Matter?

Fun article to discuss today, does it matter whether you wear a white coat to patients?

Deprescribing PPIs - New Guidelines Update from the AGA

PPIs are usually great.  PPIs sometimes need to go away. Let's talk about De-prescribing PPIs from a new guideline update from the AGA. OK

No more Salt Restriction for CHF? NOT SO FAST, MY FRIEND

Very confusing study and very confusing popular media reporting on the topic, all leads to good topic to talk about in podcast form.

Guideline Update! Aspirin for Primary Prevention of CVD

We're back! New pod episode!

Practice Efficiency: Documentation part 2!

You suck at documenting. Let's talk why and focus on how to get better.

Practice Efficiency: Documentation!

Today we go back to Practice Efficiency and look at clinic documentation!  Something we can ALL get better about.  I have thoughts. ALL THE THOUGHTS.

Guideline Update! Adult Pneumonia Vaccines!

New update! Goodbye Pneumovax 23. Hello PCV 20.  Prevnar is back, baby?

IBS responds to Placebo! A study

Primary Care.... in SPACE?

Just a short, fun episode on human physiology and space travel. Probably not clinically relevant but maaaaaaaaaybe one day? Nah, probably not.  

Best Practice - Titrating BP Meds in Elderly

Hey! New study! Is it better to increase a current medication to max dose or start new medication? We know the answer in general population, but let's talk about elderly specific patients.

The Possible Problems of PE Protocols

I like alliteration. Today is about a possible new PE protocol we can follow to rule out false positive D-Dimers by adjusting its threshold based on some variables. BUT, this can be confusing. And hard to remember. Are adding more and more complex algorithms actually worth it?

Review: Acne Treatment

Hey everyone, simple and quick review of acne treatment today. Tune in and review!

Changing Treatment for Pediatric Pneumonia?

New study! Short course, low dose Amox NON INFERIOR to traditional care. Game changer? IDK probably, let's discuss.

What‘s Up with Artificial Sweeteners?

New study highlights what artificial sweeteners are actually doing metabolically, neurologically, and impacting people's ability to lose weight.

DIY -At Home Alcohol Withdrawal Management

Hey everyone   On this episode, we review the recent AFP article on outpatient alcohol withdrawal management.