Frankly Speaking About Family Medicine

Cannabinoids include tetrahydrocannabinol (THC) and cannabidiol, which are found in marijuana, as well as synthetic compounds such as nabilone. The agents have been studied for the treatment of various chronic pain conditions. A meta-analysis was performed that analyzed any cannabinoid, for any chronic pain condition. Guest: Alan Ehrlich MD Landing Page: https://www.pri-med.com/online-education/Podcast/97-cannabis-frankly-speaking

Evidence of the efficacy of statins to reduce ASCVD morbidity and mortality in individuals > 75 years who have known clinical ASCVD (secondary prevention) is well established. Primary prevention in this population has not been as clear. Join us while we discuss a recent study in the BMJ which assessed the benefits of statins for primary prevention of ASCVD morbidity and mortality in individuals > 75 years with and without DM. Guest: Susan Feeney, DNP, FNP-BC Landing Page: https://www.pri-med.com/online-education/Podcast/96-statin-therapy-frankly-speaking.aspx#sm.0000akbf5ldmtfh2s4u14ah34rz3b

This episode will review a randomized controlled trial of adding 10.5 grams of a soluble fiber, psyllium, to a Type 2 Diabetes diet and its influence on weight loss, BMI and other parameters of diabetes. Guest: Jill Terrien PhD, ANP-BC Landing Page: https://www.pri-med.com/online-education/Podcast/95-psyllium-frankly-speaking.aspx

As fall arrives, many patients question the need for an influenza vaccine while clinicians urge patients to get it. 2017-18 flu season data shows high influenza mortality. Learn how to help motivate patients to accept the vaccine. Guest: Susan Feeney, DNP, FNP-BC Landing Page: https://www.pri-med.com/online-education/Podcast/94-influenza-frankly-speaking

8% of patients believe they have a penicillin allergy, yet the actual number is far less. Listen to this episode to learn about the incidence of penicillin allergy, the risks associated with reporting a believed allergy, and how you can better manage these patients. Guest: Susan Feeney, DNP, FNP-BC Landing Page: http://www.pri-med.com/online-education/Podcast/93-penicillin-frankly-speaking

Listen to this episode to learn about the update to the 2012 United States Preventive Services Task Force (USPSTF) recommendation on screening for cervical cancer.

Listen to this episode to learn about a small study which found that adding 35 grams of fiber and 0.8 grams of protein/kg/day to the diets of obese patients—without making any other diet changes—led to weight loss at 12 weeks. Guest: Susan Feeney, DNP, FNP-BC

Both the WHO and AAP recommend exclusive breastfeeding until 6 months of age then solids and breast milk until 12 months of age. The well-established benefits of breastfeeding include support of infant growth and development of immunity. Recently, a clinical trial from the UK found an association between the early introduction of foods and infant sleep. Join us while we discuss the findings of this study and possible implications to your care of moms and their infants.

Best practices in treating acute and chronic pain have been clouded by years of misinformation. Listen to this podcast episode to learn an evidence-based recommendations that dispels these myths and encourages a new and better approach to pain management.

The number of adults in the US on prescription medications is rising, with approximately 15% taking five or more daily medications. A recent study found that depression is a common side effect—37.2% prevalence among American adults taking prescription medications—and is associated with an increased risk of concurrent depression. Guest: Susan Feeney, DNP, FNP-BC

Chronic non-cancer pain in adults over 60 years old is common. The consequences are a decreased quality of life, disability and increased healthcare costs which can be due to the cost of therapies or from adverse pharmacologic effects to name a few. This episode discusses the results of a systematic review and meta-analysis by Niknejad et al (2018) that looked at pain outcomes in this population using psychological modalities. Guest: Jill Terrien PhD, ANP-BC

Adults often present with atraumatic shoulder pain around age 50 and are diagnosed with impingement syndrome (rotator cuff tendonitis). However, as this recent study demonstrates, the standard of care for treatment should not be surgery. Guest: Susan Feeney, DNP, FNP-BC

A recent longitudinal study of high school students in the LA area found a modest but significant association between high-frequency digital media use (phones, tablets) and subsequent ADHD symptoms. Join us as we discuss these findings and the possible impact on adolescent primary care. Guest: Susan Feeney, DNP, FNP-BC

This episode is an introductory discussion of the very real problem of physician burnout. It affects you and those around you. What do we know about burnout and how can we move beyond it? Guest: Jill Terrien PhD, ANP-BC

In this episode, we will discuss using an inhaled steroid twice a day to control mild asthma symptoms, versus using the combination budesonide and formoterol. Guest: Jill Terrien PhD, ANP-BC

It has been fairly established that short duration of sleep is associated with obesity in teens and adults; however, the impact of quantity and quality of sleep has not been as well established. A cross-sectional study by Feliciano et al. found that longer and better sleep was associated with better cardiometabolic profiles in early adolescence – independent of other factors. Guest: Susan Feeney, DNP, FNP-BC

Discussing goals of care with patients that have a serious, life-limiting illness does not affect the patient’s anxiety or depression—but can increase the quality of the communication. Listen to this podcast episode for tips that are easily adaptable to any outpatient or specialty practice. Guest: Jill Terrien PhD, ANP-BC

Breastfeeding exclusively in the first six months of life is widely recommended. However, in this study of newborns who were losing weight because their mother’s milk had not yet come in, post-breastfeeding supplementation improved weight and did not alter breastfeeding rates at one month. Guest: Susan Feeney, DNP, FNP-BC

In 2013, a groundbreaking clinical trial from Spain touted the benefits of the Mediterranean Diet to reduce CVD risk. A recent review of the study found some irregularities in the randomization procedure that cast concern on the validity of the findings. After reanalysis of the data, however, the results were essentially the same. Guest: Susan Feeney, DNP, FNP-BC

For adolescents who binge drink, when they begin and how often they do it affects academic performance. This episode discusses the findings of a longitudinal analysis of secondary school students in Canada: The COMPASS study. Guest: Jill Terrien PhD, ANP-BC

This study looked at how pain was treated following spine and joint surgery and found the majority of patients were not encouraged to use non-opioid analgesia and that most had a supply of unused opioids at home. Guest: Jill Terrien PhD, ANP-BC

Hypertension affects an estimated 80 million Americans. We diagnose, determine the need for medication therapy, and monitor treatment efficacy based on a simple office blood pressure measurement – but how accurate is that measurement, and what is the most valid method to obtain it? Guest: Susan Feeney, DNP, FNP-BC

Fibromyalgia can be difficult to treat and often requires a multifaceted approach combining exercise, medications, cognitive behavioral therapy, and health education. For many patients, pain hinders participation in a vigorous exercise regimen. Listen to this review of a randomized trial comparing aerobic exercise to tai chi in a patient population with fibromyalgia. Guest: Alan Ehrlich, MD

For women experiencing an uncomplicated UTI, nitrofurantoin and fosfomycin are two first-line options for treatment. Is one more effective than the other? Listen to this episode to learn about the results from a multinational, open-label, randomized clinical trial. Guest: Jill Terrien PhD, ANP-BC

Listen to this week’s podcast episode to learn about a meta-analysis showing no benefit to rectal examinations in men. Guest: Susan Feeney, DNP, FNP-BC

A recent AHA presentation offered data that showed an overwhelming amount of patients would prefer to take a pill or drink tea rather than exercise to lower their BP. This begs the questions: How much does drinking tea lower BP? Does exercise help those with primary HTN or resistant HTN who are already on medication? Finally, how do we get our patients to exercise? Guest: Robert A. Baldor, MD, FAAFP

Listen to this week's episode to learn about a randomized trial of children in music vs. visual arts instruction. Music instruction led to improvements in verbal intelligence, executive functions, and academic performance. Guest: Susan Feeney, DNP, FNP-BC

This episode will review The Menopause Strategies: Finding Lasting Answers for Symptoms and Health (MsFLASH) series of 4 randomized controlled trials, pooling individual data that will provide guidance for discussing pharmacologic and non-pharmacologic options for your peri- and postmenopausal patients. Guest: Jill Terrien PhD, ANP-BC

The National Institute on Aging-Alzheimer’s Association (NIA-AA) just released an updated Framework of the 2011 Guidelines for Alzheimer’s Disease Research, focusing on the use of biomarkers rather than clinical criteria to make the diagnosis. Listen to this week’s episode to learn more. Guest: Robert A. Baldor, MD, FAAFP

Chronic pain is a difficult but common problem in primary care. Patients are often desperate for any form of relief, and as a result, many are eventually started on opioid analgesics. This can be associated with many adverse effects. But is it worth it? A recent randomized trial compared opioid to non-opioid management of patients with chronic low back pain or chronic hip pain or knee pain due to osteoarthritis. Guest: Alan Ehrlich, MD

A recent research study published in JAMA Internal Medicine examined the use of antibiotics to treat acute sinusitis based upon the Infectious Diseases Society of America (IDSA) guideline recommending 5-7 days when antibiotics are indicated and found that most courses of antibiotics are too long. Listen to this week’s episode to learn more. Guest: Robert A. Baldor, MD, FAAFP

The American College of Physicians supported an evidence-based review of the topic guidelines for type 2 diabetes and concluded clinicians should aim for an A1c goal between 7.0-8.0 and recommended even less aggressive care for those over the age 80 years. Listen to this podcast episode to learn more about these new guidelines. Guest: Alan Ehrlich MD

Listen to this podcast episode for a brief summary of the literature on electronic media and its relation to sleep—specifically delayed bedtimes and decreased sleep duration. Screen-based media consumption is eating up our sleep health! Guest: Jill Terrien PhD, ANP-BC

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