Frankly Speaking About Family Medicine

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-307 Overview: The COVID-19 epidemic resulted in overflowing ICUs and significant numbers of deaths among older adults. A recent study looked at the differences in outcomes between patients admitted with “No-code” vs “CPR” status and found no difference for high-risk individuals. Listen to this brief podcast to explore the data from this study and, in turn, give patients the information they need to make informed decisions regarding their desired code status on their advanced directives. Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-306 Overview: In 2015, a landmark study, LEAP (Learning Early About Peanut Allergy), found that early introduction to peanuts, at 4 to 6 months, significantly reduced the incidence of peanut allergies in all children but especially in those at high risk for allergies. A recent survey of pediatric residents and attendings in a large academic center regarding knowledge and implementation of the guidelines uncovered a significant knowledge gap impacting the health of children. Join us as we discuss this gap and review the guidelines for preventing peanut allergies in infants and children. Episode resource links: Sandhu S, Hanono M, Nagarajan S, Vastardi MA. Knowledge assessment of early peanut introduction in a New York City population [published online ahead of print, 2022 Jun 18]. Ann Allergy Asthma Immunol. 2022;S1081-1206(22)00534-8. doi:10.1016/j.anai.2022.06.013 Greer FR, Sicherer SH, Burks AW, AAP COMMITTEE ON NUTRITION, AAP SECTION ON ALLERGY AND IMMUNOLOGY. The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods. Pediatrics. 2019;143(4): e20190281 Togias A, Cooper SF, Acebal ML, et al. Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. Ann Allergy Asthma Immunol. 2017;118(2):166-173.e7. doi:10.1016/j.anai.2016.10.004 Fleischer DM, Sicherer S, Greenhawt M, et al. Consensus Communication on Early Peanut Introduction and Prevention of Peanut Allergy in High-Risk Infants. Pediatr Dermatol. 2016;33(1):103-106. doi:10.1111/pde.12685 Du Toit, G., Roberts, G., Sayre, P. H., Bahnson, H. T., Radulovic, S., Santos, A. F., Brough, H. A., Phippard, D., Basting, M., Feeney, M., Turcanu, V., Sever, M. L., Gomez Lorenzo, M., Plaut, M., Lack, G., & LEAP Study Team (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. The New England journal of medicine, 372(9), 803–813. https://doi.org/10.1056/NEJMoa1414850 Koplin JJ, Soriano VX, Peters RL. Real-World LEAP Implementation. Curr Allergy Asthma Rep. 2021;22(6):61-66. doi:10.1007/s11882-022-01032-3 https://www.fda.gov/food/cfsan-constituent-updates/fda-completes-review-notification-regarding-health-claim-related-peanut-allergies Guest: Susan Feeney, DNP, FNP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-305 Overview: We will review the general treatment approach to gastroesophageal reflux disease (GERD) and the risks of using proton pump inhibitors (PPI) for long durations. In particular, we will examine a new study that links PPI use, in comparison with H2 receptor antagonist (H2RA) use, with a significant increase in the risk of gastric cancer. This episode will highlight the importance of looking at PPIs on a medication review and evaluating whether patients are taking them for longer than needed. Episode resource links: Abrahami D, McDonald EG, Schnitzer ME, et al. Proton pump inhibitors and risk of gastric cancer: population-based cohort study. Gut. 2022;71(1):16-24. Guest: Jillian Joseph, MPAS, PA-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-304 Overview: Pharmacogenomic testing has been suggested as a way to personalize medicine, particularly where the metabolism of medications can vary significantly. Unfortunately, despite increasing use of this testing, there has been little evidence showing a benefit in clinical outcomes. Listen to this podcast to explore the data on clinical outcomes for pharmacogenetic testing and how to best select medication for patients with depression. Episode resource links: Oslin DW, Lynch KG, Shih MC, et al. Effect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Selection and Remission of Symptoms in Major Depressive Disorder: The PRIME Care Randomized Clinical Trial. JAMA. 2022;328(2):151-161. Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-303 Overview: Millions of Americans take Vitamin D supplementation to prevent a variety of illnesses, from COVID-19 and osteoporosis to heart disease and cancer. While most studies have failed to show a benefit in preventing COVID-19, heart disease, and cancer, the evidence has been mixed, at best, in showing benefits for preventing bone fractures. Despite this, vitamin D supplementation remains popular for fracture prevention. Join us to review a study published in the New England Journal of Medicine that failed to find any benefits for preventing fractures. Episode resource links: N Engl J Med 2022;387:299-309. DOI: 10.1056/NEJMoa2202106 Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-302 Overview: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States, with a prevalence rate of more than 30% of US adults. Most have not been diagnosed or treated. Join us to discuss the new AACE guidance on the diagnosis and treatment of NAFLD to reduce the burden of this common disease. Episode resource links: AACE Guideline: Endocrine Pract: May 2022, 28(5): 528-562 Coffee: Front Pharmacol. 2021 Dec 13;12:786596. doi: 10.3389/fphar.2021.786596 Guest: Robert A. Baldor, MD Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-301 Overview: In this episode, we will discuss a simple and inexpensive yet effective strategy for slowing the loss of knee joint cartilage in a patient with osteoarthritis: walking. Hear how recent evidence suggests that including a walking regimen into treatment plans may confer numerous benefits in this patient population. Episode resource links: Busse, JW, Sadeghirad, B., Oparin, Y. et al; Management of Acute Pain From Non–Low Back, Musculoskeletal Injuries: A Systematic Review and Network Meta-analysis of Randomized Trials. Ann Intern Med.2020;173:730-738. [Epub 18 August 2020]. doi:10.7326/M19-3601 Kolasinski, S.L., Neogi, T., Hochberg, M.C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W.F., Hawker, G., Herzig, E., Kwoh, C.K., Nelson, A.E., Samuels, J., Scanzello, C., White, D., Wise, B., Altman, R.D., DiRenzo, D., Fontanarosa, J., Giradi, G., Ishimori, M., Misra, D., Shah, A.A., Shmagel, A.K., Thoma, L.M., Turgunbaev, M., Turner, A.S. and Reston, J. (2020), 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res, 72: 149-162. https://doi.org/10.1002/acr.24131 Lo GH, Vinod S, Richard MJ, et al. Association Between Walking for Exercise and Symptomatic and Structural Progression in Individuals with Knee Osteoarthritis: Data from the Osteoarthritis Initiative Cohort [published online ahead of print, 2022 Jun 8]. Arthritis Rheumatol. 2022;10.1002/art.42241. doi:10.1002/art.42241 Thudium C. Markers of synovial inflammation matrix turnover and symptoms. Presented at: OARSI 2022 World Congress on Osteoarthritis; April 7-10; Berlin, Germany (virtual meeting). Ooman JMH. Babs on a mission: An experimental study on the effects of message framing and exemplification on treatment intentions of osteoarthritis patients. Presented at: OARSI 2022 World Congress on Osteoarthritis; April 7-10; Berlin, Germany (virtual meeting). Zeng C, Doherty M, Persson MSM, et al. Comparative efficacy and safety of acetaminophen, topical and oral non-steroidal anti-inflammatory drugs for knee osteoarthritis: evidence from a network meta-analysis of randomized controlled trials and real-world data. Osteoarthritis Cartilage. 2021;29(9):1242-1251. doi:10.1016/j.joca.2021.06.004 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-300 Overview: Most primary care clinicians are unaware of a possible association between childhood cat ownership and adult psychosis. Join us to hear the results of a recent retrospective study that suggests this link. Hear practical tips to share with patients who own an outdoor cat to help them avoid the toxoplasmosis that may be a potential etiologic agent for psychiatric illness. Episode resource links: Journal of Psychiatric Research. Volume 148, April 2022, Pages 197-203 doi.org/10.1016/j.jpsychires.2022.01.058 Guest: Robert A. Baldor, MD Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-299 Overview: Polypharmacy is a burden on patients with dementia. Adverse drug reactions, side effects, the cost, and inappropriate medications that may lead to falls and morbidity/mortality may be conferring more harm than benefit. Unfortunately, 44% of men and 57% of women >65 years take five or more nonprescription and/or prescription medications per day. Join us as we discuss methods for deprescribing polypharmacy in this patient population. Episode resource links: Growdon, M. E., Gan, S., Yaffe, K., & Steinman, M. A. (2021). Polypharmacy among older adults with dementia compared with those without dementia in the United States. Journal of the American Geriatrics Society, 69(9), 2464–2475. PMID: 34101822 https://doi.org/10.1111/jgs.17291 Narayan, S. W., & Nishtala, P. S. (2017). Discontinuation of Preventive Medicines in Older People with Limited Life Expectancy: A Systematic Review. Drugs & aging, 34(10), 767–776. PMID: 28853000 https://doi.org/10.1007/s40266-017-0487-1 Guest: Jill M. Terrien PhD, ANP-BC Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-298 Overview: : Lower respiratory tract infections are a common presentation in children, and many of those children receive antibiotic prescriptions. Join us for this episode to review evidence that supports avoiding such treatment unless pneumonia or other bacterial infections are suspected. Episode resource links: Little P, Francis NA, Stuart B, et al. Antibiotics for lower respiratory tract infection in children presenting in primary care in England (ARTIC PC): a double-blind, randomised, placebo-controlled trial. Lancet. 2021;398(10309):1417-1426 Guest: Jillian Joseph, MSPAS, PA-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-297 Overview: The efficacy of probiotic formulations in the prevention of antibiotic-associated diarrhea remains unclear. Join us to review a recent study in JAMA Pediatrics that attempts to answer this question. Episode resource links: Multispecies Probiotic for the Prevention of Antibiotic-Associated Diarrhea in Children A Randomized Clinical Trial Guest: Robert A. Baldor, MD Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-296 Overview: The number of drug overdoses in the United States continues to rise in tandem with the growing opioid epidemic. In 2020, nearly 92,000 people died from drug overdoses in the United States, which was an approximate 31% increase in just one year. This episode will highlight perceived barriers to harm reduction and show primary care providers how they can play a key role in overdose prevention. Episode resource links: https://www.cdc.gov/opioids/overdoseprevention/reverse-od.html https://www.cdc.gov/drugoverdose/deaths/index.html#:~:text=Drug%20Overdose%20Deaths%20Remain%20High&text=Opioids%E2%80%94mainly%20synthetic%20opioids%20(other,of%20all%20drug%20overdose%20deaths). Bonner, L. (2022). As the opioid epidemic takes a turn for the worse, do we need more potent forms of naloxone?. Pharmacy Today, 28(3), 26. Messmer, S., & Jarrett, J. (2022). When Naloxone Isn’t Enough. New England Journal of Medicine. Tse, W. C., Djordjevic, F., Borja, V., Picco, L., Lam, T., Olsen, A., ... & Nielsen, S. (2022). Does naloxone provision lead to increased substance use? A systematic review to assess if there is evidence of a ‘moral hazard’associated with naloxone supply. International Journal of Drug Policy, 100, 103513. Guest: Mariyan L. Montaque, DNP, FNP-BC Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-295 Overview: Chronic obstructive pulmonary disease (COPD) is typically diagnosed based on spirometry findings, but what if that finding isn’t what you expect? Spirometry measurements are compared to standard values for age, sex, and race. The use of race-based equations has been questioned in several clinical situations, and researchers are now raising similar concerns about the use of race-based equations in spirometry, which may lead to health inequities. Join us for an important discussion on how to overcome these potential disparities in diagnosing COPD. Episode resource links: Liu GY, Khan SS, Colangelo LA, et al. Comparing Racial Differences in Emphysema Prevalence Among Adults With Normal Spirometry: A Secondary Data Analysis of the CARDIA Lung Study [published online ahead of print, 2022 Jul 19]. Ann Intern Med. 2022;10.7326/M22-0205. Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-294 Overview: Fibromyalgia is a common and difficult to diagnose disease, with highly subjective symptoms. Another challenge is that treatment is dependent on a patient’s implementation lifestyle changes. This brief podcast walks you through the diagnosis of fibromyalgia and offers best evidence on effective treatments. Episode resource links: Mediations: JAMA Netw Open. 2022;5(5):e2212939 Acupuncture: J Pain Res. 2022; 15: 315–329 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-293 Overview: Evidence informs us that almost one-third of antibiotic prescriptions written for children in the United States are inappropriate, meaning they are not in line with evidence-based guidelines. Antibiotics are tremendous tools and beneficial when used appropriately; however, as with all pharmacological therapy, there are risks of adverse effects and healthcare cost. When prescribed inappropriately, they unnecessarily put children at risk and cause financial burden on individuals and the system. Please join the podcast team as we discuss recent evidence on these risks and burden and consider how this evidence can help improve practice. Episode resource links: Butler AM, Brown DS, Durkin MJ, et al. Association of Inappropriate Outpatient Pediatric Antibiotic Prescriptions With Adverse Drug Events and Health Care Expenditures. JAMA Netw Open.2022;5(5):e2214153. doi:10.1001/jamanetworkopen.2022.14153 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-292 Overview: Alcohol use disorder is common, but effective medications to treat this disorder are not widely prescribed in the outpatient primary care setting, despite being available and having relatively good formulary coverage. Join us to hear how the use of medical treatment can decrease the incidence and progression of alcohol-associated liver disease. Episode resource links: Augustin G. L. Vannier et al, Incidence and Progression of Alcohol-Associated Liver Disease After Medical Therapy for Alcohol Use Disorder, JAMA Network Open (2022). DOI: 10.1001/jamanetworkopen.2022.13014 Tetreault JM, O'Connor PG. Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. UpToDate. Published April 28, 2022. Accessed June 11, 2022. Holt SR, Tetrault, JM. Ambulatory Management of alcohol withdrawal. UpToDate. Published May 19, 2022. Accessed June 11, 2022. Holt SR. Approach to treating alcohol use disorder. UpToDate. Published March 22, 2022. Accessed June 11, 2022. Guest: Jillian Joseph, MSPAS, PA-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-291 Overview: Concerns have been raised over guideline recommendations for lowering systolic blood pressure (BP) to 60 years. To achieve such targets often requires intensive BP treatments, which can result in harms from syncope or falls. Join us to review the results of a recently published meta-analysis done to estimate the time needed to potentially derive clinical benefit from such BP treatments in patients 60 years and older. Episode resource links: JAMA Intern Med. 2022;182(6):660-667. doi:10.1001/jamainternmed.2022.1657 Guest: Robert A. Baldor, MD Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-290 Overview: This brief podcast discusses the prevalence of egg and nut allergies in children, how to lower the risk of developing these allergies, and which patients are at greatest risk. Hear how to best counsel parents about their child’s allergies and help them anticipate their child’s future health. Episode resource links: The natural history of peanut and egg allergy in children up to age 6 years in the HealthNuts population-based longitudinal study; Am Aca Allergy, Asthma & Immunol 2022; https://doi.org/10.1016/j.jaci.2022.04.008 Dietary Interventions to pRevent Atopic Disease in Children, AAP 3/19: https://publications.aap.org/aapnews/news/8699 Guest: Jill M. Terrien PhD, ANP-BC Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-289 Overview: Excessive screen time has been associated with numerous adverse health outcomes. Join us for a look at a fascinating new study that explores how limiting screen time can increase physical activity in children. Listen to this brief podcast before you counsel your next patient on how screen time can affect their children’s (and their) health. Episode resource links: Pedersen J,et al. Effects of Limiting Recreational Screen Media Use on Physical Activity and Sleep in Families With Children: A Cluster Randomized Clinical Trial. JAMA Pediatr. 2022 May 23:e221519 Screen Time and Children. American Academy of Child and Adolescent Psychiatry: https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-And-Watching-TV-054.aspx Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-288 Overview: Coffee is one of the most consumed beverages worldwide. An estimated 500 million cups are consumed per day in the United States. As testimony to this, count the number of coffee shops available—most with drive-through access—the next time you are out for a drive. A growing body of evidence indicates that moderate coffee consumption (2-3 cups per day) is associated with reduction in all-cause mortality. What hasn’t been looked at closely is the effect of coffee with sugar and artificial sweeteners on these measures. Join us while we discuss recent evidence regarding consumption of coffee—with or without sweeteners—and its association with all-cause mortality. Episode resource links: Liu D, Li ZH, Shen D, Zhang PD, Song WQ, Zhang WT, Huang QM, Chen PL, Zhang XR, Mao C. Association of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Coffee Consumption With All-Cause and Cause-Specific Mortality : A Large Prospective Cohort Study. Ann Intern Med. 2022 May 31. doi: 10.7326/M21-2977. Epub ahead of print. PMID: 35635846. Wee CC. The Potential Health Benefit of Coffee: Does a Spoonful of Sugar Make It All Go Away? Ann Intern Med. 2022 May 31. doi: 10.7326/M22-1465. Epub ahead of print. PMID: 35635845. Guest: Susan Feeney, DNP, FNP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-287 Overview: Join us to discuss the rates of false positives in mammography and how to decrease them. Specifically, this session reviews data from an observational comparative effectiveness study suggesting that the type of mammography, interval, and other factors can affect the probability of false positive results. Episode resource links: Ho TH, Bissell MCS, Kerlikowske K, et al. Cumulative Probability of False-Positive Results After 10 Years of Screening With Digital Breast Tomosynthesis vs Digital Mammography. JAMA Netw Open. 2022;5(3):e222440. doi:10.1001/jamanetworkopen.2022.2440 Breast Cancer Screening Guidelines for Women (CDC Chart)—Last reviewed 9-2020 chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.cdc.gov/cancer/breast/pdf/breast-cancer-screening-guidelines-508.pdf Canelo-Aybar, C., Posso, M., Montero, N. et al. Benefits and harms of annual, biennial, or triennial breast cancer mammography screening for women at average risk of breast cancer: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC). Br J Cancer 126, 673–688 (2022). https://doi.org/10.1038/s41416-021-01521-8 Guest: Jill M. Terrien PhD, ANP-BC Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-286 Overview: The controversy surrounding whether to prescribe aspirin for primary prevention of cardiovascular disease in adult patients has left many clinicians unsure of the right approach. In this podcast, we’ll review the latest USPSTF recommendation on this topic and dig into the evidence behind the recommendation. Episode resource links: JAMA. 2022;327(16):1577-1584. doi:10.1001/jama.2022.4983 Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-285 Overview: Join us for a closer look at tirzepatide, a first-in-class glucose-dependent insulinotropic peptide (GIP) and a glucagon-like peptide-1 receptor agonist (GLP-1 RA). See how this novel glucose-lowering agent can help raise the bar in both HbA1c lowering and weight loss in patients with type 2 diabetes mellitus. Episode resource links: Karagiannis T, Avgerinos I, Liakos A, Del Prato S, Matthews DR, Tsapas A, Bekiari E. Management of type 2 diabetes with the dual GIP/GLP-1 receptor agonist tirzepatide: a systematic review and meta-analysis. Diabetologia. 2022 May 17:1–11. Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-284 Overview: Most primary care clinicians treating patients with male androgenetic alopecia are unfamiliar with studies looking at off-label use of medications for this condition. In this episode, you will hear a review of an important recent meta-analysis published in JAMA Dermatology that highlights the efficacy of commonly used agents to treat this condition. Episode resource links: JAMA Dermatol. doi:10.1001/jamadermatol.2021.5743 Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-283 Overview: Listen to this podcast to hear a simple method to help those with COPD improve their symptom control and lower exacerbation rates. Episode resource links: Am J Respir Crit Care Med Vol 205, Iss 4, pp 421–430, Feb 15, 2022 Guest: Jillian Joseph, MSPAS, PA-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-282 Overview: Monkeypox is endemic in certain parts of Africa, but outbreaks in Europe and North America have recently occurred. While still uncommon, clinicians need to be alert to the possibility of this diagnosis. This podcast gives you the tools you need to identify risk factors and distinguish the disease from other infections. Episode resource links: World Health Organization Health Topics/Monkeypox https://www.who.int/health-topics/monkeypox#tab=tab_1 Disease outbreak New/Item/Multi-country monkeypox outbreak: situation update 6-10-2022 https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON392 Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-281 Overview: Clinicians may hesitate to provide medication abortion without first performing a pelvic ultrasound or pelvic examination, but recent data may give clinicians more confidence in their decision to do so. This episode explores the evidence for the safety of telehealth-based, or no-test screening, approaches to providing medication abortion for pregnant women at less than 10 weeks’ gestation. Episode resource links: Upadhyay UD, Raymond EG, Koenig LR, et al. Outcomes and Safety of History-Based Screening for Medication Abortion: A Retrospective Multicenter Cohort Study. JAMA Intern Med. Published online March 21, 2022. doi:10.1001/jamainternmed.2022.0217 Upadhyay UD, Koenig LR, Meckstroth KR. Safety and Efficacy of Telehealth Medication Abortions in the US During the COVID-19 Pandemic. JAMA Network Open. 2021;4(8):e2122320. doi:10.1001/jamanetworkopen.2021.22320 Endler M, Lavelanet A, Cleeve A, Ganatra B, Gomperts R, Gemzell-Danielsson K. Telemedicine for medical abortion: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology. 2019;126(9):1094-1102. doi:10.1111/1471-0528.15684 Guest: Jillian Joseph, MSPAS, PA-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-280 Overview: Statins are widely used for lowering cholesterol in patients at risk for cardiovascular disease. While the benefit is more established with secondary prevention compared with primary prevention, most of the benefits are reported in relative risk reduction, which can exaggerate the benefit to an individual person. In this podcast, you’ll hear a discussion of a recent systematic review that looked at the absolute risk reduction and relative risk reduction with statins for preventing death, myocardial infarctions, and stroke. Episode resource links: Byrne, P. , Demasi, M. , Jones, M. , et al. Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment. JAMA Internal Medicine Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-279 Overview: Clinicians (and patients) know that walking is beneficial for overall health, but what are the specifics? How many steps per day lower health risks? What impact does walking have on mortality? What’s the best way to count steps? Join us to hear answers to these questions and more as we discuss evidence-based recommendations for steps/day. Episode resource links: Paluch, A. E., Bajpai, S., Bassett, D. R., Carnethon, M. R., Ekelund, U., Evenson, K. R., Galuska, D. A., Jefferis, B. J., Kraus, W. E., Lee, I. M., Matthews, C. E., Omura, J. D., Patel, A. V., Pieper, C. F., Rees-Punia, E., Dallmeier, D., Klenk, J., Whincup, P. H., Dooley, E. E., Pettee Gabriel, K., … Steps for Health Collaborative (2022). Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. The Lancet. Public health, 7(3), e219–e228. https://doi.org/10.1016/S2468-2667(21)00302-9 https://www.cdc.gov/physicalactivity/index.html This website includes data, resources and information for patients and providers for physical activity. Guest: Jill M. Terrien PhD, ANP-BC Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-278 Overview: Misconceptions abound on the long-term effects of chronic use of marijuana. This episode tackles these misconceptions head-on, highlighting new data on marijuana’s adverse effects on central nervous system function, including loss of memory, IQ points, and executive functioning. It’s a must-listen for clinicians caring for patients engaging in regular marijuana use. Episode resource links: Am J Psych 8 Mar 2022 https://doi.org/10.1176/appi.ajp.2021.21060664 Guest: Jillian Joseph, MSPAS, PA-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-277 Overview: Join us to discuss a summary of the newly published guidelines for pneumococcal vaccines and to review the most recently approved vaccines. We’ll begin by describing the challenges from the previous guidelines and how these new guidelines address these challenges. Given the burden of pneumococcal disease and that vaccination is our best weapon to combat the disease, you won’t want to miss this episode. Episode resource links: Morga, A., Kimura, T., Feng, Q., Rozario, N., & Schwartz, J. (2022). Compliance to Advisory Committee on Immunization Practices recommendations for pneumococcal vaccination. Vaccine. https://www.medscape.com/viewarticle/967675#vp_1 Schulz, P. S., Moore, S. E., Smith, D., Javed, J., & Wilde, A. M. (2022, April). Missed Pneumococcal Vaccination Opportunities in Adults With Invasive Pneumococcal Disease in a Community Health System. In Open Forum Infectious Diseases (Vol. 9, No. 4, p. ofac075). US: Oxford University Press. Center for disease Control and Prevention Resources: App for iphone and android PneumoRecs Guest: Mariyan L. Montaque, DNP, FNP-BC Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-276 Overview: The concerns over the use of NSAIDs have been well documented. The medications can raise blood pressure and have been linked to an increased risk of heart disease and stroke when used long term. These known risks, supported by the FDA’s warning in 2005, has prompted many clinicians to prescribe acetaminophen instead. But do acetaminophen products confer a lower risk of cardiovascular effects? Join us for this episode to review the results from recent trials assessing similar blood pressure effects from regular use of acetaminophen. Episode resource links: https://doi.org/10.1161/CIRCULATIONAHA.121.056015 Circulation. 2022;145:416–423 https://doi.org/10.1093/eurheartj/ehac059; European Heart Journal. 2,24,2022 Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-275 Overview: The multitude of benefits of breastfeeding for both mother and baby are well documented. However, we’ve seen mixed evidence for the relationship between breastfeeding and certain childhood lung conditions, with some studies suggesting an increase in risk. A recent study found that exclusive breastfeeding was associated with decreased lower respiratory tract infection (LRTI), asthma, and allergic rhinitis. A potential connection between these conditions, breastfeeding, and the infant’s gut microbiome was also found. Join us as we discuss these findings and how to incorporate them into your practice to improve the health of women and infants. Episode resource links: Rosas-Salazar C, Shilts MH, Tang ZZ, Hong Q, Turi KN, Snyder BM, Wiggins DA, Lynch CE, Gebretsadik T, Peebles RS Jr, Anderson LJ, Das SR, Hartert TV. Exclusive Breastfeeding, the Early-life Microbiome and Immune Response, and Common Childhood Respiratory Illnesses. J Allergy Clin Immunol. 2022 Mar 10:S0091-6749(22)00292-5. doi: 10.1016/j.jaci.2022.02.023. Epub ahead of print. PMID: 35283139. Rosas-Salazar C, Forno E, Brehm JM, Han YY, Acosta-Pérez E, Cloutier MM, Wakefield DB, Alvarez M, Colón-Semidey A, Canino G, Celedón JC. Breastfeeding duration and asthma in Puerto Rican children. Pediatr Pulmonol. 2015 Jun;50(6):527-34. doi: 10.1002/ppul.23061. Epub 2014 Aug 6. PMID: 25100626; PMCID: PMC4320027. AAP Breastfeeding Guidelines. https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Where-We-Stand-Breastfeeding.aspx ACOG. https://www.acog.org/womens-health/infographics/breastfeeding-benefits CDC Recommendations and Benefits of Breastfeeding. https://www.cdc.gov/nutrition/infantandtoddlernutrition/breastfeeding/recommendations-benefits.html CDC Breastfeeding Report Card. https://www.cdc.gov/breastfeeding/data/reportcard.htm US Dietary Guidelines for Americans. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf#page=65 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-274 Overview: Recurrent urinary tract infections (UTIs) can be a frustrating problem for both patients and clinicians. Antibiotics are often used, but a prevailing concern is that the overuse of antibiotics may lead to more resistant bacteria. This podcast discusses methenamine hippurate as an important nonantibiotic alternative for UTI prophylaxis. Episode resource links: Harding C, Mossop H, Homer T, et al. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial. BMJ. 2022 Mar 9;376:e068229. Lee BS, Bhuta T, Simpson JM, Craig JC. Methenamine hippurate for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10(10):CD003265. Published 2012 Oct 17. Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-273 Overview: The evidence continues to grow and evolve on the potential harms of e-cigarette use and on their efficacy and safety as a harm reduction strategy. One aspect of e-cigarette use that has not received much attention is the effect of secondhand exposure to the exhaled aerosol from e-cigarettes. Previous small studies have suggested some exposure risk, but a recent study of >2,000 participants found that secondhand exposure to e-cigarette aerosol increased the risk of bronchitic symptoms and shortness of breath in young adults. Join us as we discuss these findings and their implications to practice. Episode resource links: Islam T, Braymiller J, Eckel SP, et al Secondhand nicotine vaping at home and respiratory symptoms in young adults Thorax Published Online First: 10 January 2022. doi: 10.1136/thoraxjnl-2021-217041 Caponnetto P, Caruso M, Maglia M, et al. Non-inferiority trial comparing cigarette consumption, adoption rates, acceptability, tolerability, and tobacco harm reduction potential in smokers switching to Heated Tobacco Products or electronic cigarettes: Study protocol for a randomized controlled trial. Article. Contemporary Clinical Trials Communications. 2020;17100518. doi:10.1016/j.conctc.2020.100518 Gaiha SM, et al. J Adolesc Health. Association Between Youth Smoking, Electronic Cigarette Use, and COVID-19. J Adolesc Health. Vol 67, issue 4, pp 519-523; DOI: https://doi.org/10.1015/j.jadolhealth.2020.07.002 Hartmann-Boyce J, McRobbie H, Lindson N, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. Apr 29 2021;4:CD010216. doi:10.1002/14651858.CD010216.pub5 Mayo Clinic. (2022, January 13). E-cigarette users who test positive for COVID-19 are more likely to experience COVID-19 symptoms. ScienceDaily. Retrieved January 17, 2022 from www.sciencedaily.com/releases/2022/01/220113151402.htm McAlinden KD, Eapen MS, Lu W, Chia C, Haug G, Sohal SS. COVID-19 and vaping: risk for increased susceptibility to SARS-CoV-2 infection? Eur Respir J. 2020. vol. 1. McFadden, DD, Bornstein, SL, Vassallo, R, Salonen, BR, Nadir Bhuiyan, M, Schroeder, DR, Croghan, IK. Symptoms COVID 19 Positive Vapers Compared to COVID 19 Positive Non-vapers. Journal of Primary Care & Community Health, 2022; 13: 215013192110626 DOI: 10.1177/21501319211062672 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-272 Overview: Clinicians need to accurately assess the degree of heart failure at the bedside to make appropriate management decisions. However, the common bedside practice of estimating right atrial pressure by measuring jugular venous pressure (JVP) has several accuracy limitations. This session focuses on the use of point-of-care ultrasound (POC-US) to improve the accuracy of JVP measurements. Join us to hear the salient findings from a recent study comparing POC-US measurements to right heart catheterization measurements, and walk away with a clear understanding of how POC-US can quickly and easily improve accuracy. Episode resource links: Wang L, Harrison J, Dranow E, Aliyev N, Khor L. Accuracy of Ultrasound Jugular Venous Pressure Height in Predicting Central Venous Congestion. Ann Intern Med. 2021 Dec 28. doi: 10.7326/M21-2781. Epub ahead of print. Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-271 Overview: Given the prevalence of cardiovascular disease (CVD) in the United States, it is key for primary care providers to counsel patients on the importance of exercise for CVD prevention. This brief podcast explores data that will help clinicians understand the need to prescribe exercise and rehabilitation in the primary care setting. You’ll walk away with clear guidance to offer patients and ultimately improve outcomes in CVD as well as multiple chronic diseases. Episode resource links: Naci, H., & Ioannidis, J. P. (2015). Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. British journal of sports medicine, 49(21), 1414–1422. https://doi.org/10.1136/bjsports-2015-f5577rep Sanchis-Gomar, F., Lavie, C. J., Marín, J., Perez-Quilis, C., Eijsvogels, T. M., O’Keefe, J. H., ... & Blair, S. N. (2021). Exercise effects on cardiovascular disease: from basic aspects to clinical evidence. Cardiovascular Research. Guest: Mariyan L. Montaque, DNP, FNP-BC Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-270 Overview: You know GLP-1 RAs are an important class of agents for weight loss, but do you know which drug within this class is right for your patient? This brief podcast walks you through the recent evidence from the STEP 8 randomized clinical trial, comparing the efficacy and adverse reaction profiles for 2 GLP-1 RAs: semaglutide (Wegovy) and liraglutide (Saxenda). This is a must-listen for anyone looking to optimally individualize care for patients with obesity. Episode resource links: Rubino DM, Greenway FL, Khalid U, et al. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8 Randomized Clinical Trial. JAMA. 2022;327(2):138–150. doi:10.1001/jama.2021.23619 Guest: Jillian Joseph, MSPAS, PA-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-269 Overview: Join us as we discuss the trajectories of prescription drug misuse from adolescence through adulthood. This session explores the findings from a longitudinal cohort study demonstrating the need for screening patients from adolescence through adulthood for substance use disorder. You’ll walk away with the tools and resources you need to accurately screen patients and determine next best steps for each individual. Episode resource links: McCabe, S. E., Schulenberg, J. E., Schepis, T. S., Evans-Polce, R. J., Wilens, T. E., McCabe, V. V., & Veliz, P. T. (2022). Trajectories of Prescription Drug Misuse Among US Adults From Ages 18 to 50 Years. JAMA network open, 5(1), e2141995. https://doi.org/10.1001/jamanetworkopen.2021.41995 PMID: 34982159 National Institute on Drug Abuse (NIDA) Drug Screening Tool for use in general medical settings: https://archives.drugabuse.gov/nmassist/ National Institute on Drug Abuse (NIDA) Evidence Based Screening and Assessment Tools and Resources (Includes adults and adolescents) https://www.drugabuse.gov/nidamed-medical-health-professionals/screening-tools-resources/chart-screening-tools Guest: Jill M. Terrien PhD, ANP-BC Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-268 Overview: This episode will help bring awareness to the importance of educating patients about post-exposure prophylaxis (PrEP) in the primary care setting. This talk will also discuss how to reduce the stigma surrounding this prevention method. Finally, you will hear about the newly FDA approved PrEP treatment option that could potentially improve outcomes for patients. Episode resource links: https://www.healio.com/news/infectious-disease/20211220/fda-approves-first-longacting-injectable-for-hiv-prevention Philbin, M. M., Parish, C., Kinnard, E. N., Reed, S. E., Kerrigan, D., Alcaide, M. L., ... & Metsch, L. R. (2021). Interest in long-acting injectable pre-exposure prophylaxis (LAI PrEP) among women in the women’s interagency HIV study (WIHS): a qualitative study across six cities in the United States. AIDS and Behavior, 25(3), 667-678. Kim Y. S. (2021). Long-Acting Injectable Antiretroviral Agents for HIV Treatment and Prevention. Infection & chemotherapy, 53(4), 686–695. https://doi.org/10.3947/ic.2021.0136 CDC Practice guidelines https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf Guest: Mariyan L. Montaque, DNP, FNP-BC Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-267 Overview: The clinical literature is filled with new and evolving evidence on the use of e-cigarettes and potential harms. The question of their use as a harm reduction strategy is a hotly debated topic—pitting traditional combustible tobacco with its well-known effect on morbidity and mortality against electronic nicotine delivery systems (ENDS), which although not harmless, are considered less harmful than smoked cigarettes. Recent evidence is emerging on the potential cardiovascular risks posed by newer generations of ENDS with far greater delivery of nicotine. Join us while we discuss the findings from a recent study that examines ENDS use and associated increase rates of erectile dysfunction (ED) and how this information may impact your practice. Episode resource links: El-Shahawy O, Shah T, Obisesan OH, Durr M, Stokes AC, Uddin I, Pinjani R, Benjamin EJ, Mirbolouk M, Osei AD, Loney T, Sherman SE, Blaha MJ. Association of E-Cigarettes With Erectile Dysfunction: The Population Assessment of Tobacco and Health Study. Am J Prev Med. 2022 Jan;62(1):26-38. doi: 10.1016/j.amepre.2021.08.004. Epub 2021 Nov 30. PMID: 34922653. Caponnetto P. Well-being and harm reduction, the consolidated reality of electronic cigarettes ten years later from this emerging phenomenon: A narrative review. Health Psychol Res. Dec 30 2020;8(3):9463. doi:10.4081/hpr.2020.9463 Hartmann-Boyce J, McRobbie H, Lindson N, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. Apr 29 2021;4:CD010216. doi:10.1002/14651858.CD010216.pub5 Guest: Susan Feeney, DNP, FNP-BC, NP- Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-266 Overview: ‘Tis the season for pediatric fevers! Join us to review a recent meta-analysis looking at 18 studies with patients younger than 2 years old who received acetaminophen or ibuprofen for fever or pain to determine if one medication should be recommended first, before the other. After this session, you’ll be able to confidently advise parents of young children on how best to manage fever and/or pain at home with over-the-counter medications. Episode resource links: Long B, Gottlieb M. Ibuprofen vs. Acetaminophen for Fever or Pain in Children Younger Than Two Years. Am Fam Physician. 2022 Jan ;105(1):19. Wong T, Stang AS, Ganshorn H, Hartling L, Maconochie IK, Thomsen AM, Johnson DW. Combined and alternating paracetamol and ibuprofen therapy for febrile children. Evid Based Child Health. 2014 Sep;9(3):675-729. doi: 10.1002/ebch.1978. PMID: 25236309. Sullivan JE, Farrar HC. Fever and Antipyretic Use in Children. Pediatrics (2011) 127 (3): 580-587. (Reaffirmed 2016) Guest: Jillian Joseph, MSPAS, PA-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-241 Overview: Seven percent of the US population has an active levothyroxine prescription, which is significantly greater than the number of people diagnosed with overt hypothyroidism. Many of these prescriptions appear to be for the treatment of subclinical hypothyroidism and other conditions in euthyroid individuals. Join us to uncover the latest findings on the use of levothyroxine and what the evidence tells us about appropriate use and misuse of this drug. Episode resource links: Brito, J., Ross, J., El Kawkgi, O., Maraka, S., Deng, Y., Shah, N., Lipska, K. & (9000). Levothyroxine Use in the United States, 2008-2018. JAMA Internal Medicine, Publish Ahead of Print, doi: 10.1001/jamainternmed.2021.2686. Johansen, M., Marcinek, J., Yun, J. & (2020). Thyroid Hormone Use in the United States, 1997–2016. Journal of the American Board of Family Medicine, 33 (2), 284-288. doi: 10.3122/jabfm.2020.02.190159. Jeffrey R. Garber, Rhoda H. Cobin,Hossein Gharib,James V. Hennessey, Irwin Klein, Jeffrey I. Mechanick, Rachel Pessah-Pollack, Peter A. Singer,Kenneth A. Woeber. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association; November–December 2012. https://www.endocrinepractice.org/article/S1530-891X(20)43030-7/fulltext; https://www.endocrinepractice.org/action/showPdf?pii=S1530-891X%2820%2943030-7 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-265 Overview: Most cases of COVID-19 will resolve without interventions, but some patients are at high risk for complications. Several treatment options for high-risk patients are now available to help prevent the need for hospitalization. Join us to review a recent large, randomized trial evaluating fluvoxamine as a treatment for high-risk patients who were diagnosed with COVID-19. Episode resource links: Reis G, et al. TOGETHER investigators. Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial. Lancet Glob Health. 2022 Jan;10(1):e42-e51 Berwanger O. Fluvoxamine for outpatients with COVID-19: where do we stand? Lancet Glob Health. 2022 Jan;10(1):e2-e3. doi: 10.1016/S2214-109X(21)00501-5 https://activ6study.org/ Guest: Alan M. Ehrlich, MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-264 Overview: Get answers to your questions on COVID-19 infection in children. Listen to this podcast to review outcomes and potential risk factors associated with acute COVID-19 infection in this population. Finally, learn the status of immunizations for children younger than 5 years of age. Episode resource links: JAMA Netw Open. 2022;5(1):e2142322. doi:10.1001/jamanetworkopen.2021.42322 Guest: Jillian Joseph, MSPAS, PA-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-263 Overview: The FDA’s recent emergency use authorization (EUA) for oral agents to treat COVID-19 means that primary care providers (PCPs) will be on the frontline of treating patients with COVID-19. Therefore, PCPs must understand who is eligible for such treatments and how to prescribe them. We will discuss the results of the recent FDA EUA for Pfizer’s Paxlovid and Merck’s molnupiravir antiviral agents and give you the information you need to confidently prescribe them. Episode resource links: FACT SHEET FOR HEALTHCARE PROVIDERS: EMERGENCY USE AUTHORIZATION FOR MOLNUPIRAVIR (fda.gov) FACT SHEET FOR HEALTHCARE PROVIDERS: EMERGENCY USE AUTHORIZATION FOR PAXLOVID (fda.gov) Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-262 Overview: Join us as we discuss menopausal transition and the unique qualities and symptoms that are bothersome to women at an early age. Episode resource links: Coslov, N., Richardson, M. K., & Woods, N. F. (2021). Symptom experience during the late reproductive stage and the menopausal transition: observations from the Women Living Better survey. Menopause (New York, N.Y.), 28(9), 1012–1025. https://doi.org/10.1097/GME.0000000000001805 https://pubmed.ncbi.nlm.nih.gov/34313615/ ACOG Practice Guidelines: Clinical Guidelines on the Management of Menopausal Symptoms: https://www.aafp.org/afp/2014/0901/p338.html Women Living Better Website: https://womenlivingbetter.org/ Maki, P. M., Kornstein, S. G., Joffe, H., Bromberger, J. T., Freeman, E. W., Athappilly, G., Bobo, W. V., Rubin, L. H., Koleva, H. K., Cohen, L. S., Soares, C. N., & Board of Trustees for The North American Menopause Society (NAMS) and the Women and Mood Disorders Task Force of the National Network of Depression Centers (2018). Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause (New York, N.Y.), 25(10), 1069–1085. https://doi.org/10.1097/GME.0000000000001174 https://pubmed.ncbi.nlm.nih.gov/30179986/ Johnson, A., Roberts, L., & Elkins, G. (2019). Complementary and Alternative Medicine for Menopause. Journal of evidence-based integrative medicine, 24, 2515690X19829380. https://doi.org/10.1177/2515690X19829380 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419242/ Barnard, N; Kahleova, H; Holtz, D; del Aguila, F; Neola, M; Crosby, Lelia M.& Holubkov, R (2021). The Women's Study for the Alleviation of Vasomotor Symptoms (WAVS): a randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women, Menopause 28 (10), 1150-1156 doi: 10.1097/GME.0000000000001812 Guest: Jill M. Terrien PhD, ANP-BC Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-261 Overview: Stroke is a major health problem, and the risk of stroke is five-times higher in individuals with atrial fibrillation (AF) than those without. AF can be asymptomatic or subclinical. In 18% of AF patients, the condition is only detected at the time of stroke. It is not known whether individuals whose AF is deterred via screening carry a similar risk to individuals with known AF. A recent randomized trial evaluated a screening program for AF in individuals at high risk of stroke; for individuals identified with AF, anticoagulation was given for stroke prevention. Episode resource links: Svendsen JH, Diederichsen SZ, Højberg S et al. Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial. Lancet. 2021 Oct 23;398(10310):1507-1516 Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-260 Overview: We will review the current USPSTF recommendations regarding aspirin use to reduce the risk of CVD and colorectal cancer. Additionally, we will discuss as well as the findings of the ASPREE (ASPirin in reducing events in the elderly) randomized clinical trial. Episode resource links: POEMs: In Older Adults, Aspirin Increases the Risk of Metastatic of Stage 4 Cancers and Cancer Mortality. Barry, Henry C. Am Fam Physician. 2021 Sep; 104(2):online Effect of Aspirin on Cancer Incidence and Mortality in Older Adults. McNeil, John. JNCI: Journal of the National Cancer Institute Volume: 113 Issue 3 (2021) ISSN: 0027-8874 Online ISSN: 1460-2105 Guest: Jillian Joseph, MSPAS, PA-C Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-259 Overview: Per CDC data, approximately 2.5 million Americans present each year to emergency departments with head injuries, and 15% of all high school students report experiencing at least one concussion. Current guidelines recommend physical and cognitive rest for 24-48 hours post-concussion with minimal guidance on screen time parameters. Recent evidence is emerging that supports avoidance of screen time and encouragement of aerobic activity as strategies to shorten and lessen post-concussion symptoms. Join us as we discuss 2 recent studies regarding screen-time and aerobic exercise that add critical information to best practice for reducing post-concussion symptoms. Episode resource links: John J Leddy, Christina L Master, Rebekah Mannix, Douglas J Wiebe, Matthew F Grady, William P Meehan, Eileen P Storey, Brian T Vernau, Naomi J Brown, Danielle Hunt, Fairuz Mohammed, Andrea Mallon, Kate Rownd, Kristy B Arbogast, Adam Cunningham, Mohammad N Haider, Andrew R Mayer, Barry S Willer. Early targeted heart rate aerobic exercise versus placebo stretching for sport-related concussion in adolescents: a randomised controlled trial. The Lancet Child & Adolescent Health, 2021; DOI: 10.1016/S2352-4642(21)00267-4 Macnow T, Curran T, Tolliday C, et al. Effect of Screen Time on Recovery From Concussion: A Randomized Clinical Trial. JAMA Pediatr. Published online September 07, 2021. doi:10.1001/jamapediatrics.2021.2782 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2783638#graphical-abstract-tab DePadilla L, Miller GF, Jones SE, Peterson AB, Breiding MJ. Self-reported concussions from playing a sport or being physically active among high school students—United States, 2017. MMWR Morb Mortal Wkly Rep. 2018;67(24):682-685. doi:10.15585/mmwr.mm6724a3 University at Buffalo. (2021, September 30). Aerobic exercise after a sport-related concussion speeds recovery in adolescent athletes, study suggests: Daily aerobic exercise significantly reduced the risk of prolonged recovery. ScienceDaily. Retrieved October 2, 2021 from www.sciencedaily.com/releases/2021/09/210930213654.htm McCrory P ,Meeuwisse W,Dvorak J,etal. Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-847. doi:10.1136/bjsports-2017- 097699 Centers for Disease Control and Prevention. Recovery from concussion. Centers for Disease Control and Prevention; 2019. Accessed October 12, 2020. https://www.cdc.gov/headsup/basics/ concussion_recovery.html. Guest: Guest Music Credit: Richard Onorato