Primary Care Pod

USPSTF 2024 Breast Cancer Screening Guideline Update!

We're back!

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§ionRank=1&usage_type=default&anchor=H648618&source=machineLearning&selectedTitle=1~150&display_rank=1#H648618

 

vs.

 

https://pubmed.ncbi.nlm.nih.gov/37364263/

Indefinite Anticoagulant Therapy for First Unprovoked Venous Thromboembolism : A Cost-Effectiveness Study

Faizan Khan ¹, Doug Coyle ², Kednapa Thavorn ³, Sasha van Katwyk ⁴, Tobias Tritschler ⁵, Brian Hutton ⁶, Grégoire Le Gal ⁷, Marc A Rodger ⁸, Dean A Fergusson ⁹

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 Sanchez ⁴, Terry Unterman ⁵, Krista A Varady ¹

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 LRI
first 90 d	111	57
6mo	55	51%
ADULTS	769	66%
Any URI
ADULTS	500	62%

 

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