Frankly Speaking About Family Medicine

71% of adults in the United States are overweight or obese. To tackle this problem, primary care providers must stay up to date on the best evidence for addressing overweight and obese status in their patients. The DIETFITS Randomized Clinical Trial offers direction for nutritional advice in this important and serious public health concern. Guest: Kenneth Peterson, PhD, FNP-BC

Immunization practices are constantly in flux as new vaccines are approved and guidelines are updated. Recently, the FDA approved a 2-dose hepatitis B virus (HBV) vaccine and a new 2-dose herpes zoster (HZ) vaccine. Additionally, the CDC now recommends a 2-dose human papillomavirus (HPV) vaccine schedule, a change from the previous recommendation for a 3-dose schedule. This session will discuss the changing landscape of immunization practices and recent changes to recommendations. Guest: Robert A. Baldor, MD, FAAFP

Management of patients with atrial fibrillation has long centered on the relative merits of rate control versus rhythm control. The CASTLE-AF trial evaluated catheter ablation as a treatment for patients with both heart failure with reduced ejection fraction and atrial fibrillation. Listen to this week’s podcast episode to learn about the results of this new trial and how the catheter ablation impacted clinical outcomes. Guest: Alan Ehrlich MD

In this week’s episode, we’ll be continuing the discussion on the AAN’s updated practice guideline on mild cognitive impairment. Last week’s podcast episode provided overview of the updated practice guideline, and this week’s episode focuses on treatment recommendations. Guest: Robert A. Baldor, MD, FAAFP

The American Academy of Neurology recently published the first updated practice guideline on mild cognitive impairment since 2001. Listen to this week’s episode for an overview of the updated practice guideline, which includes a systematic review of prevalence, prognosis, screening, and treatment research with clear recommendations for practicing clinicians. Guest: Robert A. Baldor, MD, FAAFP

This observational study found adding very little activity, akin to going for a 30-minute walk or converting to a standing desk for half your workday, lowered all-cause and cardiovascular mortality. Guest: Alan Ehrlich, MD

Direct acting oral anticoagulants are increasingly used for stroke prevention for individuals with atrial fibrillation. Whether these agents are as safe and effective as warfarin has been a concern for many clinicians, but recent comparative effectiveness analyses are providing answers. In this week’s podcast episode, we will review these recent studies and draw some conclusions about which agents are best. Guest: Robert A. Baldor, MD, FAAFP

Listen to this week’s episode to learn about the basic concepts of behavioral activation (BA), what research has demonstrated about its use in depression, and how to apply BA in everyday care. Guest: Susan Feeney, DNP, FNP-BC

Patients with chronic diseases, including coronary artery disease, are advised to get yearly flu shots because they are at higher risk for having a more severe illness. Canadian researchers have found that in the week following being diagnosed with the flu, adults over 65 years old have a significantly increased risk of myocardial infection.

In this session we discuss the impact of length of sleep on obesity and DM II.

This session will review the existing evidence between coffee consumption and multiple health outcomes.

Treating recurrent C. difficile colitis can be difficult, but recent trials have demonstrated the benefit of treating with fecal transplantation. Questions exist, however, about around the best mode of administration. Listen to this week’s episode to learn about a recent RCT that compares oral and colonoscopic delivery methods and provides an answer. Learning Objectives: Appreciate the current guidelines for treating recurrent difficile colitis Understand the pharmacology of fecal transplantation Learn about the latest research on how best to administer such treatment

New hypertension guidelines from the American College of Cardiology have introduced a new blood pressure classification system and lowered the threshold for initiating pharmacotherapy in certain patient populations. Learning Objectives: Understand the new classification categories of hypertension Understand the new thresholds for starting treatment Understand the limitations of the new recommendations to specific patient populations

For severe, acute pain, 1000 mg of acetaminophen PLUS 400 mg of ibuprofen is as effective as acetaminophen/oxycodone, acetaminophen/hydrocodone, or acetaminophen/codeine. Listen to this week’s episode to learn more about treating acute pain safely. Learning Objectives: Review the current trial comparing Acetaminophen plus Ibuprofen to other acetaminophen/opioid combinations on pain outcomes Summarize the other data supporting this combination in children and adults Understand the path that can lead from acute pain to dependence.

This session will review the recommendations put forth by the CDC’s Advisory Committee on Immunization Practices for the use of a new shingles vaccine. Dosing, use, and efficacy will be discussed. Learning Objectives: Review the new vaccine recommendations for the prevention of shingles. Discuss the use of the current vaccine and new vaccine with dosage and schedule. Provide a resource for the treatment of post herpetic neuralgia.

Diabetes remission is defined as a return to normal blood sugar control without the use of medications. Listen to this episode to learn about a trial in which the use of a very low calorie diet in a primary care setting resulted in significant weight loss and remission of diabetes. Learning Objectives: Understand what is meant by diabetes remission Understand what treatments can lead to diabetes remission

Listen to this episode to learn about the evidence-based guidelines for the diagnosis and management of acute sinusitis. Learning Objectives: Discuss the most recent EBP Guidelines on diagnosis and management of acute sinusitis Discuss application of best practices for appropriate management of acute sinusitis and strategies for good antibiotic stewardship. Guest: Susan Feeney, DNP, FNP-BC

Medication-based maintenance therapy is recommended for patients with opioid dependence. Listen to this week’s episode to learn how once monthly naltrexone injections are as effective as daily treatment with buprenorphine/naloxone. Learning Objectives: Understand data comparing long-acting naltrexone to daily buprenorphine/naloxone Understand importance of medication-based maintenance therapy

We will discuss the use of azithromycin as a therapeutic option for patients with persistent symptomatic asthma despite controller maintenance therapy with inhaled corticosteroids and a long-acting bronchodilator. Learning Objectives: Understand the effect of chronic azithromycin for reducing asthma exacerbation Understand the role azithromycin can play in asthma step-wise therapy

What do you say when your 50-year-old patient that has been relatively sedentary in the last 3 decades wants to do a triathlon? In this episode, we will review a U.S. case series of participants in triathlon races from 1985-2016, and discuss risk, reward, and reality. Learning Objectives: Review data collected over 30 years on triathlon events and the risks to participants. Discuss recommendations for patients embarking on extreme physical activity. Review strategies to promote well-being and lower risk when considering endurance sports.

If you become frustrated trying to get a thigh cuff onto the arm of an obese patient, we may have the answer. Learning Objectives: Review the comparison of standard BP determination with using the forearm and radial pulse with a large cuff Appreciate the benefits of systolic hypertension control Review the causes of secondary hypertension in obese patients

In this episode, we discuss the first evidence-based guidelines by the American Academy of Pediatrics on body modification, piercing, and scarification, including complications and assessment of risk. Learning Objectives: Discuss the AAP’s EBP Guidelines on body modification, piercing and scarification in children, adolescents and young adults Discuss best practices for counseling adolescents and strategies for reducing associated risks regarding these practices.

How much exercise makes a difference in the primary prevention of depression and anxiety? Find out in this podcast which will provide insights from Norway’s HUNT cohort study that followed a healthy cohort of 33,908 individuals for 11 years. Learning Objectives: Review the relation of exercise and the development of depression and anxiety in a healthy population. Discuss strategies and options to alleviate stress and promote wellness.

Learning Objectives: Understand the results of the Stroke Oxygen Study Understand which patients will benefit from supplemental oxygen

Learning Objectives: Review the data on the risks of SU use Consider other second line approaches to Type 2 DM Review Primary Treatment Goals for T2DM

Learning Objectives: Discuss the AAP position and why Review findings of adverse events and where the danger lies Offer advice on what to use and how to dose.

Learning Objectives: Identify the concerns surrounding depression screening and treatment. Discuss the numerous factors primary care providers need to take into consideration to improve management of depression in their patients.

Learning Objectives: Discuss EBP Guidelines on management of Acid related GI condition and PPI prescribing Discuss best practice for appropriate PPI use in primary care and strategies for discontinuation.

Learning Objectives: Discuss the 2017-2018 American College of Advisory Committee on Immunization Practices (ACIP) 2017-2018 Seasonal Influenza Vaccine. Review age recommendations, high-risk populations and contraindications for seasonal influenza vaccination. Discuss best practices and dispel myths your patients may believe that prevent influenza vaccination.

Learning Objectives: Understand the scope of the problems associated with sleep disordered breathing in children Review outcomes from this systematic review and meta analysis Appreciate the possible indications for surgery in children with sleep disordered breathing

Learning Objectives: Clarify the concerns surrounding e-cigarette use. Discuss the potential for incorporating e-cigarette use as a smoking cessation strategy for patients.

Learning Objectives: Know which patients are most likely to benefit from antibiotics following incision and drainage of and abscess Know which antibiotics are preferred to use for patients following incision and drainage

Learning Objectives: Discuss the most recent evidence based practice guidelines on safe infant sleep environment Discuss barriers to implementing the EBP safe sleep environment guidelines Discuss strategies to improve compliance with EBP safe sleep environment guidelines

Learning Objectives: Discuss the results of a longitudinal cohort study re: alcohol consumption and cognitive decline. Review U.S. Guidelines for alcohol consumption. Discuss best practice recommendations for primary care patient discussions on the use of alcohol.

Learning Objectives: Review best practices in the identification of migraine headache. Discuss recent updates for the prevention and treatment of migraines. Review the use of technology in the care of headache patients.

Learning Objectives: Review and compare current EB guidelines from the ACS, ACOG and USPSTF Discuss breast cancer risk and its impact on screening recommendations Discuss strategies to apply guidelines in practice

Learning Objectives: Discuss the history of e-Cigarettes and how they function Discuss the findings of the recent meta-analysis/systematic review regarding US teen use and the association with future tobacco smoking behavior Discuss the potential public health concerns, implication for health policy and best practice for family and pediatric providers

Learning Objectives: Discuss the AHA position statement on fats in the diet Review the types of fat and what is known about their relationship to heart disease Recommend a dietary approach that is based upon best evidence

Learning Objectives: Discuss the findings of Martins et al survey results in the context of primary care practice Identify validated tools useful in your practice to identify opioid misuse Discuss methods to promote effective pain management including utilizing safe prescribing strategies

Learning Objectives: Review how the correlation of artificial sweeteners and CNS outcomes were related Summarize how artificial sweeteners may increase risk for obesity and Type 2 Diabetes Remind listeners that use of sucrose in appropriate dosages is safer than artificial sweeteners

This podcast reviews the results of a meta-analysis that found no negative relationship between whole milk consumption and cardiovascular disease or with mortality. Learning Objectives Understand the rationale that led to decreased milk intake in the 80's and 90's Appreciate how a meta analysis can shed light on the role whole milk might play on heart disease Be reminded that using "logic" without scientific rigor can lead to false conclusions

Teaching patients lifestyle management strategies to improve health is no easy task. First steps involve increasing provider knowledge of the impact foods have on health. This episode discusses the latest evidence on different types of meat intake and meat associated compounds on health. Learning Objectives: Review the current evidence on meat intake and mortality Discuss the “real” world impact for patients in primary care

Kids love fruit juice. But how much is OK? What are the facts on fruit juice consumption in kids and what should you advise the families you care for? In this episode, we will discuss the latest recommendations from the American Academy of Pediatrics and how they may impact your practice. Learning Objectives: Identify the AAP recommendations for fruit juice consumption across childhood from infancy through adolescence Discuss health risks associated with increased fruit juice consumption Discuss strategies to promote healthy consumption of beverages in children and families

HPV immunization has been recommended for pre-teens and teens for over a decade, however vaccination rates remain low. In October 2016 the CDC changed their recommendations to 2 doses of HPV vaccine in teens before their 15th birthday (from 3 doses), does this make it easier for completion? Learning Objectives: Review the current recommendations for Human Papilloma Vaccination (HPV) in the young adolescent population including immunogenicity. Discuss the prevalence of HPV and associated diseases and cancer Review strategies to increase vaccination rates

Corticosteroids are often prescribed for short-term use for conditions such as asthma exacerbation, contact dermatitis, gout, and Bell’s palsy. Adverse effects from chronic use of corticosteroids is well known, but many clinicians believe that the risk of significant adverse effects from short-term use is minimal. A recent retrospective cohort study was done reviewing the records of 1.5 million adults to assess the adverse effects of treatment with corticosteroids for less than 30 days. Learning Objectives: Review the conditions for which corticosteroids may be used for short-term treatment Understand the potential risks associated with short-term treatment Understand the magnitude of the potential risks relative to possible benefits

Is Alternate day fasting the future of weight loss? Maybe not... Learning Objectives Understand how Alternate day fasting is practiced Appreciate why Alternate day fasting might make physiologic sense Review the recent literature on its strengths and weaknesses

When patients present with symptoms of a sore throat, an option for managing the pain that is sometimes used is corticosteroids. A randomized trial of a 1-time dose of 10 mg in patients with moderate to severe pharyngitis who were deemed to not need antibiotics found higher rates of symptom resolution at 48 hours. Learning Objectives: Understand potential benefits of corticosteroids for treatment of pain of acute pharyngitis Understand limitations of evidence for benefit Understand other options for symptom relief

Sensitive and important conversations with your adolescent population include contraceptive options. How do long acting reversible contraceptive methods (LARC’s) fit into your conversation? Let’s discuss a recent review and update your talk! Learning Objectives: Discuss the use of long acting reversible contraceptive methods (LARC’s). Describe the efficacy or LARC’s compared to other birth control methods. Describe communication strategies useful in discussing contraception with adolescents.

Based upon CDC data of death, narcotic prescription length of less than 5 days provided the best outcomes and the lowest risk of continued narcotic use. Learning Objectives: Understand the scope of the death attributable to narcotics Learn how to prevent a patient from becoming dependent upon opioids Consider methods to wean off opioids and use other proven agents for chronic non-cancerous pain

Oxygen is frequently given to patients routinely during the initial treatment of a myocardial infarction, but there is a lack of data to support or refute this. A recent systematic review found no benefit in patients who did not have baseline hypoxia. Oxygen therapy continues to be indicated for those with hypoxia and needs to be used with caution in COPD patients with carbon dioxide retention. Learning Objectives Understand the role of oxygen in the management of acute myocardial infarction Understand the potential for harm of unnecessary oxygen therapy