Frankly Speaking About Family Medicine

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

What are your evidence-based strategies for managing acute, subacute and chronic low back pain? A review of the current American College of Physicians Clinical Practice Guideline can renew your toolkit as you help your patients with back pain maintain a healthy and active lifestyle. Learning Objectives Review the latest guidelines on acute, subacute and chronic low back pain (ACP 2/2017) Discuss non-pharmacologic and pharmacologic therapies available to the primary care provider

Most patients who suffer an acute gout attack should be started on urate lowering therapy. It is known that starting urate lowering therapy can itself precipitate a gout attack and concern for not worsening the acute symptoms has been the reason some guidelines recommend waiting until after the acute episode has subsided to start urate lowering therapy. A look at recent data indicates waiting for the acute attack to subside may not be necessary Learning Objectives: Understand the principles of urate lowering therapy for preventing gout attacks Be familiar with the risks and benefits or starting urate lowering therapy during an acute gout attack

In this week's podcast episode, we will review recent literature on ineffectiveness of laxatives and learn about indications for newer agents.

In this podcast episode, we will discuss current guidelines for a concussion evaluation or work-up as well as return to activity following a concussion. We will also put into context this paper and consider what impact this should have on your practice.

In this podcast episode, we will talk about how systolic hypertension effects outcomes, put into context a recent JACC systematic review paper on the topic and JNC 8 and discuss NNT and NNH.

In this week's podcast episode, we will identify the known health risks of OSA and outcomes of OSA treatment, discuss the new USPSTF screening recommendations on OSA and consider application of the new recommendations, known risks and outcomes of practice.

In this podcast episode, we will consider the rationale for using non-fasting labs to screen for ASCVD as well as review the controversies around their use and talk about the differential diagnosis of hypertriglyceridemia.

In this podcast episode, we will talk about the benefits of alpha antagonists on passing larger kidney stones as well as discuss the need for stone collection and analysis to prevent future stones. We will also learn how to effectively counsel patients about alpha antagonist use including risks and benefits.

In this podcast episode, we consider the premise of overdiagnosis and how it applies to women being screened for breast cancer and highlight ways to mitigate the risks of overdiagnosis of breast cancer.

Objectives: Appreciate the data on different exercise timelines Learn new options when counseling patients for exercise Understand the need to include exercise counseling for most adults

Have a patient with Statin Induced Myalgias? This episode will give you the best evidence on a simple and cost effective solution, and dispel common myths about this problem.

Can peanut allergy be prevented in children? This podcast will review the newest AAP recommendations on feeding in the first year of life, with a special emphasis on preventing atopic disorders. After listening to the podcast, listeners will be able to summarize essential points of current AAP EBP guidelines for introduction of complementary foods to infants and current EBP recommendations for introducing potentially allergenic foods, specifically peanut products, to low risk and high risk infants.

This episode will build on the previous podcast with a focus on how to apply the management guidelines in Asthma with a focus on critical features to know for board preparation.

This episode will review the basics of asthma diagnosis and management, covering the critical content for both patient management and board preparation.