Primary Care RAP for Eric Huynh: Recent Episodes
Primary Care RAP is an irresistible monthly podcast full of audio CME, presentations, reviews and perspectives. Get started today with some free CME.
So much has changed since the start of the Covid-19 pandemic, including all the new treatment options for outpatients with SARS-CoV-2 infection. From oral medications to IV infusions, the range of options can feel overwhelming. Which treatment should we prescribe when? And for which patients? How …
Devang Patel, MD • Neda Frayha, MD
Hair loss is a common complaint that we encounter in primary care, and we need to know how to recognize, treat, and refer appropriately. Jay-Sheree discusses hair loss and scalp dermatoses with UCSF dermatologist, Dr. Jenna Lester.
Jay-Sheree Allen, MD • Jenna Lester, MD
Dry cracked hands in the winter is an all too common urgent care complaint. Dermatologist Dr. Britt DeClerck walks us through the different types of hand dermatitis, and tells us all how to heal those pesky dry hand skin cracks.
Brittney DeClerck, MD • Matthieu DeClerck, MD • Mizuho Morrison, DO
Midodrine can reduce the recurrence of syncope in healthy, young patients with a high syncope burden
Steve Biederman, MD • Tom Robertson, MD
Chronic kidney disease is often recognized and managed (in the early stages) in primary care. Neda sits down with nephrologist, Dr. Manish Suneja, to walk through the second part of “CKD for the PCP” - metabolic acidosis, hyperkalemia, medications, and referral.
Manish Suneja, MD • Neda Frayha, MD
There’s almost nothing scarier to encounter than a neonate with a fever. Luckly, EM physician Dr. Kelly Sinclair is here to ease our worries and outline the most updated guidelines for this diagnosis.
Kelly Sinclair, MD • Paul Simmons, MD
Many clinicians in primary care leave clinical practice before retirement. Dr Paul Van Gorp spent 44 years in rural clinical practice and shares his thoughts on a long career in primary care with Dr. Jay-Sheree Allen.
Jay-Sheree Allen, MD • Paul VanGorp, MD
Turmeric showed modest subjective improvement in pain and functionality but no radiographic change
Steve Biederman, MD • Tom Robertson, MD
If depression is an issue, we would feel comfortable offering an SSRI to a pregnant woman.
Steve Biederman, MD • Tom Robertson, MD
Lanifibranor showed a dose dependent improvement in liver inflammation and fibrosis compared to placebo at 6 months.
Steve Biederman, MD • Tom Robertson, MD
Empagliflozin reduced combined risk of cardiovascular death or hospitalization for heart failure.
Steve Biederman, MD • Tom Robertson, MD
Breast pumps are an important tool for a mother who chooses to breastfeed her baby, but the ordering and use of them can be incredibly confusing. Neda and Dr. Elizabeth Lavery demystify this topic.
Elizabeth Lavery, MD • Neda Frayha, MD
Participating in global healthcare can be a rewarding aspect to a career in medicine, but it’s difficult to know how to get started. Paul interviews Dr. Kim Yu about the world of global health.
Kim Yu, MD, FAAFP • Paul Simmons, MD
Neda and Ashley discuss what happens when patients can read their notes and access their lab results, and how we can cultivate trust throughout this process without adding to our workloads.
Ashley Greer, PA • Neda Frayha, MD
Increased water intake is an effective antimicrobial sparing strategy to prevent recurrent cystitis in premenopausal women.
Steve Biederman, MD • Tom Robertson, MD
Happy new year! Aisha and Neda kick off this new year’s episode with a conversation about their personal new year’s resolutions for their clinical lives.
Aisha Lofters, MD • Neda Frayha, MD
Patients who were assigned to stop their medications had a higher risk of relapse of depression.
Steve Biederman, MD • Tom Robertson, MD
Variation in BMD in imaging was significant, and only a small portion of women showed sustained BMD changes on serial imaging.
Steve Biederman, MD • Tom Robertson, MD
Recent data suggests social media venues have surpassed email as the preferred method of communication. Young adults and teens are particularly susceptible to the dark sides of internet communication. Paul and Dr. Kelly Sinclair dive into the dangers of internet use and tools for our adolescent …
Kelly Sinclair, MD • Paul Simmons, MD
The quad pill achieved better BP control with no difference in adverse effects.
Steve Biederman, MD • Tom Robertson, MD
Afro-ethnic hair is different from Caucasian and Asian hair, and is prone to certain diseases that make it more susceptible to damage. Therefore it’s important to gain an understanding of scalp dermatoses of patients of African descent. Listen in as Jay-Sheree and dermatologist extraordinaire Dr …
Jay-Sheree Allen, MD • Jenna Lester, MD
Chronic kidney disease can feel overwhelming and is often managed in primary care, especially in the early stages. In this conversation, Neda discusses what the PCP needs to know about CKD with expert nephrologist, Dr. Manish Suneja.
Manish Suneja, MD • Neda Frayha, MD
Aisha and Neda answer several listener questions about long covid, POTS, and the relationship between the two.
Aisha Lofters, MD • Neda Frayha, MD
What does it really mean to order “routine labs”? Is there any evidence behind this? Our favorite TIDBSI duo, Justin and Paul, break this down for us.
Justin McCarthy, MD • Paul Simmons, MD
Neither a pest management program nor a HEPA filter significantly reduced symptom days with asthma.
Steve Biederman, MD • Tom Robertson, MD
Matt and Miz sit down with Dr. Baird to review the diagnosis and treatment of a baker’s cyst. They review how to recognize a baker cyst on an exam, red flags to consider, and whether imaging is needed.
Matt Baird, MD • Matthieu DeClerck, MD • Mizuho Morrison, DO
Caregiving can be rewarding but also stressful and challenging. Primary care clinicians have a responsibility to assess the wellbeing of caregivers as well as provide support and resources when possible. Neda interviews geriatrician Dr. Evgenia Litrivis about caring for the caregiver and assessing …
Evgenia Litrivis, MD • Neda Frayha, MD
Dr. Justin McCarthy shares his approach to challenging COVID vaccine conversations with patients that draws on his experience with motivational interviewing.
Justin McCarthy, MD
The addition of apple cider vinegar showed reduction in weight, and improved metabolic parameters, but there are many limitations.
Steve Biederman, MD • Tom Robertson, MD
Tapering events were significantly associated with increased risk of overdose and mental health crisis.
Steve Biederman, MD • Tom Robertson, MD
Matt Baird sits down with Miz and Matt to review the presentation of tennis vs golf elbow in patients including diagnosis and treatment.
Matt Baird, MD • Matthieu DeClerck, MD • Mizuho Morrison, DO
Red, tender skin? Must be cellulitis, right? Maybe not! Paul Simmons discusses cellulitis mimics in this conversation with Dr. Vu Kiet Tran.
Paul Simmons, MD • Vu Kiet Tran, MD, FCFP(EM), MHSc, MBA
In the last introduction segment of 2021, Paul and Neda cover the last of the “Less is More” recommendations from JAMA.
Neda Frayha, MD • Paul Simmons, MD
The scoring system performed decently, although implementation in conjunction with other recommendations is unclear.
Steve Biederman, MD • Tom Robertson, MD
Minimal differences were found between TT and medical treatment.
Steve Biederman, MD • Tom Robertson, MD
Among people with history of stroke or more than 60 years old with high blood pressure, rates of stroke, major cardiovascular events, and death were lower with salt substitute than with regular salt.
Steve Biederman, MD • Tom Robertson, MD
In the US, 1-2.5% of pregnant women have Hepatitis C, so we may very well come across this in our practice. Listen in as Matt and Michael discuss Hepatitis C in pregnancy with HIV fellowship-trained Family Medicine physician, Dr. Lakecia Pitts.
Lakecia Pitts, MD • Matthew Zeitler, MD • Michael Baca-Atlas, MD
Besides having a good knowledge base of medical “facts,” clinicians really need accurate thinking and language skills in order to do our jobs well. Paul SImmons and Dr. Mark Graber chat about medical errors and cognitive pitfalls that we can all fall victim to.
Mark A Graber, MD • Paul Simmons, MD
Atrial fibrillation is the most common cardiac rhythm disorder and is a leading cause of congestive heart failure, coronary artery disease, and mortality. However, prevention and management are often limited by the social determinants of health. Jay-Sheree and Dr. Utibe Essien discuss this …
Jay-Sheree Allen, MD • Utibe R. Essien, MD, MPH
In this Hippo Education bonus, world-renowned vaccine expert and pediatric infectious diseases specialist Dr. Paul Offit sits down with Peds RAP host Dr. Sol Behar and Primary Care RAP host Dr. Neda Frayha for an insightful conversation on the latest COVID vaccine for children aged 5-11 years. They …
Neda Frayha, MD • Paul Offit, MD • Solomon Behar, MD
Dementia is increasing in prevalence as our population ages, but the diagnosis has some important nuances that primary care clinicians need to understand. Neda sits down with Dr. Melissa Shepard to discuss the diagnosis and management of dementia.
Melissa Shepard, MD • Neda Frayha, MD
Cabotegravir was superior to daily oral medication in preventing HIV infection
Steve Biederman, MD • Tom Robertson, MD
If you’ve ever had a patient ask to have his testosterone levels checked and you weren’t sure how to answer, this TIDBSI segment is for you. Paul and Justin dive into the nitty gritty of testosterone levels and replacement.
Justin McCarthy, MD • Paul Simmons, MD
Decompression alone was noninferior to decompression and fusion over a period of two years, but reoperation occurred somewhat more often in the decompression only group
Steve Biederman, MD • Tom Robertson, MD
Apixaban had the greatest risk reduction in adverse effects in frail patients
Steve Biederman, MD • Tom Robertson, MD
When Jay was threatened by a patient the day after healthcare workers in a neighboring town were killed in a clinic knifing and bombing incident, it spurred her to action. Listen in as she and Neda talk about her experiences, about violence in the healthcare workplace in general, and how all of us …
Jay-Sheree Allen, MD • Neda Frayha, MD
Menopause is as natural a transition as puberty, but is not as openly discussed and can even feel taboo. Dr. Jen Gunter is trying to change this and even wrote a book about it: The Menopause Manifesto. In this conversation, Neda discusses her book and what primary care clinicians need to know about …
Jen Gunter, MD • Neda Frayha, MD
Acne is a condition that affects our patients’ quality of life, and one that PCPs can play a huge role in treating. Dr. Jenna Lester, dermatologist at UCSF, is back with Jay-Sheree and Neda to discuss all of our treatment options and what works best for our patients with acne.
Jay-Sheree Allen, MD • Jenna Lester, MD • Neda Frayha, MD
Patients who used the app as an adjunct to usual care had reduced pain-related disability at 3 months, but this improvement was small and of uncertain clinical significance
Steve Biederman, MD • Tom Robertson, MD
Vitamin C supplementation significantly reduced the frequency of the common cold but had no apparent effect on duration or severity
Steve Biederman, MD • Tom Robertson, MD
Dr. Douglas Woods literally wrote the book on Comprehensive Behavioral Intervention for Tics, and Neda was lucky enough to interview him about this innovative modality to treat tic disorders.
Douglas Woods, PhD • Neda Frayha, MD
A urine dipstick is a routine point of care test in most practices, but sometimes can be tricky to interpret. Luckily, Paul Simmons is back with “What’s That Lab” to discuss interpretation of leukocyte esterase and nitrite on urine dipstick.
Paul Simmons, MD
A 7-day course of doxycycline was superior to single-dose azithromycin in treatment of rectal chlamydia
Steve Biederman, MD • Tom Robertson, MD
There were no significant differences in cardiovascular events or major bleeding between patients assigned to 81 mg and those assigned to 325 mg
Steve Biederman, MD • Tom Robertson, MD
Have you ever wondered about when we should order an IgA? And if you order it, what does it even mean? Back to answer all of your lab questions, Dr. Paul Simmons takes us on a deep dive into IgA levels.
Paul Simmons, MD
Lisa and Kiesha discuss the gun violence epidemic in the US and how it affects children.
Kiesha Fraser Doh, MD • Lisa Patel, MD
Not much is scarier to a clinician than a pregnant woman with pre-term labor symptoms in the outpatient setting. To help avoid panic, Dr. Paul Simmons interviews Dr. Lyrad Riley about this topic.
Lyrad Riley, MD, MPH, FAAFP • Paul Simmons, MD
How do we apply evidence-based principles of harm reduction to all of our patients, even those who don’t use substances? Michael Baca-Atlas sits down with Neda to discuss the who, what, when, why, and how in this month’s introduction.
Michael Baca Atlas, MD • Neda Frayha, MD
Probiotics did not show a statistical difference in the incidence of AAD or CDAD
Steve Biederman, MD • Tom Robertson, MD
Glycemic control was similar between all groups, with increased patient satisfaction and less hypoglycemia in the basal-GLP1/SGLT groups
Steve Biederman, MD • Tom Robertson, MD
As our population ages, it’s important for us to be aware of the cognitive changes associated with aging. In this conversation, Dr. Neda Frayha discussed mild cognitive impairment with Dr. Melissa Shepard.
Melissa Shepard, MD • Neda Frayha, MD
How comfortable are you managing the involuntary commitment process for an acutely mentally ill patient from the clinic? Dr. Michael Baca-Atlas interviews UNC psychiatrist Dr. Joseph Williams for some very practical pearls for PCPs.
Joseph Williams, MD • Michael Baca-Atlas, MD
Testicular cancer is most common in young men, and the guidelines for screening are somewhat controversial. Listen in as Dr. Matt Zeitler discusses this with Dr. Hayden Shafer, who shares his own personal experience as well.
Hayden Schafer, MD • Matthew Zeitler, MD
Topical steroids can be confusing to prescribe - so many potencies and types! Luckily, dermatologist Dr. Jenna Lester is here to break it down with Neda and Jay-Sheree.
Jay-Sheree Allen, MD • Jenna Lester, MD • Neda Frayha, MD
Hs-trop was more commonly elevated in patients with renal impairment, and these elevations were less frequently attributed to MI.
Steve Biederman, MD • Tom Robertson, MD
Uterine fibroids are a common condition that we can diagnose and even treat in primary care. Listen in as Neda interviews ObGyn Dr. Sara Mazzoni about the ins and outs of fibroids.
Neda Frayha, MD • Sara Mazzoni, MD
The data isn’t great, but the potential benefits likely outweigh the risks in a trial of peppermint essential oils for IBS symptoms
Steve Biederman, MD • Tom Robertson, MD
Both were effective, however, stimulants had better efficacy but also overall more adverse events.
Steve Biederman, MD • Tom Robertson, MD
A strategy combining exercise and liraglutide improved healthy weight loss maintenance.
Steve Biederman, MD • Tom Robertson, MD
A 5 mmHg reduction in systolic blood pressure reduced the risk of major cardiovascular events by 10% irrespective of previous cardiovascular disease. This was true even at normal baseline blood pressures.
Steve Biederman, MD • Tom Robertson, MD
Andy Barnett does an in depth review of how to treat seasonal allergies including how to add /adjust meds for patients who are experiencing severe allergic symptoms despite their current medication regimen.
Andy Barnett, MD • Matthieu DeClerck, MD • Mizuho Morrison, DO
The covid pandemic has been challenging for all front-line clinicians. Can you imagine if you were in charge of the public health of an entire county? In this very special conversation, Neda sits down with Dr. Nilesh Kalyanaraman, Anne Arundel County Health Officer in Maryland, to learn about his …
Neda Frayha, MD • Nilesh Kalyanaraman, MD
How do you diagnose and manage Parvo B19 in little kids and their pregnant moms? Matt Zeitler and Neda get into all the relevant details in this super practical conversation.
Matthew Zeitler, MD • Neda Frayha, MD
Ischemic colitis is a “can’t miss” diagnosis, but something we don’t always think about in the primary care setting. Neda and Dr. Jason Shen discuss all things ischemic colitis in this interesting conversation.
Jason Shen, MD • Neda Frayha, MD
Metoprolol is associated with a reduction in mortality in patients with HFpEF and new dialysis initiation
Steve Biederman, MD • Tom Robertson, MD
Many of the children we see in practice will have never seen a dentist, or may not have access to one. In order for us to feel more comfortable with children’s dental health, Paul interviews Dr. Karlyyn Sievers about how to perform a pediatric dental exam and what advice we should give.
Karlynn Sievers, MD • Paul Simmons, MD
There was no significant change in depression scores between psilocybin and escitalopram
Steve Biederman, MD • Tom Robertson, MD
Have you ever seen an abnormal CO2 on routine labs and not known what to do? Us too! Paul Simmons walks us through the different disease states that can affect CO2 in this segment of “What’s That Lab?”
Paul Simmons, MD
Just in case you’re not a rockstar at discussing Advanced Care Planning with your patients, regular guest and geriatrician Dr. Jenny Litrivis is back to school Neda (and all of us) on how to do this important work better.
Evgenia Litrivis, MD • Neda Frayha, MD
Many of us are comfortable with caring for children with Trisomy 21, but what about adults? Neda sits down with Dr. Micaela Bowers to discuss the care of adults with Trisomy 21.
Micaela Robb Bowers, MD • Neda Frayha, MD
POTS is a syndrome we come across in primary care that can be difficult to diagnose and even harder to treat. For a rundown on POTS, along with some tips and tricks for our patients, listen in on this conversation between Neda and primary care PA, Ashley Greer.
Ashley Greer, PA • Neda Frayha, MD
We prescribe medications all the time in primary care. Sometimes, we prescribe something that can cause a lethal drug-drug interaction. Dr. Joe Martinez walks Neda through 4 common scenarios of well-intentioned drug-drug combos gone awry.
Joe Martinez, MD • Neda Frayha, MD
We knew that Paul Simmons would jump on a topic that mentions “poop.” No, not that kind of poop! In this conversation, Paul and Dr. Vu Tran discuss a different type of POOP - conditions that cause pain out of proportion to exam.
Paul Simmons, MD • Vu Kiet Tran, MD, FCFP(EM), MHSc, MBA
Lisa and UCSF Pediatrician Sabrina Fernandez discuss the importance of sleep, risks of poor sleep, and how to counsel families.
Lisa Patel, MD • Sabrina Fernandez, MD
Patient navigation reduced inpatient readmissions and ED visits in patients with comorbid substance use disorder
Steve Biederman, MD • Tom Robertson, MD
In patients with CKD, risk for worsening GFR, ESRD, or death from renal or cardiovascular causes was significantly lower with dapagliflozin
Steve Biederman, MD • Tom Robertson, MD
Short steroid bursts were associated with increased risk of pneumonia, sepsis and GIB within the first 30 days.
Steve Biederman, MD • Tom Robertson, MD
Paul and Neda are back at it, continuing their ongoing series on the JAMA Less is More series for reducing unnecessary interventions in primary care.
Neda Frayha, MD • Paul Simmons, MD
Immediate, delayed and no antibiotic prescribing led to similar symptom course, complication rate, and patient satisfaction.
Steve Biederman, MD • Tom Robertson, MD
We have been trying to figure out which febrile young infants have serious bacterial infections for almost four decades now. We now have a new evidence-based approach that allows us to do less invasive testing with a more precise way to find those sick needles in the haystack. • Drs. Mizuho …
Mizuho Morrison, DO • Solomon Behar, MD
Modified CHADS2 score performed well and consistently across all kidney function strata.
Steve Biederman, MD • Tom Robertson, MD
In-person follow-up visits were minimal and the majority of patients received a prescription.
Steve Biederman, MD • Tom Robertson, MD
Continuing our series on the Medical Home, Neda and Dr. Holly Tse discuss how to deploy good health maintenance habits between patient visits.
Holly Tse, MD • Neda Frayha, MD
When someone complains of lower extremity swelling, how confident are you in diagnosing the etiology? Listen in as Paul Simmons and Justin McCarthy discuss a thoughtful approach to this common concern in this TIDBSI conversation.
Justin McCarthy, MD • Paul Simmons, MD
Vulvar dermatoses is a relatively common complaint that can affect women of all ages. There are a wide variety of symptoms and severity and finding the correct diagnosis requires a thorough history and physical examination. A biopsy may be necessary to confirm the diagnosis and exclude malignancy …
Brittney DeClerck, MD • Jenny Beck-Esmay, MD • Mizuho Morrison, DO
DOACs had improvement in risk of stroke or embolization and less bleeding compared with warfarin in patients with valvular atrial fibrillation, excluding mechanical valves or mitral stenosis.
Steve Biederman, MD • Tom Robertson, MD
How robust is your toolkit when it comes to pain management? Especially when it comes to opioid alternatives? It’s about to become a whole lot fuller, thanks to this conversation with Jay and Neda.
Jay-Sheree Allen, MD • Neda Frayha, MD
There is an association between breastfeeding and higher IQ scores, but the confounders are complex.
Steve Biederman, MD • Tom Robertson, MD
Advising our patients on prevention of skin cancer through sun protection is an important part of preventive care. But what sunscreens are best? How can we help patients succeed? Drs. Neda Frayha and Aleah Thompson try not to burn out on sun care in this sunny conversation.
Aleah Thompson, MD • Neda Frayha, MD
Gluten “intolerance” is all the rage, but how can we evaluate our patients’ concerns while differentiating from celiac disease? Paul Simmons dives into diagnosis and treatment of celiac disease with Dr. Alan Ehrlich, Editor of DynaMed and someone who knows quite a bit about this condition, both …
Alan Ehrlich, MD • Paul Simmons, MD
After a run-in period of subcutaneous semaglutide, patients who continued semaglutide experienced continued weight loss in contrast to placebo where weight was regained.
Steve Biederman, MD • Tom Robertson, MD
Vulvar dermatoses is a relatively common complaint that can affect women of all ages. There are a wide variety of symptoms and severity and finding the correct diagnosis requires a thorough history and physical examination. A biopsy may be necessary to confirm the diagnosis and exclude malignancy …
Brittney DeClerck, MD • Jenny Beck-Esmay, MD • Mizuho Morrison, DO
What is a medical home and how can it help us succeed in keeping patients current on their screenings and chronic disease management? Dr. Holly Tse gives Neda super practical tips on how we can rock our health maintenance core measures in this two-part series.
Holly Tse, MD • Neda Frayha, MD
What is a medical home and how can it help us succeed in keeping patients current on their screenings and chronic disease management? Dr. Holly Tse gives Neda super practical tips on how we can rock our health maintenance core measures in this two-part series.
Holly Tse, MD • Neda Frayha, MD
Have you ever been in a situation when a patient requests something that’s inappropriate or tries to dictate their care? Do you know the best way to respond? Drs. Michael Baca-Atlas and Matt Zeitler discuss the evidence-based way to respond to these situations.
Matthew Zeitler, MD • Michael Baca-Atlas, MD
Treating to an albumin >3.5 did not improve renal dysfunction, infection or mortality.
Steve Biederman, MD • Tom Robertson, MD
Among patients receiving initial treatment for symptomatic paroxysmal afib, there were lower rates of recurrence of afib with ablation compared to antiarrhythmic drug therapy. The rate of recurrence was very low in both groups.
Steve Biederman, MD • Tom Robertson, MD
Do you like our “Things I do, but should I?” series? Keeping with this spirit, Paul Simmons and Dr. Mark Graber hone in on the top 10 things we should all STOP doing in clinical practice based on the most recent evidence.
Mark A Graber, MD • Paul Simmons, MD
Knee pain is a common urgent care complaint. Matt Baird sits down to discuss patellofemoral pain including its presentation, treatment, and patient education.
Matt Baird, MD • Matthew DeLaney, MD, FACEP, FAAEM
14% of older adults with dementia filled prescriptions consistent with CNS-active polypharmacy
Steve Biederman, MD • Tom Robertson, MD
Empagliflozin improved LVEF and led to significantly greater functional capacity and quality of life scores over placebo
Steve Biederman, MD • Tom Robertson, MD
Do you freeze up when you receive an abnormal pap result? If you’re not always sure of what to do next, listen in as Dr. Elizabeth Lavery, Ob/Gyn, walks us through the 2019 guidelines for management of abnormal pap smears.
Elizabeth Lavery, MD • Neda Frayha, MD
When a listener asked us to devote a conversation to thoracic outlet syndrome, Neda knew she had to tackle it - she’s had several patients with this disorder herself. Here, Neda and Aisha dive into the nuances of how to approach and treat both neurogenic and vascular TOS.
Aisha Lofters, MD • Neda Frayha, MD
USPSTF recommends annual lung cancer screening with low-dose CT in adults aged 50-80 who have 20 pack-year smoking history and currently smoke or quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years.
Steve Biederman, MD • Tom Robertson, MD
Our listeners have lots of questions about chronic kidney disease. In the introduction to this month’s PC RAP episode, Aisha and Neda dig into the best CKD diet advice we can give our patients.
Aisha Lofters, MD • Neda Frayha, MD
Reports of long term health issues after COVID infection have raised concerns about when it is safe to return to participate in sports after COVID infection. Cardiology, sports medicine, and pediatric societies have provided guidance to guide health care professionals in advising their patients in …
Janet Semple-Hess, MD • Tracy Zaslow, MD
In the era of covid, we need to be more mindful than ever of how to help our patients with alcohol withdrawal syndrome detox safely in the outpatient setting. Our Addiction Medicine expert and Family Medicine physician extraordinaire, Dr. Michael Baca-Atlas, joins Neda for an enlightening …
Michael Baca-Atlas, MD • Neda Frayha, MD
MRI use for acute LBP was associated with increased amount of surgery, cost, opioid prescriptions and higher pain scores
Steve Biederman, MD • Tom Robertson, MD
Among obese patients in rural primary clinics, in-clinic group visits resulted in greater weight loss at 2 years, though differences were small
Steve Biederman, MD • Tom Robertson, MD
It’s been over a year since the start of the pandemic, and we are still catching up on preventive visits and cancer screenings. Neda discusses this public health concern and the impact of it with Dr. Shana Ntiri.
Neda Frayha, MD • Shana Ntiri, MD, MPH
Physical activity improves CV risk, but does not compensated for the negative effects of obesity
Steve Biederman, MD • Tom Robertson, MD
Think of seeing a patient with scabies. Are you itchy yet? If you can tolerate the itching, listen in on this conversation between Neda and Dr. Avir Mitra on the unique challenges of a centuries old disease.
Avir Mitra, MD • Neda Frayha, MD
Almost 2 million adolescents and adults in the US are living with HIV. Many of these are women of childbearing age. How do we manage our pregnant patients who are HIV positive, especially if we have limited access to specialists? Hippo’s own Drs. Matt Zeitler and Michael Baca-Atlas discuss HIV and …
Kecie Pitts, MD • Matthew Zeitler, MD • Michael Baca-Atlas, MD
The young febrile infant is at risk for serious infections. Older risk stratification strategies have involved extensive, invasive work-ups. New research from the PECARN group has allowed for a simpler evaluation of the full term, well appearing febrile young infant using only blood and urine …
Nate Kupperman, MD, MPH • Solomon Behar, MD
Huffing, dripping, dabbing, vaping. Do you know what these terms mean? If not (or even if you do), tune in as Paul Simmons discusses new (and old) drugs of abuse with Dr. Kelly Sinclair.
Kelly Sinclair, MD • Paul Simmons, MD
Bariatric surgery led to significantly more diabetic remission at ten years compared to medical weight loss
Steve Biederman, MD • Tom Robertson, MD
Suicide appears to be the most common cause of firearm injury death in the US, and most people who die from suicide never reach the hospital. Assaults and unintentional injuries account for most nonfatal injuries.
Steve Biederman, MD • Tom Robertson, MD
The young febrile infant is at risk for serious infections. Older risk stratification strategies have involved extensive, invasive work-ups. New research from the PECARN group has allowed for a simpler evaluation of the full term, well appearing febrile young infant using only blood and urine …
Nate Kupperman, MD, MPH • Solomon Behar, MD
In this Hippo Education bonus, Dr. Rob Orman digs into the data just published regarding mRNA vaccine safety in pregnant patients, and what it means for our patients. He also reviews data just published looking at the effect of COVID on maternal and neonatal morbidity and mortality among pregnant …
Rob Orman, MD
Covid isn’t going anywhere. And neither is Long Covid, or as it’s now called, Post-Acute Sequelae of SARS-CoV-2, or PASC. We sit down with pulmonologist, critical care physician, and emerging PASC expert Dr. Andi Levine from the University of Maryland School of Medicine to learn all about this …
Andrea Levine, MD • Neda Frayha, MD
The news this week has been replete with stories about increased clot risk in those who have received the AstraZeneca and Johnson & Johnson COVID-19 vaccines. In this episode, we break down: what we know so far about vaccine induced thrombotic thrombocytopenia (VITT), the research that has revealed …
Rob Orman, MD
Less is more! We were thrilled to learn about the JAMA Internal Medicine series highlighting which primary care services we can scale back on or do away with completely. In this month’s Primary Care RAP introduction, Neda and Paul continue breaking down some of these recommendations and how they’ll …
Neda Frayha, MD • Paul Simmons, MD
Early referral from primary care to physical therapy improved disability more than usual care alone.
Steve Biederman, MD • Tom Robertson, MD
People aged 70-100 with elevated LDL cholesterol had the highest absolute risk of myocardial infarction and lowest estimated number needed to treat in 5-years to prevent one event
Steve Biederman, MD • Tom Robertson, MD
Have you ever been a part of a really bad handoff? How about a really good handoff? You know the difference between them, but what is the evidence-based way to perform them effectively? Listen in as Neda discusses handoffs with hospitalist Dr. Subha Airan-Javia.
Neda Frayha, MD • Subha Airan-Javia, MD
Many of our patients have lived through trauma, and the Covid-19 pandemic is a form of collective trauma in itself. How can we, as primary care clinicians, provide sensitive, trauma-informed care to our patients? Neda sits down with national experts Drs. Sadie Ellisseou and Megan Gerber to discuss …
Megan Gerber MD, MPH • Neda Frayha, MD • Sadie Elisseou, MD
Injecting local anesthetic burns, right? What if there was a way to minimize the pain associated with injection of local anesthetic? Drs. Brian Rayala and Matthew Zeitler at UNC Chapel Hill look at the evidence regarding this, and provide some insight into reduction of pain with this common …
Brian Rayala, MD • Matthew Zeitler, MD
Baseline depressive symptoms were associated with CVD incidence
Steve Biederman, MD • Tom Robertson, MD
Clogged ducts, warm compresses, and dicloxacillin, oh my! Join Neda as she dives into lactational mastitis with women’s health expert, Dr. Elizabeth Lavery.
Elizabeth Lavery, MD • Neda Frayha, MD
Many of our patients have lived through trauma, and the Covid-19 pandemic is a form of collective trauma in itself. How can we, as primary care clinicians, provide sensitive, trauma-informed care to our patients? Neda sits down with national experts Drs. Sadie Ellisseou and Megan Gerber to discuss …
Megan Gerber MD, MPH • Neda Frayha, MD • Sadie Elisseou, MD
Our Peds RAP colleague Dr. Lisa Patel and her colleague (and circumcision expert) Dr. Amy Lawson review some tips and tricks for circumcision.
Amy Lawson, MD • Lisa Patel, MD
Fluoroquinolones were not associated with increased aortic aneurysm or aortic dissection risk compared to penicillins or cephalosporins
Steve Biederman, MD • Tom Robertson, MD
Glycemic control was statistically reduced, but effects were modest
Steve Biederman, MD • Tom Robertson, MD
Cannabis Hyperemesis syndrome and other complications from acute cannabis intoxication are becoming a more common presentation in the UC/ED due to the increased use of cannabis products. Keeping this diagnosis on your clinical radar can expedite the workup and appropriate treatment of these …
Matthieu DeClerck, MD • Tarlan Hedayati, MD
In this Hippo Education bonus, Lisa Patel, MD, sits down with Jeanne Noble, MD, Associate Professor of Emergency Medicine and Director of COVID Response at UCSF Parnassus, to discuss the clinical data and updated CDC guidelines regarding school reopening during COVID, from in-school transmission …
Jeanne Noble, MD • Lisa Patel, MD
Have you ever wondered why there’s a Black and Non Black eGFR for our patients or why is race even a factor in pulmonary function tests? Dr. Jay-Sheree Allen and Dr. Neda Frayha discuss the use of race in clinical decision making tools. Think calculators, algorithms, where you insert your patient’s …
Jay-Sheree Allen, MD • Neda Frayha, MD
Dr Richard Alan John Asher was an eminent British hematologist and endocrinologist who died in April 1969. During his career, he wrote an essay titled, “Seven Sins of Medicine.” Drs. Paul Simmons and Keith Dickerson ruminate on this essay and how it still applies to the practice of medicine today.
Keith Dickerson, MD • Paul Simmons, MD
How are your anxiety levels? Because we’re about to ratchet them up to an 11. In this segment, EM/IM physician Dr. Joe Martinez teaches Paul about 4 patients with deadly diagnoses who presented with seemingly benign findings. Let’s heighten our awareness of do-not-miss pathology that can masquerade …
Joe Martinez, MD • Paul Simmons, MD
There was not an increased risk of spinal hematoma complications in pts with coagulopathy
Steve Biederman, MD • Tom Robertson, MD
Once-weekly treatment with insulin icodec had glucose-lowering efficacy and safety profile similar to those of once daily insulin glargine U100 in patients with type 2 diabetes
Steve Biederman, MD • Tom Robertson, MD
It seems like gabapentin is prescribed for everything from hot flashes to dementia. Are we prescribing it appropriately? In this segment, Dr. Molly Heublein takes a deep dive into the use (and misuse) of gabapentinoids.
Molly Heublein, MD • Neda Frayha, MD
Higher BPs were associated with more CV risk but data on the included studies is limited
Steve Biederman, MD • Tom Robertson, MD
When our own Dr. Aisha Lofters realized she should have used the word “poop” instead of “stool” when discussing colon cancer screening with her patient, it was a major light bulb moment for her. Join her and Neda as they explore what health literacy means, how low health literacy can affect patient …
Aisha Lofters, MD • Neda Frayha, MD
Unsafe driving behaviors were higher in the THC and equal THC/CBD groups 40-100 minutes after vaporization. There was no significant difference between CBD only and placebo
Steve Biederman, MD • Tom Robertson, MD
Hospitalist Corner Lightning Round is back! This time Dr. Maj Cina drops knowledge on a few common inpatient scenarios, focusing on apixaban and colonoscopy prep.
Majid Cina, MD • Neda Frayha, MD
Recurrent pregnancy loss can be difficult for our patients to live with. Reproductive endocrinologist Dr. Lauren Roth joins us for a conversation on the causes, evaluation, and management of recurrent pregnancy loss
Lauren Roth, MD • Matthew DeLaney, MD, FACEP, FAAEM
Dr Richard Alan John Asher was an eminent British hematologist and endocrinologist who died in April 1969. During his career, he wrote an essay titled, “Seven Sins of Medicine.” Drs. Paul Simmons and Keith Dickerson ruminate on this essay and how it still applies to the practice of medicine today.
Keith Dickerson, MD • Paul Simmons, MD
There is a lot of variability in terms of practice patterns when it comes to providing medical care for an out of hospital event. Keys to preparation include having a good understanding of the particular event logistics and anticipating potential injuries and medical complications.
Matt Baird, MD • Matthew DeLaney, MD, FACEP, FAAEM
There was no difference between omega-fatty acid supplements and placebo on CV outcomes in eldelrly pts with recent MI
Steve Biederman, MD • Tom Robertson, MD
In this Hippo Education bonus, Dr. Lisa Patel and Dr. Maya Ragavan discuss intimate partner violence (IPV) in the context of COVID-19. While data has focused on prevalence, they dive into how the pandemic has changed survivors’ experiences, access to resources, approach to safety planning, privacy …
Lisa Patel, MD • Maya Ragavan, MD
In this installment of Hippo Education’s Race and Medicine series, Jay and Neda dive into some of the unique challenges facing Black medical students and residents. They also discuss solutions in both undergraduate and medical education with two experts in the field: Dr. Millard Collins, Chair of …
Jay-Sheree Allen, MD • Millard D. Collins, MD, FAAFP • Neda Frayha, MD • Renee Crichlow, MD, FAAFP
Kappa? Lambda? SPEPs? MGUS? WTH? Hematologist Dr. Victoria Giffi walks us through a clear, helpful primer on this alphabet soup of immunoglobulins.
Neda Frayha, MD • Victoria Giffi, MD
There are significant health disparities for men who have sex with men. In this enlightening segment, Drs. Matt Zeitler and Hayden Shafer discuss these disparities and how we can address them in our primary care practice.
Hayden Schafer, MD • Matthew Zeitler, MD
Patients reported errors in medical documentation almost a quarter of the time, and half of those errors were deemed serious.
Steve Biederman, MD • Tom Robertson, MD
What is the deal with amitriptyline? Is it a panacea? Or a pariah? PC RAP’s own Dr. Jay-Sheree Allen and Dr. Neda Frayha break it all down for us in this medication deep dive.
Jay-Sheree Allen, MD • Neda Frayha, MD
How’s your toenail-removing game? If it needs a little practice, listen to this segment about onychocryptosis to help you proceed with confidence in the why and how of removing a toenail.
John Doughton, MD • Michael Baca-Atlas, MD
Antibiotics were not inferior to appendectomy at 90 days. 30% of the antibiotic group ended up having an appendectomy by 90 days.
Steve Biederman, MD • Tom Robertson, MD
Among smokers recently diagnosed with cancer, sustained counseling and provision of free cessation medication resulted in higher six month quit rates.
Steve Biederman, MD • Tom Robertson, MD
Use of palliative care was associated with less acute healthcare use and modestly lower symptom burden, but there was no significant difference in quality of life.
Steve Biederman, MD • Tom Robertson, MD
On average, 5,000 new medical articles are published every day. In this segment, Dr. Alan Ehrlich, Executive Editor of DynaMed, and Paul Simmons discuss some practical tips in staying current with the literature and applying it to our everyday practice.
Alan Ehrlich, MD • Paul Simmons, MD
When you are deciding to bill a level 99213 vs 99214, how comfortable are you with your documentation? How about billing for procedures? Paul dives deep into coding with Dr. Kim Yu in this segment, including the 2021 Medicare coding changes.
Kim Yu, MD, FAAFP • Paul Simmons, MD
There are significant health disparities for men who have sex with men. In this enlightening segment, Drs. Matt Zeitler and Hayden Shafer discuss these disparities and how we can address them in our primary care practice.
Hayden Schafer, MD • Matthew Zeitler, MD
Can you picture attending a routine prenatal visit in a visit with other pregnant women? What does the literature say about this? Neda discusses group prenatal care with Ob/Gyn Dr. Sara Mazzoni.
Neda Frayha, MD • Sara Mazzoni, MD
Computer games did not improve children's working memory at six months.
Steve Biederman, MD • Tom Robertson, MD
Physicians at all training levels had deficiencies in EKG interpretation, even after education interventions.
Steve Biederman, MD • Tom Robertson, MD
Tattoos have become more and more common over the past decade. Besides regret, there are other cutaneous complications that clinicians should be aware of. Having a broad differential beyond simple bacterial infections can assist in making decisions on appropriate treatment and prompt referral to …
Brittney DeClerck, MD • Matthew DeLaney, MD, FACEP, FAAEM • Matthieu DeClerck, MD
Early rhythm control therapy was associated with a lower risk of adverse cardiovascular outcomes than usual care among patients with early atrial fibrillation and cardiovascular conditions
Steve Biederman, MD • Tom Robertson, MD
PFTs? Easy as ABC! Pulmonologist Dr. Nirav Shah is back, this time walking Neda and Paul through pulmonary function tests in a super clear, straightforward way.
Neda Frayha, MD • Nirav Shah, MD • Paul Simmons, MD
Just when we all get accustomed to treating COVID-19, along comes Long Covid Syndrome to keep us on our toes. Some patients take months to recover and experience debilitating fatigue, dyspnea, and joint pains that have a huge impact on their quality of life. Neda and Paul answer a few listener …
Neda Frayha, MD • Paul Simmons, MD
It’s time for another installment of our fan-favorite “What’s That Lab?” series! This time, our own Paul Simmons answers a listener question about bilirubin.
Paul Simmons, MD
Among patients with heart failure, SGLT inhibitors improved rate of hospitalizations and decline in renal function regardless of diabetes status
Steve Biederman, MD • Tom Robertson, MD
PFTs? Easy as ABC! Pulmonologist Dr. Nirav Shah is back, this time walking Neda and Paul through pulmonary function tests in a super clear, straightforward way.
Neda Frayha, MD • Nirav Shah, MD • Paul Simmons, MD
Why are we so afraid of death? What is the vicarious death bed test, and what role does love play? How can we help our patients face death on their own terms, and how can we all live our best lives beforehand? We ask these questions and more of Dr. BJ Miller, a palliative care specialist with …
BJ Miller, MD • Neda Frayha, MD
The COVID-19 pandemic has struck minority populations and populations of color most severely. One population hit particularly hard, but to little public notice, has been the Native American population in North America. Our own Paul Simmons and Dr. Matt Nelson, a family physician providing …
Matthew Nelson, DO, MPH • Paul Simmons, MD
Less is more! We were thrilled to learn about the JAMA Internal Medicine series highlighting which primary care services we can scale back on or do away with completely. In this month’s Primary Care RAP introduction, Neda and Paul begin breaking down some of these recommendations and how they’ll …
Neda Frayha, MD • Paul Simmons, MD
Endocrinologist Dr. Rana Malek is back on Primary Care RAP, this time teaching Neda and Paul about the in’s and out’s of polycystic ovarian syndrome in her usual, chock-full-of-clinical-pearls way.
Neda Frayha, MD • Paul Simmons, MD • Rana Malek, MD
Time-restricted eating on its own is not more effective in weight loss than eating throughout the day.
Steve Biederman, MD • Tom Robertson, MD
Among patients with recurrent CDI treatment with FMT, cure rates were high with minimal adverse effects.
Steve Biederman, MD • Tom Robertson, MD
In this Hippo Education bonus, Dr. Paul Simmons and Dr. Jay-Sheree Allen sit down to discuss what lab studies are recommended on admission of a COVID patient to the hospital, which labs are followed daily, and how they’re best used.
Jay-Sheree Allen, MD • Paul Simmons, MD
Do you know how eczema may look different on skin of color compared to light skin? How about psoriasis? Or melanoma? Why do our dermatology lectures feature rashes and skin cancers on light skin only? Dr. Jenna Lester, the dermatologist at UCSF and the founder and director of UCSF’s Skin of Color …
Jay-Sheree Allen, MD • Jenna Lester, MD • Neda Frayha, MD
In this Hippo Education bonus, Dr. Matthieu DeClerck and Dr. Manie Beheshti, an infectious disease specialist, answer common questions that clinicians have regarding the new mRNA vaccine, including how mRNA vaccines work, concerns about what we know and don’t know, and how to best approach patients.
Manie Beheshti, MD • Matthieu DeClerck, MD
Raising kids while working as front-line clinicians in the Covid-19 pandemic has introduced unprecedented challenges to our lives. Dr. Jason Liebzeit and Primary Care RAP host Dr. Neda Frayha sit down for some real talk on being caregivers as well as clinicians in the time of Covid-19, including …
Jason Liebzeit, MD, FACEP • Neda Frayha, MD
Almost half of the children in the study experienced some degree of adversity, and this was associated with a moderately higher risk of mortality in adulthood.
Steve Biederman, MD • Tom Robertson, MD
Among patients with elevated triglycerides despite statin use, risk of ischemic events while on icosapent ethyl was significantly lower compared to placebo. However, it was not significant when looking only at the subgroup taking it for primary prevention.
Steve Biederman, MD • Tom Robertson, MD
Icosapent ethyl showed a significant reduction in coronary plaque size and improved stability compared with placebo.
Steve Biederman, MD • Tom Robertson, MD
Iron deficiency anemia requiring intravenous iron is a delayed consequence of bariatric surgery. Young age, anemia, and low ferritin before surgery are associated with an increased risk of iron deficiency anemia during follow-up.
Steve Biederman, MD • Tom Robertson, MD
At the end of this weird, wearisome 2020, Neda invites senior Family Medicine resident and Instagram phenom, Dr. Aleah Thompson, to join her for a meta-discussion of how to find the right PCP. Helpful for friends, family, neighbors, and maybe even ourselves.
Aleah Thompson, MD • Neda Frayha, MD
Does it make you dizzy to hear a complaint of dizziness? Here, Michael Baca-Atlas will break down dizziness in the older adult with Family Medicine residency program director and expert in geriatrics, Dr. Mallory McClester Brown. We hope it helps your head stop spinning!
Mallory McClester Brown, MD • Michael Baca-Atlas, MD
How comfortable are you with recommending bariatric surgery to your patients? How about caring for your patients who have had bariatric surgery? In this segment, Neda has an in-depth discussion about all things bariatric surgery with Dr. Arghavan Salles, bariatric surgeon and physician author …
Arghavan Salles, MD, PhD • Neda Frayha, MD
Most women experience high rates of satisfaction with IUD as a form of contraception. There are reasons, however, that women may want to have an IUD removed prior to the recommended time. Dr. Molly Heublin, our resident women’s health expert, takes us through reasons for removal as well as some …
Molly Heublein, MD
Treatment with vitamin D3 did NOT result in statistically significant difference in the incidence and recurrence of depression.
Steve Biederman, MD • Tom Robertson, MD
Hospitalist Corner Lightning Round is back! This time Dr. Maj Cina drops knowledge on 4 common inpatient scenarios in the arena of infectious diseases.
Maj Cina, MD • Matthew DeLaney, MD, FACEP, FAAEM • Neda Frayha, MD
Lice are a common infestation, especially in pediatric patients. Thankfully, treatment is often very straight forward and successful. The key to diagnosis is inspection for live louse, nits, and eggs. First line treatment includes wet combing, topical pediculicides, or shaving of hair. Second line …
Brittney DeClerck, MD • Matthieu DeClerck, MD • Mizuho Morrison, DO
In April 2018, we discussed whether or not we should become Facebook friends with our patients. A lot has changed in the world of social media since that episode; Neda and Jay-Sheree Allen update the discussion and share thoughts about this potentially useful tool.
Jay-Sheree Allen, MD • Neda Frayha, MD
How comfortable are you with recommending bariatric surgery to your patients? How about caring for your patients who have had bariatric surgery? In this segment, Neda has an in-depth discussion about all things bariatric surgery with Dr. Arghavan Salles, bariatric surgeon and physician author …
Arghavan Salles, MD, PhD • Neda Frayha, MD
This year we’ve launched two special audio series to help clinicians practice the best medicine possible: one on the Covid-19 pandemic, and the other on dismantling systemic racism in medicine. In this special conversation, these two audio series come together for an in-depth view of racial …
Jasmine R. Marcelin, MD, FACP • Jay-Sheree Allen, MD • Neda Frayha, MD
Compression therapy resulted in lower incidence of recurrent cellulitis
Steve Biederman, MD • Tom Robertson, MD
Paul and Matt go over the ins and outs of dog and cat bites. This discussion includes appropriate wound management, use of prophylactic antibiotics,and post-exposure rabies prophylaxis.
Matthieu DeClerck, MD • Paul Simmons, MD
Do you have a super amazing approach to patients with joint complaints? If not, you will after listening to this practical conversation between Neda and Dr. Uzma Haque, a rheumatologist and arthritis expert at Johns Hopkins.
Neda Frayha, MD • Uzma Haque, MD
For most of us, people over the age of 65 make up a huge portion of the patients we see and the energy we pour into clinical care. And yet most of us receive woefully inadequate training to provide the best care for these patients and to overcome structural, systemic biases against the elderly. In …
Louise Aronson, MD, MFA • Neda Frayha, MD
COPD can be a big, unwieldy topic in primary care. Thank goodness we have pulmonologist Dr. Kathryn Robinett to walk us through a practical, real world approach to the evaluation, classification, and management of COPD in our primary care practices. Spoiler alert: it’s not always about the Gold …
Kathryn Robinett, MD • Paul Simmons, MD
A low-intensity, multifaceted intervention was associated with improved antibiotic prescribing for uncomplicated cystitis without adverse outcomes
Steve Biederman, MD • Tom Robertson, MD
Constipation can be a tricky thing to both diagnose and treat. In this month’s intro segment, Neda and Aisha discuss the work up and management of this common complaint.
Aisha Lofters, MD • Neda Frayha, MD
Our cancer patients need to consider lots of different factors when it comes to preserving their fertility. Reproductive endocrinologist Dr. Lauren Roth walks us through the options available to our oncofertility patients.
Lauren Roth, MD • Matthew DeLaney, MD, FACEP, FAAEM • Neda Frayha, MD
Incorporation of lung US significantly reduced the risk of urgent visits for worsening CHF
Steve Biederman, MD • Tom Robertson, MD
Monocytosis is a fairly common finding that is often of undetermined significance. In this “What’s that Lab?” segment, Paul presents an approach to this abnormality we can use in our practice.
Paul Simmons, MD
For most of us, people over the age of 65 make up a huge portion of the patients we see and the energy we pour into clinical care. And yet most of us receive woefully inadequate training to provide the best care for these patients and to overcome structural, systemic biases against the elderly. In …
Louise Aronson, MD, MFA • Neda Frayha, MD
There was no significantly lower rate of serious fall injury.
Steve Biederman, MD • Tom Robertson, MD
Among employees of a large US warehouse retail company, a workplace wellness program resulted in greater rates of positive self-reported behaviors but no significant differences in clinical measures of health, healthcare spending and utilization, and employment outcomes
Steve Biederman, MD • Tom Robertson, MD
In this Hippo Education bonus conversation, Drs. Jay-Sheree Allen and Neda Frayha sit down with American Academy of Family Physicians President Dr. Ada Stewart. They discuss the AAFP’s recent policy statement that racism is a public health crisis; what the AAFP is doing as an organization to …
Ada Stewart, MD, FAAFP • Jay-Sheree Allen, MD • Neda Frayha, MD
Toxicology aficionado Cyrus Rangan sits down with Parul and Ilene to take us through the prevention, diagnosis, and management of carbon monoxide toxicity.
Cyrus Rangan, MD • Ilene Claudius, MD • Parul Bhatia, MD
Neonatal hyperbilirubinemia affects almost 84% of term newborns! If you’re a little rusty on the subject, listen in as Drs. Lekecia Pitts and Matthew Zeitler discuss the evaluation and management of this important (and common) diagnosis.
Lakecia Pitts, MD • Matthew Zeitler, MD
Serious adverse events are associated with short bursts of steroids and are most common within the first month.
Steve Biederman, MD • Tom Robertson, MD
In this Hippo Education bonus, world-renowned vaccine expert and Pediatric Infectious Diseases specialist Dr. Paul Offit sits down with Peds RAP host Dr. Sol Behar and Primary Care RAP host Dr. Neda Frayha for a candid conversation on where we stand with the development of a COVID-19 vaccine …
Neda Frayha, MD • Paul Offit, MD • Solomon Behar, MD
When you discover an enlarged lymph node in someone who otherwise feels well, what do you do? Aisha and Neda tackle this exact issue in the Introduction to the October 2020 Primary Care RAP episode.
Aisha Lofters, MD • Neda Frayha, MD
Delirium affects up to ⅓ of older patients in the hospital and is associated with significant morbidity and even mortality. How do we recognize it? Treat it? Better yet, prevent it? Geriatrician Dr. Jenny Litrivis sits down with Neda to help us provide better care to our patients at risk for …
Evgenia Litrivis, MD • Neda Frayha, MD
Viral warts are common in children and most resolve spontaneously without treatment. Salicylic acid with regular paring and occlusion is the preferred treatment for cutaneous viral warts. Cryotherapy in combination with salicylic acid is recommended as a second line treatment.
Brittney DeClerck, MD • Matthieu DeClerck, MD • Mizuho Morrison, DO
Triple therapy at either dose resulted in lower rate of COPD exacerbations.
Steve Biederman, MD • Tom Robertson, MD
New statin use was significantly associated with a lower risk of mortality in US veterans > 75 years of age.
Steve Biederman, MD • Tom Robertson, MD
Screening for lung cancer is a controversial topic among medical professionals and patients. In this segment, our intrepid Things I Do But Should I duo Paul and Justin dig deep into the guidelines so we can guide our patients through this decision.
Justin McCarthy, MD • Paul Simmons, MD
Delirium affects up to ⅓ of older patients in the hospital and is associated with significant morbidity and even mortality. How do we recognize it? Treat it? Better yet, prevent it? Geriatrician Dr. Jenny Litrivis sits down with Neda to help us provide better care to our patients at risk for …
Evgenia Litrivis, MD • Neda Frayha, MD
In older adults with subclinical hypothyroidism and high symptom burden at baseline, levothyroxine did not improve hypothyroid symptoms or tiredness compared with placebo
Steve Biederman, MD • Tom Robertson, MD
Anticoagulation prevents recurrent VTE in patients with distal DVT
Steve Biederman, MD • Tom Robertson, MD
With the number of cancer survivors growing and the longer lasting effects of newer treatments, how well equipped are primary care clinicians to care for cancer survivors over the long haul? Dr. Cathy Handy Marshall, an oncologist at Johns Hopkins, joins Neda for a conversation about cancer …
Catherine Marshall, MD, MPH • Neda Frayha, MD
In this Hippo Education bonus conversation, Drs. Jay-Sheree Allen and Neda Frayha sit down with Dr. Joia Crear Perry, thought leader and researcher on racism as a root cause of health inequities, obstetrician-gynecologist, and Founder and President of the National Birth Equity Collaborative. They …
Jay-Sheree Allen, MD • Joia Crear-Perry, MD, FACOG • Neda Frayha, MD
In this Hippo Education bonus, Dr. Lisa Patel from the Peds RAP team sits down with Dr. Jaya Aysola, Assistant Professor of Medicine and Pediatrics and Assistant Dean of Inclusion and Diversity at the Perelman School of Medicine at the University of Pennsylvania. The COVID-19 pandemic has strained …
Jaya Aysola, MD, DTMH, MPH • Lisa Patel, MD
In this Hippo Education bonus, Dr. Mizuho Morrison from the Urgent Care RAP team sits down with Dr. Ajsa Nikolic, family medicine physician and medical director for Ochsner Health’s Virtual Care Provider Network. They discuss practical do’s and don’ts for those starting out in telemedicine, as an …
Ajsa Nikolic, MD • Mizuho Morrison, DO
Throughout our career, we will inevitably have to give some bad news to our patients, and many of us feel unprepared. Neda discusses an evidence-based model for breaking bad news with geriatrician and palliative care expert Dr. Jenny Litrivis. We even include an example role-play for your listening …
Evgenia Litrivis, MD • Neda Frayha, MD
Antibiotics did NOT reduce length of stay, adverse events, or readmission rates
Steve Biederman, MD • Tom Robertson, MD
P2Y12 was associated with a very slight risk reduction for myocardial infarction compared to aspirin. There were comparable risks of stroke.
Steve Biederman, MD • Tom Robertson, MD
What is the deal with clonidine? In this introduction to the September PC RAP episode, Neda and Paul answer some listener questions about this controversial medication.
Neda Frayha, MD • Paul Simmons, MD
A cough lasting longer than 8 weeks can be a major frustration for our patients (and everyone around them). In this segment, pulmonologist and cough expert Dr. Kathryn Robinett walks Neda and Paul through a real-world approach to chronic cough and drops tons of beautiful, shimmery knowledge pearls …
Kathryn Robinett, MD • Neda Frayha, MD • Paul Simmons, MD
In recent years, CBD has become increasingly popular as a “cure” for ailments ranging from pain to anxiety. How much evidence is there to back up these claims? Drs. Michael Baca-Atlas and Hayden Shafer do a literature deep-dive.
Hayden Schafer, MD • Michael Baca Atlas, MD
Postpartum depression has gained a lot of national attention in recent years, but what about depression during pregnancy? Neda discusses the important topic of perinatal mental health with Ob/Gyn Dr. Sara Mazzoni.
Neda Frayha, MD • Sara Mazzoni, MD
Almost half of hospital personnel recommended password sharing and that few hospitals enabled patients to limit the types of information seen by those with proxy access.
Steve Biederman, MD • Tom Robertson, MD
Among older patients treated with multiple antihypertensive medications, a strategy of medication reduction, compared with usual care was NON-INFERIOR with regard to systolic blood pressure control at 12 weeks.
Steve Biederman, MD • Tom Robertson, MD
The world of diabetes management has changed dramatically in the past several years. Given the new ADA guidelines and all the new literature on SGLT2 inhibitors and GLP1 receptor antagonists, endocrinologist Dr. Beth Lamos is back to help us understand how to use these drugs in practice.
Elizabeth Lamos, MD • Neda Frayha, MD
To freeze or not to freeze, that is the question that Drs. Paul Simmons and Justin McCarthy will attempt to answer in this Things I Do But Should I? conversation on cryotherapy.
Justin McCarthy, MD • Paul Simmons, MD
How comfortable are you with placement of LARCs (implants and IUDs)? If you could use a refresher, Drs. Paul Simmons and Karlynn Sievers walk through the procedures as part of our “Proceed with Confidence” series.
Karlynn Sievers, MD • Paul Simmons, MD
Distracted driving laws were associated with significant reduction in fatal MVCs for teenage drivers
Steve Biederman, MD • Tom Robertson, MD
How comfortable are you with placement of LARCs (implants and IUDs)? If you could use a refresher, Drs. Paul Simmons and Karlynn Sievers walk through the procedures as part of our “Proceed with Confidence” series.
Karlynn Sievers, MD • Paul Simmons, MD
In this Hippo Education bonus, Dr. Lisa Patel from our Peds RAP team sits down with Dr. Ryan Padrez, Medical Director at The Primary School, Assistant Clinical Professor in Pediatrics at Stanford University and Executive Committee member on the Council of School Health at the American Academy of …
Lisa Patel, MD • Ryan Padrez, MD
In this Hippo Education bonus conversation, Drs. Jay-Sheree Allen and Neda Frayha sit down with noted health disparities researcher Dr. Utibe Essien, an Assistant Professor of Medicine at the University of Pittsburgh School of Medicine and Core Investigator for the Center for Health Equity Research …
Jay-Sheree Allen, MD • Neda Frayha, MD • Utibe R. Essien, MD, MPH
Pediatricians Roy Benaroch and Geoff Simon break down the latest literature on Pediatric COVID-19.
Geoff Simon, MD • Roy Benaroch, MD
When a patient presents with a subacute cough, is eosinophilic esophagitis in your differential? It will be after you listen to this deep dive on EoE with Drs. Micaela Robb Bowers and Neda Frayha. •
Micaela Robb Bowers, MD • Neda Frayha, MD
To validate the CSRS and determine its ability to predict 30-day serious outcomes. •
Steve Biederman, MD • Tom Robertson, MD
Got time? A lot of our resident listeners have been asking for tips and tools for time management in the clinic. Dr. Nikki Southall joins Paul and Neda for a conversation about typical time sinks, some great time management tips, and strategies for becoming more efficient at work. •
Neda Frayha, MD • Nikki Southall, MD • Paul Simmons, MD
G codes and split billing and abbreviations, oh my! If the Medicare Annual Wellness Visit boils your brain, listen in as Neda and Dr. Jay-Sheree Allen break it down into a simplified checklist. •
Jay-Sheree Allen, MD • Neda Frayha, MD
To investigate readmission characteristics following hospitalizations for COPD exacerbations. •
Steve Biederman, MD • Tom Robertson, MD
HELLP syndrome is a scary diagnosis, especially for primary care clinicians. Listen in as Neda and Aisha discuss HELLP syndrome from H to P. We hope it HELLPs your practice. •
Aisha Lofters, MD • Neda Frayha, MD
As we continue our series on breast health, Dr. Molly Heublein takes us through all we need to know about breast cancer chemoprophylaxis. •
Molly Heublein, MD
To assess the efficacy of liraglutide as a weight loss medication in adolescents.
Steve Biederman, MD • Tom Robertson, MD
In August’s introduction segment, Neda and Dr. Jay-Sheree Allen discuss a case of giant cell arteritis and summarize the diagnosis and treatment of the condition. •
Jay-Sheree Allen, MD • Neda Frayha, MD
To examine whether gabapentin would be useful in the treatment of AUD, including alcohol withdrawal. •
Steve Biederman, MD • Tom Robertson, MD
Andy, Drew, and Miz discuss common presentations of patella fractures and review appropriate stabilization, treatment and follow-up recommendations.
Andy Little, DO • Drew Kalnow, DO • Mizuho Morrison, DO
Iron deficiency is incredibly common and yet also difficult to both manage and treat. Dr. Victoria Giffi, hematologist extraordinaire, drops tons of knowledge bombs on Paul in this helpful and clear primer on iron deficiency. •
Paul Simmons, MD • Victoria Giffi, MD
To evaluate the safety and efficacy of apixaban for the treatment of cancer-associated venous thromboembolism. •
Steve Biederman, MD • Tom Robertson, MD
Race and health are inextricably linked to each other. Pediatricians Nathan Chomilo and Michael Cosimini break down the AAP Policy Statement on the health effects of racism on children.
Michael Cosimini, MD • Nathan Chomilo, MD
Do you automatically refer to a urologist when a patient asks about a vasectomy? Have you ever considered that this procedure can actually be done in the primary care office? Our own Paul Simmons discusses this with Dr. Lyrad Riley in the first installment of a new series on procedural tips and …
Lyrad Riley, MD, MPH, FAAFP • Paul Simmons, MD
Compared with implantable loop recorders, the diagnostic yield of detecting Afib improved with increased number of screenings and duration of screenings. •
Steve Biederman, MD • Tom Robertson, MD
Ilene Claudius reviews for us the classification of burns in pediatric patients and how this affects management. Criteria and referral to a burn center is discussed as well as the treatment of burns for outpatient vs. inpatient management. •
Ilene Claudius, MD • Lisa Patel, MD • Matthieu DeClerck, MD • Mizuho Morrison, DO
Use of low-dose aspirin was associated with significantly lower risk of hepatocellular carcinoma and lower liver-related mortality in patients with chronic viral hepatitis. •
Steve Biederman, MD • Tom Robertson, MD
Treatment-limiting POLSTs were significantly associated with lower rates of ICU admission compared with full-treatment POLSTs. However, 38% of patients with treatment-limiting POLSTs received intensive care that was potentially discordant with their POLST. •
Steve Biederman, MD • Tom Robertson, MD
We all learned about mumps in school, but how often is it on your differential? In this segment, Dr. Micaela Robb Bowers takes Neda through a crash course on mumps, including complications and fertility concerns. •
Micaela Robb Bowers, MD • Neda Frayha, MD
A score of <3 on the PEN-FAST clinical decision rule was associated with a high NPV and could be used to identify low risk PCN allergies
Steve Biederman, MD • Tom Robertson, MD
Insured adults have been visiting PCPs less often and nearly one half had no PCP visits in a given year by 2016 •
Steve Biederman, MD • Tom Robertson, MD
How much do you know about Neonatal Abstinence Syndrome? Whether you work in hospital medicine or in the clinic, it’s important to be aware of the risks of substances on neonates and understand what happens after they’re born. In this segment, Dr. Michael Baca-Atlas and Dr. Matt Zeitler take a deep …
Matthew Zeitler, MD • Michael Baca Atlas, MD
Have you ever ordered a lab and then been baffled by the results? Paul Simmons starts a new series called, “What’s That Lab” in which he teaches us what we need to know about common laboratory tests. First up: Ferritin. •
Paul Simmons, MD
Colon cancer screening guidelines seem to be changing constantly. For the newest updates, tune in to Paul and Neda’s conversation with GI guru, Dr. Sandra Quezada. •
Neda Frayha, MD • Paul Simmons, MD • Sandra Quezada, MD
How comfortable are you with uncertainty? Super comfortable? Great! Then there’s absolutely no reason to listen to this month’s intro conversation, in which Neda and Paul talk about how they’ve coped with all the uncertainty of the covid-19 pandemic and dive into the literature to find some …
Neda Frayha, MD • Paul Simmons, MD
We’ve talked about IV contrast and the kidneys, but what about the gadolinium-based contrast agents we use for MRIs? Are they safe in kidney disease? Neda and Paul break down nephrogenic systemic fibrosis and how we should think about the GBCAs. •
Neda Frayha, MD • Paul Simmons, MD
Medical tests can lie. X-rays are simply a test. The purpose of any test is to affect our pre-test probability - it is not to make a diagnosis. Any test result (positive or negative) must be placed in the clinical context it is being used. We should have an expectation of any test before we order …
Arun Sayal, MD • Neda Frayha, MD
In recent weeks, many of our medical organizations have released official statements declaring racism to be a public health crisis. In this introduction to Hippo Education’s new Race and Medicine audio series, Dr. Jay-Sheree Allen sits down with Primary Care RAP host Dr. Neda Frayha for a candid …
Jay-Sheree Allen, MD • Neda Frayha, MD
Drs. Brian Lin and Mike Weinstock discuss alterations to our usual practice patterns of laceration repair in the setting of the COVID pandemic, which include increasing patient throughput through faster closure techniques, reducing total points of contact with the healthcare system by using …
Brian Lin, MD • Mike Weinstock, MD
How are you coping with all of the death around us these days? In this Hippo Education update, Primary Care RAP host Dr. Neda Frayha interviews Dr. BJ Miller, a hospice and palliative care specialist at Mettle Health whose TED talk on what really matters at the end of life has been viewed over 10 …
BJ Miller, MD • Neda Frayha, MD
Most cases of AGE in children are self-limited illness that can be managed with supportive care. Antiemetics facilitate oral rehydration. Treat more severe cases with IV fluid rehydration. Do not empirically treat suspected bacterial diarrhea with antibiotics given risk of HUS with certain strains …
Matthieu DeClerck, MD • Solomon Behar, MD
Few things can ruin our mood more quickly than a request for a prior authorization or a peer-to-peer. In this segment, Neda and Dr. Ashish Patel tackle the beast that is the dreaded prior authorization. •
Ashish Patel, MD • Neda Frayha, MD
Are you an expert in continuous glucose monitors and how to use them? Great! Then you can teach us! If not, endocrinologist and friend of the podcast Dr. Beth Lamos is back to walk us through the indications for CGMs and practical ways to use them in our patients.
Elizabeth Lamos, MD • Paul Simmons, MD
Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. •
Steve Biederman, MD • Tom Robertson, MD
Are you stumped by prescribing medications to nursing mothers? Do you know about pumping and dumping? Neda sits down with Dr. Elizabeth Lavery to discuss the use of medications in breastfeeding women so we can feel empowered to prescribe in this population. •
Elizabeth Lavery, MD • Neda Frayha, MD
Most cases of AGE in children are self-limited illness that can be managed with supportive care. Antiemetics facilitate oral rehydration. Treat more severe cases with IV fluid rehydration. Do not empirically treat suspected bacterial diarrhea with antibiotics given risk of HUS with certain strains …
Matthieu DeClerck, MD • Solomon Behar, MD
Effect of Sunscreen Application on Plasma Concentration of Sunscreen Active Ingredients. •
Steve Biederman, MD • Tom Robertson, MD
Dr. Mizuho Morrison & Dr.Jenny Beck Esmay both having had covid themselves, briefly discuss the clinical course and what presence of IgM vs. IgG signifies. They discuss what we currently know about antibody testing (national availability, reliability, sensitivity) as well as convalescent plasma …
Jenny Beck-Esmay, MD • Mizuho Morrison, DO
Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care. •
Steve Biederman, MD • Tom Robertson, MD
An elderly patient with knee pain limps into your clinic asking for a “cortisone shot”. Do you reach for the needle? Paul Simmons and Justin McCarthy dive in to the real evidence behind intra-articular knee injections in this TIDBSI segment. •
Justin McCarthy, MD • Paul Simmons, MD
Asthma treatment guidelines have been evolving since the last published guidelines in 2007. Take a deep breath with Paul Simmons as he dives into the 2019 recommendations from GINA. •
Paul Simmons, MD
Ever wondered what to do when a patient has flashers or floaters? None other than Dr. Glaucomflecken is here to teach Mike and Neda about how to tell these presentations apart, how to manage them, and when to call your friendly local ophthalmologist.
Mike Weinstock, MD • Neda Frayha, MD • Will Flanary, MD
Risk of Acute Kidney Injury Following Contrast-enhanced CT in Hospitalized Pediatric Patients. •
Steve Biederman, MD • Tom Robertson, MD
Screening for Hepatitis C Virus Infection in Adolescents and Adults USPSTF recommendation statement.
Steve Biederman, MD • Tom Robertson, MD
Does the thought of completing a death certificate scare you half to death? In this month’s intro segment, Neda and Aisha get into the nitty gritty of how to accomplish this (sometimes) daunting task. •
Aisha Lofters, MD • Neda Frayha, MD
*Editor's note: As of June 4, 2020, The Lancet article by Mehra MR et al has been retracted. (https://www.thelancet.com/lancet/article/s0140673620313246) • In this Hippo Education short, Dr.Salim Rezaie from REBEL EM and Lit Matters critically appraises two papers published on Friday May 22nd …
Salim Rezaie, MD
COVID-19 causes STEMI’s, arrhythmias and myocarditis?!? Emergency medicine and cardiology guru Amal Mattu, MD chats with Mizuho Morrison, DO on the cardiovascular effects of COVID-19. They discuss: the known pathophysiology of how viral infections affect the heart; Review the new consensus …
Amal Mattu, MD • Mizuho Morrison, DO
Children seem to be less affected than adults by the direct effects of COVID-19 infection, but the pandemic has brought forth other health risks to the pediatric population. Sol Behar interviews Oakland, CA based primary care pediatricians Celine Sparrow and Katie D’Harlingue about the indirect …
Celine Sparrow, MD • Katherine D'Harlingue, MD • Solomon Behar, MD
Sol Behar interviews New York City pediatric emergency doctor Dr. Ee Tay, highlighting the features of pediatric COVID disease, including an emerging illness that is being compared to Kawasaki Shock Syndrome called “pediatric inflammatory multisystem disease” (PIMS).
Ee Tay, MD • Solomon Behar, MD
In this Hippo Education update, Primary Care RAP host Dr. Neda Frayha interviews regular guest and Infectious Diseases expert Dr. Devang Patel for a discussion of where the IDSA stands on all the potential treatments for COVID-19, a review of the remdesivir paper that is all the rage lately, and a …
Devang Patel, MD • Neda Frayha, MD
Sol Behar interviews Oakland, CA based primary care pediatricians Celine Sparrow and Katie D’Harlingue about the impact of COVID-19 on primary care practices. They discuss practical details of how to safely continue caring for their patients, selves and staff members. They also share strategies and …
Celine Sparrow, MD • Katherine D'Harlingue, MD • Solomon Behar, MD
Dr. Matthieu DeClerck talks to Dr. Manie Beheshti on how the healthcare system should approach the “re-opening” of society as we plan the lifting of social restrictions. What safety implementations need to be in place in order to protect our most vulnerable patients. What changes can we anticipate …
Manie Beheshti, MD • Matthieu DeClerck, MD
Have you ever had a patient who is on peritoneal dialysis? What does this even mean? How does it work? Neda and Paul answer these questions and more in this 2 part-segment about peritoneal dialysis. •
Neda Frayha, MD • Paul Simmons, MD
The use of scribes in medical practices has been around for decades. They have been utilized in emergency departments, primary care practices, inpatient medical teams, and specialty practices. The use of scribes in the urgent care can be a big improvement to the practice if the implementation is …
Matthew DeLaney, MD, FACEP, FAAEM • Neda Frayha, MD • Sam Ashoo, MD
Sol and Matthieu discuss the differential diagnosis, evaluation and management of pediatric lymphadenopathy, including when to pursue imaging and specialist referral. •
Matthieu DeClerck, MD • Solomon Behar, MD
To examine different OUD treatment pathways and associations with overdose or opioid-related acute care. •
Steve Biederman, MD • Tom Robertson, MD
To assess the risks of fracture associated with differences in concentrations of 25-hydroxyvitamin D in observational studies and the risks of fracture associated with supplementation with vitamin D alone or in combination with calcium •
Steve Biederman, MD • Tom Robertson, MD
When PC RAP listener David wrote to us that he has seen more of his patients using alcohol in pregnancy, our own Michael Baca-Atlas put on his addiction medicine hat to review research and recommendations regarding alcohol use in pregnancy. •
Michael Baca-Atlas, MD
To investigate the effect of abstinence from alcohol on secondary prevention of atrial fibrillation. •
Steve Biederman, MD • Tom Robertson, MD
We’ve been discussing breast health and breast cancer screening recently on PC RAP, but haven’t touched on the physical exam yet. In this segment, Dr. Rebecca Zendel Berliner walks us through how to perform a complete history and physical exam for a breast complaint. •
Neda Frayha, MD • Rebecca Zendel Berliner, MD
Have you ever had a patient who is on peritoneal dialysis? What does this even mean? How does it work? Neda and Paul answer these questions and more in this 2 part-segment about peritoneal dialysis. •
Neda Frayha, MD • Paul Simmons, MD
Hippo Education’s EM/Ortho expert, Dr. Arun Sayal, joins Matt DeClerck and Neda Frayha for a high-yield conversation about knee pain, the knee exam, and knee X-rays.
Arun Sayal, MD • Matthieu DeClerck, MD • Neda Frayha, MD
To identify prevalence and risk factors associated with unnecessary bimanual pelvic exams and pap smears in young women less than 21 y/o. •
Steve Biederman, MD • Tom Robertson, MD
When a listener wrote that many different chronic pain syndromes felt a little confusing to her, we were relieved that it wasn’t just us! Join us as our regular contributor Dr. Molly Heublein breaks down different pain syndromes that we see all the time in primary care. •
Molly Heublein, MD
To determine whether adding antiviral treatment for patients with an influenza like illness reduces time to recovery. •
Steve Biederman, MD • Tom Robertson, MD
Isn’t primary care full of diagnoses you’d never heard of before? In the intro to our May 2020 episode, Neda and Aisha go through the basics of proctalgia fugax, a condition that affects 20% of patients (or more!). •
Aisha Lofters, MD • Neda Frayha, MD
In this Hippo Education Short, psychiatrist Dr. Melissa Shepard sits down with Primary Care RAP host Dr. Neda Frayha for some real talk on the mental health challenges facing health care workers in the COVID-19 pandemic, and some concrete, tangible tools to help us get through this period. Spoiler …
Melissa Shepard, MD • Neda Frayha, MD
Dr. Matthew DeLaney and Dr. Michael Weinstock sit down to discuss the threat of lawsuits in the midst of the COVID pandemic. The last thing anyone wants to think about is the risk of a lawsuit. Unfortunately, despite the extra challenges posed by our current pandemic, the threat of medicolegal …
Matthew DeLaney, MD, FACEP, FAAEM • Mike Weinstock, MD
Drs. Mike Weinstock and Josh Russell, from Urgent Care RAP, just published a landmark COVID study: CXRs obtained from confirmed and symptomatic COVID-19 patients presenting to the UC were normal in 58.3% of cases, and normal or only mildly abnormal in 89% of patients.
Josh Russell, MD • Matthew DeLaney, MD, FACEP, FAAEM • Mike Weinstock, MD
COVID airway management creates a lot of anxiety for those of us non-intensivists. Dr. Mizuho Morrison interviews Dr. Scott Weingart (founder of EMCrit.org and Chief of the Division of Emergency Critical Care at Stony Brook University Hospital, NY) on the basics of COVID airway management.
Mizuho Morrison, DO • Scott Weingart MD
Patients with COVID-19 present in a variety of ways, and clinicians need to have a low index of suspicion for diagnosis. Management involves emergency referral for patients with a low oxygen saturation. Every patient should be treated as if they could have COVID-19.
Frank Illuzzi, MD • Matthieu DeClerck, MD • Mike Weinstock MD
Covid-19 is a rapidly spreading pandemic that is having worldwide ramifications. As Emergency Rooms and Hospitals quickly get overwhelmed by ill patients, the Urgent Care and Primary Care settings are playing critical roles in identifying who can go home vs. those that need to be transferred to the …
Matthew DeLaney, MD, FACEP, FAAEM • Matthieu DeClerck, MD
There are so many active threads, subthreads, and sub-sub-threads of conversation in the medical community surrounding the COVID-19 pandemic. In this Hippo Education Short, Drs. Tom Robertson and Steve Biederman of Primary Care RAP’s Paper Chase take 4 hot topics in COVID-19 and examine the …
Steve Biederman, MD • Tom Robertson, MD
To assess the effect of post-discharge scheduling assistance on PCP followup or readmissions. •
Steve Biederman, MD • Tom Robertson, MD
Sol interviews Children’s Hospital of Philadelphia NICU doc Joanna Parga-Belinkie to discuss COVID-19 and the some of the peripartum issues that come up during the novel coronavirus pandemic for both pregnant moms and their newborns.
Joanna Parga-Belinkie, MD • Solomon Behar, MD
If your car broke down on the side of the road, wouldn’t you ask for help? New PC RAP contributor Dr. Jay-Sheree Allen brings this analogy to how we can help our patients seek the appropriate mental health care they need, focusing on the indications for and benefits of therapy. •
Jay-Sheree Allen, MD • Neda Frayha, MD
To investigate the safety of a standardized perioperative DOAC management strategy. •
Steve Biederman, MD • Tom Robertson, MD
To assess effect of Dapagliflozin vs placebo in patients with HFrEF.
Steve Biederman, MD • Tom Robertson, MD
Sometimes it can seem like every other child we see has a food allergy. How prevalent are food allergies in the general population, and how can we best diagnose and manage them? To shed light on these questions, as well as recent guideline changes in the allergy community and novel therapies on the …
Neda Frayha, MD • Torie Grant, MD MHS
Neda and Paul are back at it, answering your questions. Here they cover: TMJ dysfunction, the new Nordic diet, and hypopigmentation. •
Neda Frayha, MD • Paul Simmons, MD
Sometimes it can seem like every other child we see has a food allergy. How prevalent are food allergies in the general population, and how can we best diagnose and manage them? To shed light on these questions, as well as recent guideline changes in the allergy community and novel therapies on the …
Neda Frayha, MD • Torie Grant, MD MHS
To evaluate beta blockers efficacy in preventing COPD exacerbations.
Steve Biederman, MD • Tom Robertson, MD
It’s estimated that at least 1.4 million Americans identify as transgender. In this segment, Neda and endocrinologist Dr. Elizabeth Lamos discuss how we, as primary care clinicians, can best serve our transgender patients at any point before, during, or after their gender transition. •
Elizabeth Lamos, MD • Neda Frayha, MD
Vaginal bleeding - an Ob/Gyn concern, right? Not so fast. Turns out, we can handle quite a bit of this in primary care. Neda and Dr. Megan Jones dive into diagnosis and management of bleeding in both the pre and post-menopausal woman. •
Megan Jones, MD • Neda Frayha, MD
Mizuho sits down with emergency medicine pharmacist/toxicologist Bryan Hayes, PharmD to answer some pertinent questions and myth-bust clarifications about pharmaceutical options in COIVD-19 treatment.
Bryan Hayes, PharmD • Mizuho Morrison, DO
When a patient with poorly controlled diabetes presents with numbness and tingling in their feet, how well do we really know what to do next? To help us understand diabetic neuropathy a bit better, Dr. Harpreet Tsui joins Neda to discuss screening, diagnosis, and treatment pearls. •
Harpreet Tsui, DO • Neda Frayha, MD
Pre-charting can be a controversial topic in the medical community. Should we do it? Should we not? Aisha shares her thoughts on the advantages and disadvantages of pre-charting, as well as some tips and tricks she uses in her own practice. •
Aisha Lofters, MD
To evaluate the safety and efficacy of 10 mg prednisolone in treatment of patients with osteoarthritis and signs of inflammation. •
Steve Biederman, MD • Tom Robertson, MD
Tramadol - good or bad? This age-old question has been burning for decades. Today, Paul Simmons and Justin McCarthy will attempt to settle the matter once and for all in our latest Things I Do But Should I conversation. •
Justin McCarthy, MD • Paul Simmons, MD
Has your clinical practice shifted to telemedicine yet? In the era of COVID-19, clinicians everywhere are being thrown into telemedicine, often without any experience or background knowledge. To help us all get up to speed with this patient care technology, Hippo Education’s Dr. Neda Frayha sits …
Edward Kaftarian, MD • Neda Frayha, MD
Many healthcare workers are worried if we get called in to help with COVID patients because this may be outside our scope of practice. Aaron Bright, MD sits down with Salim Rezaie, MD to simplify critical frontline lessons to keep you and your patients safe if you get called in. Topics include …
Aaron Bright, MD • Salim Rezaie, MD
Our panel of podcast hosts from a variety of practice settings discuss the logistical and psychological impact of the COVID-19 pandemic on healthcare workers and discuss strategies to mitigate the stress associated with the pandemic.
Matthieu DeClerck, MD • Mike Weinstock, MD • Neda Frayha, MD • Solomon Behar, MD
In this Hippo Education Short, Infectious Diseases specialist Dr. Devang Patel and our own Dr. Neda Frayha discuss the latest, clinician-focused updates on the COVID-19 coronavirus outbreak.
Devang Patel, MD • Neda Frayha, MD
While eye complaints are common, true eye related emergencies are fortunately rare. Any patient with sudden painful vision loss, binocular diplopia or possible penetrating globe injury should be seen emergently by an ophthalmologist. •
Matthew DeLaney, MD, FACEP, FAAEM • Neda Frayha, MD • Will Flanary, MD
To assess if there is a superior first-line antihypertensive.
Steve Biederman, MD • Tom Robertson, MD
To describe prescribing trends of gabapentinoids in hospitalized patients. •
Steve Biederman, MD • Tom Robertson, MD
To assess incidence compare mortality from neurodegenerative disease morbidity and mortality among soccer players. •
Steve Biederman, MD • Tom Robertson, MD
It is now recommended that NOACs are chosen over warfarin, in patients with atrial fibrillation, except in patients with moderate to severe mitral valve stenosis or a mechanical heart valve. •
Matthew DeLaney, MD, FACEP, FAAEM • Neda Frayha, MD • Tarlan Hedayati, MD
To investigate the relationship between metabolic surgery and incident major adverse cardiovascular events in patients with type 2 diabetes and obesity. •
Steve Biederman, MD • Tom Robertson, MD
To assess the ability of a smartwatch to identify individuals with new afib. •
Steve Biederman, MD • Tom Robertson, MD
Approximately 8.2% of the population engages in same-sex behaviors. This population is considered in the sexual minority, and has a different set of health needs from the sexual majority. Neda, Tom, and Dr. Helen Hedian dive into the details of these needs so we can better serve our LGB patients …
Helene Hedian, MD • Neda Frayha, MD • Tom Robertson, MD
Sol Behar interviews Portland, OR doctors Holly Tse (urgent care) and Paul Lewis (infectious disease and public health) to chat about the real world experience of responding to the measles outbreak in their community. •
Holly Tse, MD • Paul Lewis, MD • Solomon Behar, MD
Hyperprolactinemia is a common endocrine condition that can be treated in the primary care setting if our patients aren’t able to see an endocrinologist. Aisha and Neda run through the complete diagnosis and management of hyperprolactinemia in this segment. •
Aisha Lofters, MD • Neda Frayha, MD
When a patient with COPD and CHF presents with shortness of breath, how do we know what’s causing it? The heart? The lungs? Both? Neda discusses the best approach for this diagnostic conundrum with Dr. Sam Ashoo, ED physician and dyspnea expert. •
Neda Frayha, MD • Sam Ashoo, MD
When we treat patients, whether in the hospital or outpatient setting, involving their family members can lead to improved outcomes. Tom and Miz discuss the engagement of family members with Dr. Giora Netzer, who literally wrote the book on family centered care. •
Giora Netzer, MD, MSCE • Mizuho Morrison, DO • Tom Robertson, MD
When the PC RAP mailbag is overflowing, Neda and Paul get to work and tackle a few of your questions at once. •
Neda Frayha, MD • Paul Simmons, MD
Dysphagia? Sounds like a hard-to-swallow diagnosis. ENT expert, Dr. Elizabeth Guardini, helps us navigate phases of swallowing, diagnostic testing, and deciding when to refer to a specialist.
Elizabeth Guardiani, MD • Matthew DeLaney, MD, FACEP, FAAEM • Neda Frayha, MD
Randomized Trial of Medical versus Surgical Treatment for Refractory Heartburn.
Steve Biederman, MD • Tom Robertson, MD
Talking about sex with our patients can feel uncomfortable, but is an important part of primary care practice. Dr. Helene Hedian walks us through how to have this conversation in a sensitive and inclusive manner.
Helene Hedian, MD • Neda Frayha, MD • Tom Robertson, MD
We provide supplemental oxygen all the time. But how often do we really understand the physiology behind what we’re doing, or the different modalities we have available to us? Dr. Avir Mitra, Clerkship Director of Emergency Medicine at the Icahn School of Medicine at Mount Sinai Beth Israel in New …
Avir Mitra, MD • Neda Frayha, MD
Broken hearts? Octopus traps? What’s the deal with Takotsubo cardiomyopathy? Matt DeClerck and Neda Frayha dive into the details of this interesting condition in this introduction segment. •
Matthieu DeClerck, MD • Neda Frayha, MD
N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel. •
Steve Biederman, MD • Tom Robertson, MD
We provide supplemental oxygen all the time. But how often do we really understand the physiology behind what we’re doing, or the different modalities we have available to us? Dr. Avir Mitra, Clerkship Director of Emergency Medicine at the Icahn School of Medicine at Mount Sinai Beth Israel in New …
Avir Mitra, MD • Neda Frayha, MD
We have been waiting and waiting and waiting for the new community acquired guidelines. And here they are! Infectious Diseases expert Dr. Devang Patel joins Matt DeLaney and Neda Frayha for a conversation on CAP in general and the new guidelines in specific.
Devang Patel, MD • Matthew DeLaney, MD, FACEP, FAAEM • Neda Frayha, MD
How Much Time are Physicians and Nurses Spending Together at the Patient Bedside.
Steve Biederman, MD • Tom Robertson, MD
Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial •
Steve Biederman, MD • Tom Robertson, MD
Management of sprains can be divided into the acute and functional phase. In the acute phase early range of motion exercises and techniques to manage pain and swelling are key aspects of treatment. In the functional phase the focus shifts more to emphasize strength, stability, and a return to …
Matt Baird, MD • Matthew DeLaney, MD, FACEP, FAAEM • Neda Frayha, MD
The clinical and cost-effectiveness of total vs partial knee replacement I patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomized controlled trial. •
Steve Biederman, MD • Tom Robertson, MD
In this Hippo Education Short, Infectious Diseases specialist Dr. Devang Patel sits down with our own Dr. Neda Frayha to discuss what we know so far about the new 2019-n-CoV coronavirus outbreak and what front-line clinicians can do if we suspect a patient of ours might have this viral illness.
Devang Patel, MD • Neda Frayha, MD
To obtain patients’ perspectives of factors associated with the onset and continuation of high hospital use.
Steve Biederman, MD • Tom Robertson, MD
To evaluate the efficacy of a polypill containing atorvastatin amlodipine losartan and hydrochlorothiazide for lowering blood pressure and LDL.
Steve Biederman, MD • Tom Robertson, MD
Kari Sampsel MD reviews how to recognize and manage sexual assault from a medical perspective and also social support that patients warrant.
Kari Sampsel, MD • Mizuho Morrison, DO
Even in the primary care setting, we all need to be prepared to deal with emergencies, including anaphylaxis. Dr. Jason Liebzeit, EM physician, arms us with the knowledge and power to recognize and treat anaphylaxis in the primary care setting.
Jason Liebzeit, MD • Neda Frayha, MD
The medical assistant workforce is the largest in US ambulatory clinics. As nurses shift to inpatient roles, we use medical assistants more and more in the outpatient setting. Neda and Dr. Michael Baca-Atlas chat about how to best utilize this group of allied health professionals as well as share …
Michael Baca Atlas, MD • Neda Frayha, MD
To determine whether providing essential medicines at no charge to outpatients who reported not being able to afford medicines improves adherence.
Steve Biederman, MD • Tom Robertson, MD
To compare the efficacy of oral finasteride and topical minoxidil for males with androgenetic alopecia.
Steve Biederman, MD • Tom Robertson, MD
As marijuana becomes legal in more states, it’s important for us to be able to advise our patients on the risk of inhaled marijuana causing lung disease. Neda discusses the current literature with Dr. Kathryn Robinett, pulmonologist extraordinaire.
Kathryn Robinett, MD • Neda Frayha, MD • Tom Robertson, MD
Wet to dry dressings? Nope! Our Urgent Care RAP cousin Matt DeLaney schools Neda and Paul on a better way to do wound care. Such as: Foam dressings address the important elements of wound healing; they absorb exponentially more than gauze, keep wound somewhat moist, and can stay on for 3-7 days …
Matthew DeLaney, MD, FACEP, FAAEM • Neda Frayha, MD • Paul Simmons, MD
PC RAP has covered the start-screening-mammos-at-age-50 perspective in the past. Today, we’ll explore the other side of the coin: why women’s health focused organizations recommend beginning annual screening mammography at age 40. Neda sat down with Dr. Alison Chetlen, breast imaging expert and …
Alison Chetlen, DO • Neda Frayha, MD
To determine patterns of apixaban use and its outcomes in dialysis-dependent patients with ESRD and atrial fibrillation.
Steve Biederman, MD • Tom Robertson, MD
Itching is a common complaint in pregnancy. When do we need to worry about cholestasis of pregnancy when a pregnant woman complains of itching? Neda sits down with our newest PC Rap contributor, Dr. Matthew Zeitler, to scratch the surface of the most common pregnancy-specific liver disease.
Matthew Zeitler, MD • Neda Frayha, MD
Respiratory failure in primary care? Not an oxymoron! Our own Drs. Mizuho Morrison and Tom Robertson interview returning pulmonologist extraordinaire, Dr. Nirav Shah, about how we approach and manage respiratory failure, both before our patients need the ICU and after they come out of intensive …
Mizuho Morrison, DO • Nirav Shah, MD • Tom Robertson, MD
Back pain is one of the most common complaints that we see in primary care. Many of our patients have either already seen a chiropractor for their pain, or ask our opinion about seeing one. Neda and Tom Robertson talk with Dr. John Allen about the literature regarding chiropractic care.
John Allen, MD • Neda Frayha, MD
When someone comes in with prostate related symptoms and infection, it’s hard to know if we’re working with prostatitis vs prostate abscess. How can we improve our prostate game? Dr. Tarlan Hedayati schools Drs. Matt DeClerck and Neda Frayha on some prostate pro tips. •
Matthieu DeClerck, MD • Neda Frayha, MD • Tarlan Hedayati, MD
Regardless of your clinical setting, DVT’s are a common entity that we need to be very comfortable working up and treating. And though on the surface the workup and Tx is seemingly straightforward...the truth is there are some nuances and special cases that aren’t completely intuitive...Mizuho …
Mizuho Morrison, DO • Salim Rezaie, MD
Regardless of your clinical setting, DVT’s are a common entity that we need to be very comfortable working up and treating. And though on the surface the workup and Tx is seemingly straightforward...the truth is there are some nuances and special cases that aren’t completely intuitive...Mizuho …
Mizuho Morrison, DO • Salim Rezaie, MD
Examine what strategies are utilized by diabetic patients to deal with high prescription drug costs. •
Steve Biederman, MD • Tom Robertson, MD
Many of our patients rely on parts of Eastern medicine in their own health care. In this segment, our own Dr. Molly Heublein discusses the foundations of both Ayurvedic and traditional Chinese medicine as they pertain to our patients. •
Molly Heublein, MD
Evaluate the association between years since quitting smoking and incident CVD.
Steve Biederman, MD • Tom Robertson, MD
Describe prevalence of overdiagnosis of COPD and relationship to over treatment.
Steve Biederman, MD • Tom Robertson, MD
Examine the association between Primary Care Physician density and population-level mortality. •
Steve Biederman, MD • Tom Robertson, MD
How many times have you ordered a CMP as part of a routine lab work up, and encountered an elevated alkaline phosphatase? If your next question is, “what now?”, you’ll appreciate Dr. Paul Simmons sharing his tips for the work up of this common finding.
Paul Simmons, MD
Although we typically think of gestational diabetes as an obstetric diagnosis, it has implications that can affect a woman even after her delivery. Miz and Neda sit down with Dr. Rana Malek to discuss gestational diabetes and what we need to know as primary care clinicians.
Mizuho Morrison, DO • Neda Frayha, MD • Rana Malek, MD
How comfortable do we feel prescribing antidepressants, anxiolytics, and even antipsychotics to adolescents and teenagers? Our listener Spencer asked us to explore this fascinating and important topic, so Aisha and Neda are on the task. •
Aisha Lofters, MD • Neda Frayha, MD
Dr. Feranmi Okanlami was an orthopedic surgery resident at Yale when he dove into a swimming pool and sustained a spinal cord injury that left him paralyzed. He shares his story and what he has learned about living with a disability, both as a physician and as a patient. He aims to disabuse our …
Feranmi Okanlami, MD • Neda Frayha, MD
Hoarseness is a common complaint in the primary care setting. Our ENT colleague, Dr. Elizabeth Guardiani, sits down with Drs. Matt DeLaney and Neda Frayha to discuss how we can approach this in primary care as well as when to refer to a specialist. •
Elizabeth Guardiani, MD • Matthew DeLaney, MD, FACEP, FAAEM • Neda Frayha, MD
When a patient presents with atypical GI symptoms, we often suspect Helicobacter pylori as the culprit. Do we need to send them immediately to a GI doc, or can we handle this one on our own? In this segment, Aisha and Neda discuss testing, treatment, and follow up of H pylori in the primary care …
Aisha Lofters, MD • Neda Frayha, MD
Evaluate the CV risk of a new oral GLP1 agonist semaglutide.
Steve Biederman, MD • Tom Robertson, MD
We all know what to do in pre-op visits for non-cardiac surgery. But guidelines on the pre-op management of cardiac surgery patients are hard to find. Neda sat down with Dr. Michael Grant, a cardiac anesthesiologist at the Johns Hopkins University School of Medicine, to learn what we need to worry …
Michael Grant, MD • Neda Frayha, MD
Peripartum cardiomyopathy accounts for 10% of maternal deaths in the United States. How do we know when to suspect it? How do we manage it? Regular contributor Michael Baca-Atlas sits down with Neda for a primer on all things PPCM. •
Michael Baca-Atlas, MD • Neda Frayha, MD
To determine whether opioid prescriptions to family members were associated with overdose for individuals who themselves did not have an opioid prescription. •
Steve Biederman, MD • Tom Robertson, MD
Dental fractures? Abscesses? Bleeding after dental surgery? We may not be dentists, but our patients come to us with tooth problems nonetheless. Paul Simmons polishes our knowledge of common dental problems.
Paul Simmons, MD
We all know what to do in pre-op visits for non-cardiac surgery. But guidelines on the pre-op management of cardiac surgery patients are hard to find. Neda sat down with Dr. Michael Grant, a cardiac anesthesiologist at the Johns Hopkins University School of Medicine, to learn what we need to worry …
Michael Grant, MD • Neda Frayha, MD
Dysuria is a much less common complaint in men than in women. In this segment, Vanessa and Adrien discuss the approach, work up, and management of men with dysuria. We’ll get down to the nitty gritty, answering the eternal question: does he need a prostate exam? •
Adrien Selim, MD • Vanessa Gervais, MD
Examine whether 30 day readmission risk was independently associated with “disadvantaged index” of: 1. where the pt lives, and 2. the population the hospital primarily services. •
Steve Biederman, MD • Tom Robertson, MD
To test the hypothesis of noninferiority of 1-month dual antiplatelet therapy versus 12-months after percutaneous coronary intervention (PCI). •
Steve Biederman, MD • Tom Robertson, MD
To assess if point-of-care CRP testing could reduce unnecessary use of antibiotics without harming patients who have acute COPD. •
Steve Biederman, MD • Tom Robertson, MD
Last month, Dr. Salim Rezaie and Neda got into the controversy around contrast induced nephropathy -- correction --- post-contrast AKI. This month, Dr. Swapnil Hiremath shares his perspective as a nephrologist and how, if at all, it should change our practice.
Swapnil Hiremath, MD MPH
Which meds are safe for a pregnant woman to take when she has a migraine? Upper respiratory tract infection? Back pain? Our listener Cassie asked, and Paul and Neda answer in the introduction to this month’s Primary Care RAP. •
Neda Frayha, MD • Paul Simmons, MD
When Neda learned that one of her patients might have benign ethnic neutropenia, she knew she needed to do some research. Here she and Aisha discuss the diagnosis and management of this interesting condition. •
Aisha Lofters, MD • Neda Frayha, MD
Patients with chronic diseases starting in childhood are living longer and healthier lives. When a complex pediatric patient transitions to adult care, what special considerations do we need to bear in mind? Neda sits down with Dr. Jonathan Tolentino to discuss the transition of patients from …
Jonathan Tolentino, MD • Neda Frayha, MD
Assess if there is an association between sleep quality and fragmentation and atherosclerosis. •
Steve Biederman, MD • Tom Robertson, MD
One of our listeners asked, “what’s the deal with porphyria? I don’t get it.” We bet this listener is not alone. Paul and Neda kick off the October episode with a breakdown of acute intermittent porphyria and porphyria cutanea tarda and how we may spot them in primary care. And yes, there is a King …
Neda Frayha, MD • Paul Simmons, MD
Last month, we covered all things penicillin allergy in the outpatient setting. This month, we bring this topic to the hospital and learn what we can do for our inpatients to mitigate the risk of complications from having a (likely incorrect) PCN allergy attached to the patient’s chart. Neda sits …
Emily Heil, PharmD • Neda Frayha, MD
Hematology Rounds are back with our beloved hematologist, Dr. Tom DeLoughery. Here he sits down with our own Matt DeClerck to talk about how to diagnose and treat hemophilias in our day to day practices. • 6.2.6
Matthieu DeClerck, MD • Tom Deloughery, MD
Hematology Rounds are back with our beloved hematologist, Dr. Tom DeLoughery. Here he sits down with our own Matt DeClerck to talk about how to diagnose and treat hemophilias in our day to day practices. • 6.2.6
Matthieu DeClerck, MD • Tom Deloughery, MD
To assess the efficacy and risk profile for apixaban in different weight groups in patients with atrial fibrillation. • 6.2.6
Steve Biederman, MD • Tom Robertson, MD
It all started when Paul and Neda researched porphyria to answer a mailbag question. Paul couldn’t get the song ‘Ophelia’ by the Lumineers out of his head. So he did what any self-respecting lyrical genius would do and wrote a different version of the song. Hippo Education’s own Melinda Hershey …
“Doc, my shoulder hurts.” We hear this all the time. But how often do we have a thoughtful, stepwise approach to diagnosing and managing rotator cuff disease? Dr. Matt Baird, an EM and Sports Medicine specialist, gives our own Matt DeLaney the lowdown on rotator cuff injuries and how we can …
Matt Baird, MD • Matthew DeLaney, MD, FACEP, FAAEM • Rick Pescatore, DO
To assess associations between anticholinergic drug treatments and risk of dementia in persons 55 years or older. • 6.2.6
Steve Biederman, MD • Tom Robertson, MD
Human trafficking is one of the many subjects we will encounter in our work and that we don’t learn enough about in training. Dr. Jaime Hope sits down with Neda to mythbust many commonly held misconceptions about human trafficking, and to share tips on how we can identify and help trafficking …
Jaime Hope, MD • Neda Frayha, MD
To determine the risk of prolonged opioid use in patients receiving tramadol compared with other short acting opioids. • 6.2.6
Steve Biederman, MD • Tom Robertson, MD
Post-contrast AKI (or contrast induced nephropathy as it used to be called) is one of those hot-button issues in modern medicine. Is it really a thing? Was it ever, really? Neda sits down with Dr. Salim Rezaie of Rebel EM for an invigorating conversation about this controversial topic and what the …
Neda Frayha, MD • Salim Rezaie, MD
To examine predictors and outcomes associated with excess duration of antibiotic treatment for pneumonia. • 6.2.6
Steve Biederman, MD • Tom Robertson, MD
To assess associations between number of steps per day, step intensity, and all cause mortality. • 6.2.6
Steve Biederman, MD • Tom Robertson, MD
We bring our Weight Loss Series of 2019 to a close with a discussion of one of the most highly discussed diets of the decade, the ketogenic diet. Does it work? What’s the science behind it? What do we need to advise our patients who are interested in it? Dr. John Allen gives Neda the skinny on this …
John Allen, MD • Neda Frayha, MD • Paul Simmons, MD
Given the recent spike of VAPI (vaping associated pulmonary injury) cases, our HIPPO medical editorial team review the clinical presentation and latest management recommendations for this lung disease. Mizuho Morrison and Sol Behar discuss a recent case, and review the hot-off-the-press published …
Mizuho Morrison, DO • Solomon Behar, MD
Another year, another lipid guideline! The latest ACC/AHA guidelines on managing lipids have quite a few changes from what we’re used to. So, Neda sat down with Dr. Robert Reilly, general internist and Medical Director of The Villages Health, to break down the new recommendations.
Neda Frayha, MD • Robert Reilly, MD
We see “ALL: PCN” all the time. But how often is it true? And why does it matter? Neda sits down with Dr. Torie Grant, a Med/Peds Allergist and Immunologist at Johns Hopkins, to learn all about the risks attached to a penicillin allergy label and some easy approaches to debunking this allergy in …
Neda Frayha, MD • Torie Grant, MD MHS
Patients with heart failure who were implanted with a pulmonary artery pressure sensor had lower rates of heart failure hospitalization and more time alive out of hospital.
Steve Biederman, MD • Tom Robertson, MD
Standard-dose apixaban and a P2Y12 inhibitor without aspirin resulted in less bleeding and fewer hospitalizations.
Steve Biederman, MD • Tom Robertson, MD
We are continuing our series on helping patients lose weight with this hilarious conversation with Dr. Nikki Southall, primary care physician, internist, and Lead Physician for Education at the Baltimore VA Medical Center. She walks us through how to help our patients choose a dietary plan that can …
Mizuho Morrison, DO • Neda Frayha, MD • Nikkita Southall, MD
In patients with DM2 and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group.
Steve Biederman, MD • Tom Robertson, MD
Pediatric headaches are common. Thankfully the bad etiologies are rare. Having a consistent approach to the history and physical exam is essential to helping the clinician distinguish between the common, benign etiologies and the bad, rarer etiologies. Looking for the redflags in your history and …
Matthew DeLaney, MD, FACEP, FAAEM • Matthieu DeClerck, MD • Timothy Horeczko, MD, MSCR, FACEP, FAAP
Asthma is a pretty bread-and-butter diagnosis in primary care, but how much do we know about all the new therapies on the market? Asthma expert and pulmonologist Dr. Kathryn Robinett shares the latest on asthma management with Miz and Neda. Hint: step-up therapy is for the boards, but not as …
Kathryn Robinett, MD • Mizuho Morrison, DO • Neda Frayha, MD
Our hospitalist corner lightning round is back! This time with four common clinical scenarios involving the cardiovascular system. Buckle your seatbelts as Drs. Maj Cina and Neda Frayha take us on a tour of cardiac biomarkers, diuresis in acute congestive heart failure, and so much more.
Maj Cina, MD • Neda Frayha, MD
Use of sodium polystyrene sulfonate is associated with a higher risk of hospitalization for serious adverse GI events, suggesting caution with the ongoing use of sodium polystyrene sulfonate.
Steve Biederman, MD • Tom Robertson, MD
Among hospitalized patients undergoing colonoscopy, inadequate bowel preparation rates are high and associated with an increased length of stay. Avoiding opiates, performing colonoscopy before noon, and maintaining a liquid diet or NPO all can reduce rates of inadequate bowel preparation.
Steve Biederman, MD • Tom Robertson, MD
When Paul and Neda read a recent JAMA article on how time of day may affect our rates of ordering mammograms or colon cancer screening tests, they knew they needed to debrief about it.
Neda Frayha, MD • Paul Simmons, MD
We see “ALL: PCN” all the time. But how often is it true? And why does it matter? Neda sits down with Dr. Torie Grant, a Med/Peds Allergist and Immunologist at Johns Hopkins, to learn all about the risks attached to a penicillin allergy label and some easy approaches to debunking this allergy in …
Neda Frayha, MD • Torie Grant, MD MHS
Neda is joined by her UC RAP friends Miz, Matt, and Matt for a conversation about how primary care clinicians are the unsung heroes of medicine.
Matthew DeLaney, MD, FACEP, FAAEM • Matthieu DeClerck, MD • Mizuho Morrison, DO • Neda Frayha, MD
Chagas disease is on the rise in the United States and becoming more widespread. Why? How do these patients present, and how do we make the diagnosis and then treat them appropriately? How can we prevent further transmission? In this segment, Drs. Mizuho Morrison and Neda Frayha review the ins and …
Mizuho Morrison, DO • Neda Frayha, MD
To evaluate a multipronged intervention to reduce low-value preoperative care for patients undergoing cataract surgery and analyze costs from various fiscal perspectives. •
Steve Biederman, MD • Tom Robertson, MD
To assess whether a specific pregnancy-adapted algorithm can be safely used to avoid unnecessary diagnostic imaging in suspected PE. •
Steve Biederman, MD • Tom Robertson, MD
Are you someone who’s great at bringing others together? You know who you are - you throw a fabulous party, all your friends come to you for advice on what show they should binge or which restaurant to try, you create awesome events for all your friends and family out of thin air.Here at Primary …
Neda Frayha, MD
Study the prevalence of PE among patients presenting to the ED with syncope.
Steve Biederman, MD • Tom Robertson, MD
What do we usually do when a female patient comes to us with recurrent UTIs? And should we be doing this? Our Things I Do But Should I duo, Vanessa and Adrien, are here to share pearls for the prophylaxis and management of recurrent UTIs. •
Adrien Selim, MD • Vanessa Gervais, MD
Neda and Michael discuss the spectrum of outpatient tobacco cessation treatment including FDA approved pharmacotherapy, innovative strategies, and alternative/complementary treatments. •
Michael Baca-Atlas, MD • Neda Frayha, MD
Can HIV be managed in the primary care setting? With today’s advances in antiretroviral therapy, the answer is yes. Infectious Diseases physician Dr. Devang Patel sits down with Miz and Neda for a conversation about the latest developments in HIV treatment. •
Devang Patel, MD • Mizuho Morrison, DO • Neda Frayha, MD
Pediatric cardiologist Pierangelo Renella discusses with Sol how to distinguish between innocent and pathologic heart murmurs. •
Pierangelo Renella, MD • Solomon Behar, MD
Neda and Michael discuss the spectrum of outpatient tobacco cessation treatment including FDA approved pharmacotherapy, innovative strategies, and alternative/complementary treatments. •
Michael Baca-Atlas, MD • Neda Frayha, MD
Patient complaints may reveal medical errors and may escalate to litigation. Be sure whatever process you have in place has been developed in conjunction with your risk management department or insurance carrier. This allows for an “early warning” system to be in place for your malpractice …
Mizuho Morrison, DO • Sam Ashoo, MD
Matthew DeLaney, MD, FACEP, FAAEM • Matthieu DeClerck, MD • Mizuho Morrison, DO • Neda Frayha, MD
To determine if immediate cardioversion in recent-onset atrial fibrillation is necessary compared to a wait-and-see approach. •
Steve Biederman, MD • Tom Robertson, MD
Usually the words “chronic” and “pain” together can feel defeating. Especially when it’s an entity that’s been as poorly understood as chronic pelvic pain. Aisha and Neda are here to shed light on this pain syndrome and provide us with management tips and tricks to help our patients. •
Aisha Lofters, MD • Neda Frayha, MD
Lisa Patel and Andi Marmor discuss how new advances in genetic testing and personalized medicine raise ethical issues for providers and families. •
Andrea Marmor, MD • Lisa Patel, MD
Why does storytelling in medicine matter? How can it impact our lives, and the care we provide our patients, for the better? In this segment, Neda sits down with Dr. Emily Silverman, academic hospitalist at the Zuckerberg San Francisco General Hospital and creator and host of The Nocturnists, to …
Emily Silverman, MD • Neda Frayha, MD
Vaginal bleeding in the first trimester of pregnancy is one of those topics that seems straightforward but is actually pretty complex. Dr. Jenny Beck-Esmay speaks with our own Dr. Neda Frayha about how to approach first-trimester bleeding in a logical, organized, evidence-based way that’s easy to …
Jenny Beck-Esmay, MD • Neda Frayha, MD
To determine if nonspecific symptoms and fever affect probability of acute bacterial infection in older patients.
Steve Biederman, MD • Tom Robertson, MD
Allowing program directors flexibility in adjusting duty-hour schedules for trainees did not adversely affect 30-day mortality or patient safety. •
Steve Biederman, MD • Tom Robertson, MD
Paul Simmons brings us another helpful, algorithmic approach to treating a common primary care condition - this time, migraines. Do you know the POUND mnemonic? Or a simple, 5-step approach to treating migraines? After listening to this piece, you will. •
Neda Frayha, MD • Paul Simmons, MD
Ever wondered if your patient is just a little too obsessive? You might be right: patients with obsessive compulsive disorder (OCD) and related disorders often present to general health care settings rather than a psychiatrist’s office. Dr. Shawn Hersevoort is back with us, sharing lots of OCD …
Mizuho Morrison, DO • Shawn Hersevoort, MD, MPH
To determine the association between delirium and 30-day readmission.
Steve Biederman, MD • Tom Robertson, MD
Ever wondered if your patient is just a little too obsessive? You might be right: patients with obsessive compulsive disorder (OCD) and related disorders often present to general health care settings rather than a psychiatrist’s office. Dr. Shawn Hersevoort is back with us, sharing lots of OCD …
Mizuho Morrison, DO • Shawn Hersevoort, MD, MPH
To evaluate whether adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis would result in lower incidence of deep-vein thrombosis than pharmacologic thromboprophylaxis alone. •
Steve Biederman, MD • Tom Robertson, MD
When an international expert in obesity medicine is (a) a fun, great teacher and (b) happy to talk to Hippo about how we can help our patients lose weight effectively, we jump at the chance to interview her. In this segment, Dr. Kim Gudzune from Johns Hopkins University School of Medicine reviews …
Kimberly Gudzune, MD, MPH • Matthew DeLaney, MD, FACEP, FAAEM • Neda Frayha, MD
To review the phenomenon of missing or misused DEA numbers and what to do if it happens to you. •
Matthieu DeClerck, MD • Neda Frayha, MD
Our Things I Do But Should I? duo brings us another great discussion on the use of oral codeine for acute cough. We tend to prescribe this for our patients at their wits’ end with cough, but should we? Listen to this segment to find out. •
Adrien Selim, MD • Vanessa Gervais, MD
Andi and Miz sit down with PEM doc Ilene Claudius to sort out high yield and “can’t miss” pediatric foot and ankle injuries. •
Ilene Claudius, MD • Matthew DeLaney, MD, FACEP, FAAEM • Mike Weinstock, MD
One of our listeners wrote in asking about updates in fatty liver, so Aisha and Neda discuss this common primary condition in the introduction to our June 2019 episode. •
Aisha Lofters, MD • Neda Frayha, MD
The price of alirocumab would have to be reduced considerably to be cost-effective. •
Steve Biederman, MD • Tom Robertson, MD
When our listener Brianne asked us to do a segment on informed consent (because how we do ever know if we’re doing it right?), we jumped at the chance to brush up our informed consent knowledge and skills. Neda speaks with Dr. Mara Gordon, a Family Medicine physician at Georgetown and a writer for …
Mara Gordon, MD • Neda Frayha, MD
In this segment, Dr. Sandra Quezada teaches Tom and Neda about the importance of specific health maintenance components in the care of patients with inflammatory bowel disease. We primary care providers can feel empowered to take great care of these patients without sending them back to their …
Neda Frayha, MD • Sandra Quezada, MD • Tom Robertson, MD
There is uncertainty around the effect of medication compared with placebo. Larger RCTs are needed to resolve the uncertainty around efficacy of medications for knee osteoarthritis. •
Steve Biederman, MD • Tom Robertson, MD
Compounded pain creams were not better than placebo for treatment of chronic pain. •
Steve Biederman, MD • Tom Robertson, MD
When an international expert in obesity medicine is (a) a fun, great teacher and (b) happy to talk to Hippo about how we can help our patients lose weight effectively, we jump at the chance to interview her. In this segment, Dr. Kim Gudzune from Johns Hopkins University School of Medicine reviews …
Kimberly Gudzune, MD, MPH • Neda Frayha, MD
E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support.
Steve Biederman, MD • Tom Robertson, MD
Aerobic exercise speeds recovery and may reduce incidence of delayed recovery in adolescents with sports related concussions. •
Steve Biederman, MD • Tom Robertson, MD
Our favorite hospitalist Dr. Maj Cina is back, this time with a lightning round of common inpatient scenarios and the latest evidence to support or refute our common practices in these situations, which span the fields of GI, ID, Pulmonology, and Nephrology. •
Majid Cina, MD • Neda Frayha, MD
We probably know on a gut level that cannabis use in pregnancy is not ideal, but what do the data show? How can we quantify the risks and best advise our pregnant patients who may be regular cannabis users? In this segment, Dr. Erin Lurie sits down with Neda to review the specific risks of cannabis …
Erin Lurie, MD, CCFP • Neda Frayha, MD
Mizuho Morrison and Rick Pescatore discuss the data surrounding the use of probiotics alongside antibiotics for the prevention of antibiotic-associated diarrhea (AAD) and Clostridium Difficile colitis. They review the most up to date literature on this natural supplement.
Mizuho Morrison, DO • Rick Pescatore, DO
Polycythemia vera is a relatively rare myeloproliferative disorder characterized by increased RBC production. In this segment, our own Matt DeClerck interviews Hematology guru Dr. Tom Deloughery on the in’s and out’s of PV. Clinical suspicion for PV should occur in any patient with elevated RBC …
Matthieu DeClerck, MD • Tom Deloughery, MD
We all make clinical decisions all the time, hundreds of times per day. But how do we make these decisions? What reasoning skills are we using that we may not even be aware of? And how can we get better at this? Dr. Sandra Oza, Assistant Professor of Medicine at the Albert Einstein College of …
Neda Frayha, MD • Sandra Oza, MD
Supplementation with vitamin D did not result in lower incidence of invasive cancer or cardiovascular events than placebo.
Steve Biederman, MD • Tom Robertson, MD
How often do we groan when we find incidental lung nodules on imaging? How do we know what counts as high-risk and when to re-image different patients? In this segment, Tom Robertson and Neda Frayha explore this all-too-common dilemma and share guideline-based recommendations on what to do for lung …
Tom Robertson, MD
General practitioners manage a wide variety of OB questions and concerns from their patients. In this segment, Dr. Megan Jones and Neda Frayha tackle a potpourri of OB topics for the general practitioner: vaginal bleeding in the pregnant patient, nausea and vomiting in pregnancy, management pearls …
Megan Jones, MD • Neda Frayha, MD
Among patients initiating oral anticoagulant therapy, incidence of UGIB was highest in patients prescribed rivaroxaban and lowest for patients prescribed apixaban. The incidence of hospitalization for UGIB was lower among patients who were receiving PPI cotherapy. •
Steve Biederman, MD • Tom Robertson, MD
Anemia after hospitalization increased in parallel with decreased RBC transfusion. There was no accompanying increase in RBC use, rehospitalization, or mortality 6 months post-discharge. This longitudinal study supports the safety of current practice recommendations to limit RBC transfusions. •
Steve Biederman, MD • Tom Robertson, MD
Mizuho Morrison and Sol Behar how to diagnose croup, and help sort out what does and does not work in the management of acute croup. •
Mizuho Morrison, DO • Solomon Behar, MD
In this segment, Brandon Grove reviews the literature on wandering in patients with dementia and some innovative strategies to help keep these patients safe.
Brandon Grove, MD
Stethoscopes in the ICU carry complex polymicrobial colonies, reflecting important bacterial species that can cause healthcare-associated infections, including Staph. Cleaning practices reduce contamination but are only partially successful. •
Steve Biederman, MD • Tom Robertson, MD
Ever struggled with how to prescribe lancets, test strips, or insulin pen needles? Or wondered which syringe length or gauge to order? In this mind-blowingly practical, helpful segment, endocrinologist and clinician educator Dr. Rana Malek teaches Miz and Neda the basics of what to order for our …
Mizuho Morrison, DO • Neda Frayha, MD • Rana Malek, MD
Our Primary Care RAP mailbag is bursting at the seams! Paul and Neda tackle more of our listeners’ great questions in this lightning round of Q&A.
Neda Frayha, MD • Paul Simmons, MD
Pioglitazone did not reduce the occurrence of cardiovascular events in patients with mild DM and previous MI. •
Steve Biederman, MD • Tom Robertson, MD
Polycythemia vera is a relatively rare myeloproliferative disorder characterized by increased RBC production. In this segment, our own Matt DeClerck interviews Hematology guru Dr. Tom Deloughery on the in’s and out’s of PV. Clinical suspicion for PV should occur in any patient with elevated RBC …
Matthieu DeClerck, MD • Tom Deloughery, MD
Acute rhinosinusitis is one of the most common conditions we see in primary care. In this segment, Dr. Jacob Anderson gives us a helpful primer on the presentation, diagnosis, and treatment of acute rhinosinusitis, whether viral or bacterial in origin.
Jake Anderson, DO
To compare the rate of moderate to severe exacerbations between triple therapy and dual or monotherapy in patients with COPD.
Steve Biederman, MD • Tom Robertson, MD
Introduce the concept of the patient experience and how the focus is different from patient satisfaction/press ganey measures. Discuss actionable items on things clinicians can do to improve the pt experience.
Jaime Hope, MD • Matthieu DeClerck, MD • Neda Frayha, MD
Listeners, you are writing in with topic requests at record speed! In this introduction to the April 2019 episode, Neda and Paul tackle a smorgasbord of your questions.
Neda Frayha, MD • Paul Simmons, MD
Urinary incontinence in women is a common problem that we can diagnose and treat almost entirely in a primary care setting. In this segment, Drs. Molly Heublein and Neda Frayha go all in on the bladder and bring us management pearls to help our patients.
Molly Heublein, MD • Neda Frayha, MD
To investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.
Steve Biederman, MD • Tom Robertson, MD
What do you do when you find an adrenal incidentaloma? In this mini-segment, Neda asks endocrinologist and adrenal gland aficionado Dr. Kashif Munir how we should approach the adrenal incidentaloma.
Kashif Munir, MD • Neda Frayha, MD
How often do we just go through the motions of the physical exam, without really knowing which maneuvers can give us superpowers? Or which ones are worthless? In this segment, Paul Simmons teaches Neda how to become a master diagnostician with the evidence-based physical exam.
Neda Frayha, MD • Paul Simmons, MD
Our Things I Do But Should I duo is on a myth-busting streak! In this segment, they explore whether or not we really need to avoid doxycycline for Lyme prophylaxis in kids under the age of 8.
Adrien Selim, MD • Vanessa Gervais, MD
In acute superficial bursitis, aspiration can be both therapeutic and diagnostic. In this segment, Brandon Grove takes us on a tour of olecranon and pre-patellar bursitis, and how to approach aspiration and treatment.
Brandon Grove, MD
To determine if alirocumab (a human monoclonal antibody to PCSK9) would improve cardiovascular outcomes after an acute coronary syndrome in patients receiving high-intensity statin therapy.
Steve Biederman, MD • Tom Robertson, MD
Andi and Parul review the new CDC and AAP pediatric concussion guidelines with Sports Medicine doctor Tracy Zaslow, director of the Children’s Hospital Los Angeles Concussion clinic.
Andrea Marmor, MD • Parul Bhatia, MD • Tracy Zaslow, MD
To evaluate a hospital-initiated program that combined transition and long-term self-management support for patients hospitalized due to COPD and their family caregivers.
Steve Biederman, MD • Tom Robertson, MD
We all advocate for our patients on a regular basis, but how many of us have blown the whistle on a massive public health crisis? In this segment, Neda interviews Dr. Mona Hanna-Attisha, the Flint, MI pediatrician who opened the world’s eyes to lead in the water that was poisoning Flint’s citizens …
Mona Hanna-Attisha, MD, MPH • Neda Frayha, MD
To evaluate the non-inferiority of NO prophylaxis compared to guidelines recommended prophylaxis in preventing contrast induced nephropathy
Steve Biederman, MD • Tom Robertson, MD
To evaluate urinary biomarkers of kidney damage in patients with intensive vs standard BP control (as opposed to looking at GFR as marker of kidney damage) using patients from the SPRINT trial.
Steve Biederman, MD • Tom Robertson, MD
To evaluate if a novel antibiotic Zoliflodacin is effective in treatment of uncomplicated gonorrhea. •
Steve Biederman, MD • Tom Robertson, MD
How much do we really know about the pharmacologic treatment of alcohol use disorder? After this segment with Dr. Michael Baca-Atlas and our own Neda Frayha, the answer will be, a whole lot. •
Michael Baca Atlas, MD • Neda Frayha, MD
How much do we really know about the pharmacologic treatment of alcohol use disorder? After this segment with Dr. Michael Baca-Atlas and our own Neda Frayha, the answer will be, a whole lot.
Michael Baca Atlas, MD • Neda Frayha, MD
Ever tried to give feedback to a learner only to have the whole interaction feel awkward and unproductive? We are starting a series of conversations to help us all become better medical educators, and in this segment, Dr. Nikki Southall and our own Neda Frayha share some strategies and pearls for …
Neda Frayha, MD • Nikki Southall, MD
Jason Woods digs deep into the diagnosis, complications, and management of nephrotic syndrome with pediatric nephrology doctor Danielle Sorrano. •
Danielle Sorrano, MD • Jason Woods, MD
Miz and Matt Delaney sit down with Rick Pescatore to discuss a common condition: balanoposthitis. They discuss causes, differential diagnosis and treatment. They discuss the typical disease course, as well as what to do with cases not responding to first line therapy.
Matthew DeLaney, MD, FACEP, FAAEM • Mizuho Morrison, DO • Rick Pescatore, DO
To determine the incidence of infectious and noninfectious patient-reported complications associated with the indwelling urethral catheter. •
Steve Biederman, MD • Tom Robertson, MD
Interstitial cystitis can be a tricky disease to diagnose and treat. The good news is that primary care providers can make a huge difference here, without needing to refer these patients to specialists. In this segment, Aisha and Neda review the diagnosis and treatment of IC. •
Aisha Lofters, MD • Neda Frayha, MD
To present official recommendations for the medical management of opioid-induced constipation. •
Steve Biederman, MD • Tom Robertson, MD
Following Shawn Hersevoort’s helpful primer on all the personality disorders, our own Aisha Lofters and Neda Frayha bring us a segment specifically on how best to manage patients with borderline personality disorder in the primary care setting. •
Aisha Lofters, MD • Neda Frayha, MD
To discuss the epidemiology and identification of sepsis, identify areas of increased focus in sepsis management, discuss three recent large trials about early goal-directed therapy, and delineate how we may improve our processes of care. •
Mizuho Morrison, DO • Nirav Shah, MD • Tom Robertson, MD
To evaluate the efficacy of rivaroxaban alone or in combination with aspirin for secondary prevention of CV disease.
Steve Biederman, MD • Tom Robertson, MD
What is the deal with aspirin for primary prevention of cardiovascular disease? In this segment, Tom and Steve break down some of the most recent, headline-grabbing articles on this exact subject.
Steve Biederman, MD • Tom Robertson, MD
Acute rhinosinusitis is one of the most common conditions we see in primary care. In this segment, Dr. Jacob Anderson gives us a helpful primer on the presentation, diagnosis, and treatment of acute rhinosinusitis, whether viral or bacterial in origin.
Jake Anderson, DO
Continuing the recent discussion between Matt DeClerck and Dr. Tom Deloughery on the direct oral anticoagulants (DOACs), this month we bring you a segment on reversing these DOACs with Matt, Neda, and Dr. Tarlan Hedayati. What are the agents currently on the market, including the newest kid on the …
Matthieu DeClerck, MD • Neda Frayha, MD • Tarlan Hedayati, MD
BOTTOM LINE: Remote telemedical interventions reduced hospital admission days and all-cause mortality •
Steve Biederman, MD • Tom Robertson, MD
When a patient comes into your practice with blood pressures of 180/100 but they feel totally fine, what should you do? How much evaluation should they undergo? Should they be treated in the office? Or should they be referred to the ED? In this segment, Dr. Joseph Martinez chats with our own Mizuho …
Joe Martinez, MD • Matthew DeLaney, MD, FACEP, FAAEM • Mizuho Morrison, DO
In January 2019, we featured two segments on creative approaches to the problem of clinician burnout. In this segment, Aisha and Neda continue this conversation and discuss specific organizational strategies our health systems, hospitals, and clinics can adopt to prevent - and cope with - the …
Aisha Lofters, MD • Neda Frayha, MD
The ever-fantastic Dr. Shawn Hersevoort is back for another installment of Psychiatry Files! In this segment, he and Mizuho Spangler discuss a practical approach to understanding and managing patients with different personality disorders.
Mizuho Morrison, DO • Shawn Hersevoort, MD, MPH
BOTTOM LINE: Statin treatment was associated with reductions in the incidnece of atheroscleortic CVD and all cause mortality in elderly adults age 75-84 with diabetes. In adults age > 74 without diabetes or adults >85 with diabetes, statin treatment was not associated with a reduction in CVD or all …
Steve Biederman, MD • Tom Robertson, MD
Listeners have been asking for lots of segments on oral contraceptive pills, especially on how to choose an agent when prescribing OCPs to a patient for the first time. In this segment, Molly and Neda build on our Things I Do But Should I duo’s recent OCP myth-busting and go through a systematic …
Molly Heublein, MD • Neda Frayha, MD
The ever-fantastic Dr. Shawn Hersevoort is back for another installment of Psychiatry Files! In this segment, he and Mizuho Spangler discuss a practical approach to understanding and managing patients with different personality disorders.
Mizuho Morrison, DO • Shawn Hersevoort, MD, MPH
BOTTOM LINE: Among nonpregnant adults with subclinical hypothyroidism, the use of thyroid hormone therapy was not associated with improvements in general quality of life or thyroid-related symptoms. These findings do not support the routine use of thyroid hormone therapy in adults with subclinical …
Steve Biederman, MD • Tom Robertson, MD
Matt Delaney interviews Jeff Holmes MD to discuss polymyalgia rheumatica. PMR should be suspected in patients over 50 with symptoms involving aching and stiffness about the upper arms, posterior neck, pelvic girdle, and/or lumbar region (all worse upon arising in morning). Jeff and Matt discuss …
Jeff Holmes, MD • Matthieu DeClerck, MD
What to do when you notice incidental eosinophilia in a patient? In this segment, Tom walks Neda through a fascinating case of peripheral eosinophilia, what it means, and how to work it up in the most strategic, effective way.
Neda Frayha, MD • Tom Robertson, MD
BOTTOM LINE: Galcanezumab monthly injections provided clinical benefits and improved functioning in terms of reduced headache days per month, reduced use of acute migraine meds and improved patient symptom scores, with low incidence of adverse effects. •
Steve Biederman, MD • Tom Robertson, MD
BOTTOM LINE: In patients with left-sided endocarditis in stable condition, changing to oral antibiotics was noninferior to continued intravenous antibiotics.
Steve Biederman, MD • Tom Robertson, MD
A listener wrote us and asked for a segment on alopecia in women. This is a highly distressing concern for most patients, with a straightforward, algorithmic approach to workup and treatment. In this segment, Aisha Lofters and Neda Frayha look to the scalp and provide an overview of how to diagnose …
Aisha Lofters, MD • Neda Frayha, MD
When a listener asked us about the adverse effects of proton pump inhibitors and whether (and how) we should deprescribe these drugs, Neda and Rob jumped all over it. In this segment, they’ll review the major categories of adverse effects described in the literature and figure out what it all means.
Neda Frayha, MD • Rob Orman, MD
BOTTOM LINE: Among patients with E coli or K pneumoniae bloodstream infection and ceftriaxone resistance, definitive treatment with piperacillin-tazobactam compared with meropenem did not result in a noninferior 30-day mortality. These findings do not support use of piperacillin-tazobactam in this …
Steve Biederman, MD • Tom Robertson, MD
Acute kidney injury in hospitalized patients is a big deal, with significant morbidity and morality. In this segment, Neda asks hospitalist and Med Peds physician Dr. Nidhi Goel and clinical pharmacist Dr. Asha Tata how to prevent AKI in our hospitalized patients.
Asha Tata, PharmD • Neda Frayha, MD • Nidhi Goel, MD
What does the former CFO of Pixar have to do with physician burnout and the culture of medicine? We find out in this segment. Neda interviews Dr. Todd Cassese and Lawrence Levy, who helped build Pixar into the company it is today. Together they talk about the need for continuous self-care rather …
Lawrence Levy, JD • Neda Frayha, MD • Todd Cassese, MD
BOTTOM LINE: The provision of procalcitonin assay results, along with instructions on their interpretation, to emergency department and hospital-based clinicians did not result in less use of antibiotics than did usual care among patients with suspected lower respiratory tract infection.
Steve Biederman, MD • Tom Robertson, MD
What does the former CFO of Pixar have to do with physician burnout and the culture of medicine? We find out in this segment. Neda interviews Dr. Todd Cassese and Lawrence Levy, who helped build Pixar into the company it is today. Together they talk about changing professional cultures, the …
Lawrence Levy, JD • Neda Frayha, MD • Todd Cassese, MD
Imagine waking up and suddenly being A&O x 1. You know who you are, but not anything about your surroundings or what day or time it is. Transient global amnesia is a diagnosis that often presents to the primary care office and can be totally alarming for everyone involved. Is it linked to a risk of …
Neda Frayha, MD • Tom Robertson, MD
Amal Mattu discusses two large branches of pitfalls in patients being evaluated for ACS: EKG pitfalls and HISTORY red flags. We discuss pitfalls and red flags relating to medical legal risks when dealing with chest pain. • Additional talking points: • ECG: 25-50 % misses, look closer …
Amal Mattu, MD • Matthew DeLaney, MD, FACEP, FAAEM • Mizuho Morrison, DO
In this Things I Do But Should I segment, Adrien and Vanessa tackle some commonly held misconceptions about oral contraceptive pills. It’s one segment of an ongoing series on OCPs, inspired by questions from our listeners.
Adrien Selim, MD • Vanessa Gervais, MD
BOTTOM LINE: Increased cancer detection at lower positivity thresholds is counterbalanced by substantial increases in positive tests. Tailored thresholds may provide screening benefits that are more equal among different demographic groups, depending on local resources.
Steve Biederman, MD • Tom Robertson, MD
When we last heard from reproductive endocrinologist and fertility specialist Dr. Lauren Roth, she took us through the workup and treatment algorithm of patients with infertility. In this segment, Dr. Roth walks us through the basics of egg freezing and genetic screening.
Lauren Roth, MD • Neda Frayha, MD
Miz and Jenny discuss current diagnosis, workup and management of GERD. Jenny highlights the step-up approach to treatment when lifestyle modifications alone are insufficient.
Jenny Beck-Esmay, MD • Mizuho Morrison, DO
BOTTOM LINE: Treatment of carefully selected patients with acute PE and low risk by PESI < 86, echocardiography, and CUS without inpatient hospitalization is safe and acceptable to patients. Results must be viewed with caution because of the small sample size relative to the end point and the …
Steve Biederman, MD • Tom Robertson, MD
BOTTOM LINE: Single-dose baloxavir was without evident safety concerns, was superior to placebo in alleviating influenza symptoms, and was superior to both oseltamivir and placebo in reducing the viral load 1 day after initiation of the trial regimen in patients with uncomplicated influenza …
Steve Biederman, MD • Tom Robertson, MD
There are four main types of hypertensive disorders in pregnancy, and there are nuances to how each should be managed differently. In this segment, Drs. Megan Jones and Neda Frayha walk us through these four categories, how to tell them apart from one another and how to manage them, including when …
Megan Jones, MD • Neda Frayha, MD
BOTTOM LINE: Diclofenac poses a cardiovascular health risk compared with non-use, paracetamol use, and use of other traditional NSAIDs. •
Matthew DeLaney, MD, FACEP, FAAEM • Matthieu DeClerck, MD
Tremor is the most common movement disorder in primary care, and the vast majority of tremors can be evaluated and managed by primary care providers. Differentiating between causes of tremor is, for the most part, clinical – and it matters because treatments differ. In this segment, Drs. Paul …
Neda Frayha, MD
Aspirin use prevented serious vascular events in persons who had diabetes and no evident cardiovascular disease at trial entry, but it also caused major bleeding events.
Matthew DeLaney, MD, FACEP, FAAEM • Matthieu DeClerck, MD
BOTTOM LINE: Among other recommendations, the USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years, and screening every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV …
Matthew DeLaney, MD, FACEP, FAAEM • Matthieu DeClerck, MD
Tremor is the most common movement disorder in primary care, and the vast majority of tremors can be evaluated and managed by primary care providers. Differentiating between causes of tremor is, for the most part, clinical – and it matters because treatments differ. In this segment, Drs. Paul …
Emily Rose, MD, FAAEM, FAAP, FACEP • Mizuho Morrison, DO
BOTTOM LINE: Overall, apixaban was found to be the safest drug, with reduced risks of major, intracranial, and gastrointestinal bleeding compared with warfarin. Rivaroxaban and low dose apixaban were associated with increased risks of all cause mortality compared with warfarin.
Matthew DeLaney, MD, FACEP, FAAEM • Matthieu DeClerck, MD
Kids can have strokes?! Did you know that pediatric strokes are actually more common than pediatric brain tumors? Miz speaks to Emily Rose MD, Pediatric Emergency Medicine specialist on the topic of pediatric stroke. They explore the underlying causes, when to suspect it and how management differs …
Emily Rose, MD, FAAEM, FAAP, FACEP • Mizuho Morrison, DO
BOTTOM LINE: There is moderate- to high-quality evidence that anticonvulsants are ineffective for treatment of low back pain or lumbar radicular pain. There is high-quality evidence that gabapentinoids have a higher risk for adverse events.
Matthew DeLaney, MD, FACEP, FAAEM • Matthieu DeClerck, MD
Andrew Buelt has often wondered why clinicians are so quick to prescribe ACE inhibitors over ARBs. In this segment, he looks at the literature to investigate whether or not this is actual best practice.
Andrew Buelt, DO
Our listeners are always asking for more Hematology content. They are also always asking for more Ob/Gyn content! In this segment, Neda and Rob address the two together with a few cases featuring both hypercoagulability and contraception.
Neda Frayha, MD • Rob Orman, MD
1 in 5000 Americans has sickle cell disease, and these patients are at high risk for a variety of complications. Mizuho sits down with Jessica Osterman and Katie Harter to discuss sickle cell disease, pain crisis and emergencies.
Jess Osterman, MD • Katherine Harter, MD • Mizuho Morrison, DO
Observation care may be one of the most confusing topics in medicine. What is it? Who qualifies for it? What are the financial and clinical implications? In this segment, Drs. Steve Biederman and Tom Robertson take us on a tour of observation care and all that it means.
Steve Biederman, MD • Tom Robertson, MD
Notalgia paresthetica and meralgia paresthetica are common sensory neuropathies that cause paresthesias in specific anatomic locations. If you’re anything like our team, these disease entities may sound vaguely familiar but maybe not totally memorable from your school days. In this segment, Dr …
Molly Heublein, MD
After 6 months of combination triple therapy or usual care, those with combination pill had 9 points lower SBP.
Andrew Buelt, DO • Joe Weatherly, DO
What do you do if a patient comes in with a big, swollen parotid gland? How can we tell the difference between suppurative vs nonsuppurative parotitis? And should we be worried if we suspect the suppurative kind? Dr. Tom Robertson has us covered in this segment about the workup and treatment of …
Neda Frayha, MD • Tom Robertson, MD
The incidence in this cohort of sudden cardiac death was 0.38% of the players monitored.
Andrew Buelt, DO • Joe Weatherly, DO
There was no mean length for age difference at 1 year of age, among children born to supplemented or non-supplemented mothers.
Andrew Buelt, DO • Joe Weatherly, DO
Insulin pumps are an amazing technological advancement that makes control of blood sugar so much more accurate and titratable. However when the gadget goes awry it is important to know what to do. Matt sits down with Ryan Pedigo MD to discuss troubleshooting the insulin pump when its not working …
Matthieu DeClerck, MD • Ryan Pedigo, MD
Aspirin is not like a baseball cap and does not appear to be a “one size fits all”.
Andrew Buelt, DO • Joe Weatherly, DO
Insomnia is a common primary care complaint. Sure, we can all prescribe benzos, but isn’t there something else we can do first? In this segment, our own Aisha Lofters and Neda Frayha discuss the evidence surrounding different non-pharmacological treatment options.
Aisha Lofters, MD • Neda Frayha, MD
A listener asked for a review of menopause treatment options, especially given the controversial findings of the Women’s Health Initiative. So, in this segment, Drs. Molly Heublein and Neda Frayha discuss an evidence-based approach to the treatment of menopause symptoms.
Molly Heublein, MD • Neda Frayha, MD
Dr. Rana Awdish, a pulmonary and critical care physician in Detroit, Michigan, wrote an incredibly powerful, bestselling memoir (In Shock) about her own experiences as a critical care patient. In this segment, she sits down with Neda Frayha to talk about healing, the ways the giant medical …
Neda Frayha, MD • Rana Awdish, MD
When a PC RAP listener wrote us with a question about the differences among service animals, emotional support animals, and therapy animals, our own animal lover Brandon Grove looked into the indications, uses, and legal protections (or lack thereof) afforded to each group. In this segment, he …
Brandon Grove, MD
The latest guidelines on the workup and management of syncope are over 278 pages long. Good thing Hippo Education is here to distill all that down into a Primary Care RAP segment! Dr. Sam Ashoo joins our own Mizuho Spangler to give us all a little spoon-fed loveliness. In this segment, they talk …
Mizuho Morrison, DO • Sam Ashoo, MD
When PC RAP listener Lisa wrote us that she’s observed different clinicians manage superficial thrombophlebitis in lots of different ways, from doing absolutely nothing to serial ultrasound to anticoagulation, our own Rob Orman couldn’t wait to put his love of hematology to use. In this segment, he …
Neda Frayha, MD • Rob Orman, MD
The latest guidelines on the workup and management of syncope are over 278 pages long. Good thing Hippo Education is here to distill all that down into a Primary Care RAP segment! Dr. Sam Ashoo joins our own Mizuho Spangler to give us all a little spoon-fed loveliness. In this segment, they talk …
Mizuho Morrison, DO • Sam Ashoo, MD
When a patient needs an oral contraceptive pill AND happens to have acne, which pill should we prescribe? Are any particular OCPs better than others? In this installment of Things I Do But Should I, Drs. Adrien Selim and Vanessa Gervais walk us through the OCP management of contraception and acne.
Adrien Selim, MD • Vanessa Gervais, MD
Our co-hosts for the episode, Neda Frayha and Aisha Lofters, are used to seeing patients with necrotizing pancreatitis in the hospital. But in the outpatient setting? Not so much. In this segment, Aisha and Neda review the literature on optimal timing and techniques for debridement and necrosectomy …
Aisha Lofters, MD • Neda Frayha, MD
Managing diabetes in our inpatients can be fraught with error. Should we hold their oral home meds? What if they’re on a home insulin regimen? In this segment, hospitalist Majid Cina highlights the three big complications to avoid in inpatients with diabetes, current targets for blood glucose …
Maj Cina, MD • Neda Frayha, MD
Dr. Paul Offit is a world-renowned expert on the safety and efficacy of vaccines. He has authored over 160 articles, co-invented the rotavirus vaccine, and been featured on shows like “60 Minutes,” “The Daily Show,” and “The Colbert Report,” among many others. In this segment, Sol Behar and Neda …
Neda Frayha, MD • Paul Offit, MD • Solomon Behar, MD
This study, funded by AstraZeneca, Sanofi and Bristol Meyers and Squibb and others, showed a flat risk of 6.4% over the 5 years following a TIA or minor ischemic event.
Andrew Buelt, DO • Joe Weatherly, DO
In patients with minor ischemic stroke or high-risk TIA, those who received a combination of clopidogrel and aspirin had a lower risk of major ischemic events but a higher risk of major hemorrhage at 90 days than those who received aspirin alone. •
Andrew Buelt, DO • Joe Weatherly, DO
Among women undergoing cervical cancer screening, the use of primary HPV testing compared with cytology testing resulted in a significantly lower likelihood of CIN3+ at 48 months.
Andrew Buelt, DO • Joe Weatherly, DO
Post intensive critical care syndrome is a phenomenon that can affect up to half of all ICU survivors and cause long-lasting consequences like impaired memory, depression, and weakness. In this segment, Dr. Steve Biederman takes us on a tour of PICS, including risk factors, prevention, and possible …
Neda Frayha, MD • Steve Biederman, MD
It’s time for Hematology Rounds with Dr. Tom DeLoughery! In this segment, he and our own Matt DeClerck review the indications for and potential benefits and pitfalls of the direct oral anticoagulants (DOACs).
Matthieu DeClerck, MD • Tom Deloughery, MD
When a patient comes to us saying, “my colonoscopy found diverticulosis. What should I do?”, what do we say? Should we recommend fiber? Is there any evidence that avoiding nuts and seeds is actually helpful? New contributor Paul Simmons and Neda Frayha walk through an evidence-based review of the …
Neda Frayha, MD
While widely prescribed, fluoroquinolones have been associated with a large number of adverse events and are the focus of multiple lawsuits against providers. • Currently there are FDA warnings regarding quinolone use and the risk of tendinitis, tendon rupture and peripheral neuropathy. More …
Matthew DeLaney, MD, FACEP, FAAEM
It’s a med ed podcast mashup! In this segment, The Curbsiders join Neda for a discussion of some recent articles that caught their attention.
Chris Chiu, MD • Matthew Watto, MD • Neda Frayha, MD • Stuart Bringham, MD
Pretreatment with mifepristone followed by treatment with misoprostol was way better and likely this should change your practice.
Andrew Buelt, DO • Joe Weatherly, DO
38% of adults surveyed were on medications with depression as a possible adverse event and those that took 3 or more of these medications were 10.3% more likely to have depression.
Andrew Buelt, DO • Joe Weatherly, DO
Lisa and Sol review the latest recommendations issued by the American Academy of Pediatrics for the 2018-19 influenza vaccine and management of influenza illness.
Lisa Patel, MD • Solomon Behar, MD
If you want your patient to fill their P2y12 inhibitor, then give them something they can afford, aka clopidogrel.
Andrew Buelt, DO • Joe Weatherly, DO
When a listener wrote us that he’s been noticing a lot of incidental thoracic aortic aneurysms on his patients’ calcium scoring CT scans, our Andrew Buelt couldn’t wait to dig into the literature on how best to monitor and manage these incidental TAAs. In this segment, he shares everything he …
Andrew Buelt, DO
Miz and Jenny discuss diagnosis and management of hyperemesis gravidarum. Given recent concerns raised about the safety profile for Ondansetron • in both maternal and fetal health, Miz and Jenny review the most recent ACOG guidelines for treatment regimens as well as referral indications.
Jenny Beck-Esmay, MD • Mizuho Morrison, DO
ADA guidelines for management of cardiovascular disease in diabetics have several grade A recommendations that we will cover in this paperchase.
Andrew Buelt, DO • Joe Weatherly, DO
E-cigarettes and vaping are everywhere these days, and they’re becoming more and more popular with adolescents and teenagers. Are they safe? What are the risks of electronic cigarettes? And have they been shown to help people quit smoking traditional cigarettes? In this segment, Brandon Grove walks …
Brandon Grove, MD
Maternal glyburide resulted in more perinatal complications vs maternal insulin.
Andrew Buelt, DO • Joe Weatherly, DO
There was a statistical reduction in the percent of premature children with recurrent wheezing at 12 months in those who received vitamin D supplements.
Andrew Buelt, DO • Joe Weatherly, DO
A listener wrote in wondering if and when she should refer her patients with IVC filters to have these filters removed. Andrew Buelt and Neda Frayha look to the literature for some answers.
Andrew Buelt, DO • Neda Frayha, MD
Idiopathic pulmonary fibrosis has been a devastating diagnosis with limited mean survival time. In this segment, pulmonologist Dr. Nirav Shah and our own Neda Frayha review how to diagnose this disease, when we should consider biopsy, and some new FDA-approved therapies with some encouraging …
Neda Frayha, MD • Nirav Shah, MD
Among children and adults with Lennox–Gastaut syndrome, the addition of cannabidiol at a dose of 10 mg or 20 mg per kilogram per day to a conventional antiepileptic regimen resulted in greater reductions in the frequency of drop seizures than placebo.
Andrew Buelt, DO • Joe Weatherly, DO
The new IDSA/SHEA practice guidelines on Clostridium difficile infection have a few changes from what we’re used to, mostly about the diagnostic algorithm and first-line treatment options. In this segment, Drs. Devang Patel and Neda Frayha review the new guidelines and how they impact our clinical …
Devang Patel, MD • Neda Frayha, MD
Sam and Miz discuss the diagnosis of calciphylaxis, which are indolent lesions involving the thighs commonly in dialysis patients. Typically gradual in onset, we need to consider calciphylaxis (CUA) if a necrotic core is present. This disease is rare but has a high mortality rate associated, hence …
Mizuho Morrison, DO • Sam Ashoo, MD
Infertility affects 1 in 8 couples in the U.S., and patients often present first to their primary care providers. In this segment, reproductive endocrinologist and fertility specialist Dr. Lauren Roth takes us through the workup and treatment algorithm of patients with infertility, including …
Lauren Roth, MD • Neda Frayha, MD
When a listener wrote in wondering how she can best advise her female patients in their 40s who gain weight for seemingly no reason, the PC RAP team jumped all over this request. Endocrinologist and weight loss specialist Dr. Ava Port reviews why weight creep happens in aging women, as well as …
Ava Port, MD • Neda Frayha, MD
Bottomline: If you want to quit smoking when you get out of the hospital, then it is best that you don't try to use E-Cigarettes as a crutch.
Andrew Buelt, DO • Joe Weatherly, DO
What do you do if you’re on a flight, someone gets sick, and a flight attendant asks, “is there a doctor on board?” Brandon Grove and Neda Frayha walk you through a play by play of what to expect, which actions to take, and what the law says about it all.
Brandon Grove, MD • Neda Frayha, MD
There are over 140 different types of interstitial lung disease, all with their own acronym. This adds up to a complex alphabet soup that can be hard to keep straight in our daily practice. In this segment, pulmonologist and medical educator Dr. Nirav Shah provides us with a broad framework for …
Neda Frayha, MD • Nirav Shah, MD
When a listener wrote in wondering how she can best advise her female patients in their 40s who gain weight for seemingly no reason, the PC RAP team jumped all over this request. Endocrinologist and weight loss specialist Dr. Ava Port reviews why weight creep happens in aging women, as well as …
Ava Port, MD • Neda Frayha, MD
Bottomline: Varied benefits of antidepressants. Amitriptyline was most effective for acute treatment of depression. Agomelatine and fluoxetine were the most acceptable and only ones with fewer dropouts than placebo.
Andrew Buelt, DO • Joe Weatherly, DO
Bottomline: The unpublished data from the trial demonstrated a statistically significant decrease in all-cause mortality but not in the primary endpoint - sudden cardiac death.
Andrew Buelt, DO • Joe Weatherly, DO
Miz and Matt interview Dr.Brittney DeClerck on the diagnosis and management of diaper dermatitis.
Brittney DeClerck, MD • Matthieu DeClerck, MD • Mizuho Morrison, DO
Skin tags, or acrochordons, are benign but annoying skin lesions.
Adrien Selim, MD • Vanessa Cardy, MD
Mononucleosis is a common viral illness that often presents with fatigue, lymphadenopathy and sore throat. While most patients with mono have a benign self-limited course, providers need to be vigilant for patients with splenomegaly who are at risk of possible rupture.
Andrew Buelt, DO
What are the main disease processes we should look for in every post-syncope ECG? What can’t we afford to miss? Which subtle signs can point to a sinister diagnosis? In this segment, Malcolm Thaler and Matt Delaney review the most common and dangerous cardiac causes of syncope and how they may show …
Malcolm Thaler, MD • Matthew DeLaney, MD, FACEP, FAAEM
Mononucleosis is a common viral illness that often presents with fatigue, lymphadenopathy and sore throat. While most patients with mono have a benign self-limited course, providers need to be vigilant for patients with splenomegaly who are at risk of possible rupture.
Matthew DeLaney, MD, FACEP, FAAEM • Solomon Behar, MD
Bottomline: Volunteer patients with CVD that sustained plant-based diets for a mean of 3.7 years, experienced a low rate of cardiac events with some seeing reversal in their coronary artery disease.
Andrew Buelt, DO • Joe Weatherly, DO
Bottomline: If you don't want to have increased risk of diabetes, then lose the weight before the age of 13, otherwise the risk persists into adulthood. Start good habits early!
Andrew Buelt, DO • Joe Weatherly, DO
In patients with gout and major cardiovascular coexisting conditions, febuxostat was noninferior to allopurinol with respect to rates of adverse cardiovascular events. All-cause mortality and cardiovascular mortality were higher with febuxostat than with allopurinol.
Andrew Buelt, DO • Joe Weatherly, DO
Heidi James sits down with psychiatrist Shawn Hersevoort to review the spectrum of trauma related disorders. They break down the diagnostic criteria, differences among disorders, and major treatment options.
Heidi James, MD • Shawn Hersevoort, MD, MPH
In this segment, Andrew Buelt walks us through the do’s and don’ts of managing patients who want to leave the health care setting against medical advice.
Andrew Buelt, DO
Having varicose veins was significantly associated with increased risk of incident DVT, but not as much for PE or PAD.
Andrew Buelt, DO • Joe Weatherly, DO
Solid fuel use of cooking and heating was associated with increases in all causes of mortality in this prospective cohort study of 271,217 adults in China.
Andrew Buelt, DO • Joe Weatherly, DO
Are you a fan of your annual physicals, or are you moving away from them in your practice? In this segment, Neda and our new PC RAP contributor Aisha Lofters debate the merits and drawbacks of the annual physical. Spoiler alert: Aisha wins!
Aisha Lofters, MD • Neda Frayha, MD
Heidi James sits down with psychiatrist Shawn Hersevoort to review the spectrum of trauma related disorders. They break down the diagnostic criteria, differences among disorders, and major treatment options.
Heidi James, MD • Shawn Hersevoort, MD, MPH
In part 2 of our two-part series on selecting the best IV fluids for our patients, Maj Cina and Neda cover maintenance fluids and how to manage a variety of common scenarios like hypo- and hypernatremia.
Maj Cina, MD • Neda Frayha, MD
Patients with significant or massive hemoptysis should be sent to the ED for further evaluation.Patients with non-massive hemoptysis should be evaluated with initially with a chest x-ray.
Matthew DeLaney, MD, FACEP, FAAEM • Scott Irvine, MD
The American College of Physicians developed 4 guidance statements regarding the treatment of diabetes mellitus type 2 with medications; these include the importance of personalized goals, a goal A1c of 7-8% for most adults, deintensifying treatment in patients with A1c of <6.5%, and moving away …
Andrew Buelt, DO • Joe Weatherly, DO
In this PC RAP family reunion, Rob Orman and Neda Frayha discuss the latest evidence on the use of aspirin in low-risk a-fib (CHA2DS2-VASc score of 0 or 1).
Neda Frayha, MD • Rob Orman, MD
Among adults undergoing hip fracture surgery, increased wait time was associated with a greater risk of 30-day mortality and other complications. A wait time of 24 hours may represent a threshold defining higher risk.
Andrew Buelt, DO • Joe Weatherly, DO
Preconception counseling is an important part of primary care visits and has been shown to improve maternal and fetal outcomes. In this segment, Neda Frayha and Molly Heublein discuss the importance of preconception counseling and the different components thereof so that we can best guide and treat …
Molly Heublein, MD • Neda Frayha, MD
Once patients received 5 days of rivaroxaban prophylaxis after total hip or knee arthroplasty, there was no significant difference between extended prophylaxis with aspirin vs. rivaroxaban to prevent symptomatic VTE.
Andrew Buelt, DO • Joe Weatherly, DO
Sertraline may not be an effective treatment for major depressive disorder in patients with non–dialysis-dependent chronic kidney disease.
Andrew Buelt, DO • Joe Weatherly, DO
There was no significant difference in 12-month weight loss between the low fat and low carb diets. Neither genotype pattern nor baseline insulin secretion was associated with dietary effects on weight loss.
Andrew Buelt, DO • Joe Weatherly, DO
Has a friend or family member ever asked you for medical advice? Join the club! In this segment, Neda Frayha, Miz Spangler, and Sol Behar discuss how to handle requests for advice and even treatment from non-patients.
Mizuho Morrison, DO • Neda Frayha, MD • Solomon Behar, MD
Fever in HIV-AIDS patients remains a challenge. HAART has contributed to a decrease in its incidence but has not altered the spectrum of causes. It is a common cause of admission to hospitals and is associated with substantial cost and significant mortality. In most cases fever of unknown origin in …
Heidi James, MD
Not all coughs are created equal. In this segment, Drs. Heidi James and Beth Haskins walk through when we should think about antibiotics and when we shouldn’t.
Beth Haskins, MD • Heidi James, MD
Most of us order normal saline for our inpatients as easily as we breathe the air around us. But it’s not always the best choice for our patients, even in resuscitation scenarios. In this segment, Maj Cina and Neda Frayha discuss the evidence behind colloids vs crystalloids and then, within …
Maj Cina, MD • Neda Frayha, MD
Rick is joined by his wife Jessica Pescatore, an OB/GYN, to review the diagnosis of abnormal uterine bleeding. The temporization of massive vaginal bleeding as well as the outpatient treatment of AUB are discussed.
Jessica Pescatore, DO • Rick Pescatore, DO
Pulmonary embolism was identified in less than 1% of patients with syncope.
Andrew Buelt, DO • Joe Weatherly, DO
Trigeminal neuralgia is one of the most bothersome, painful conditions our patients may experience. In this segment, Drs. Matt Delaney and Malcolm Thaler review the causes of trigeminal neuralgia, how to work up these patients, and which treatments may offer some relief.
Malcolm Thaler, MD • Matthew DeLaney, MD, FACEP, FAAEM
RV3-BB was able to prevent severe rotavirus gastroenteritis similarly when given over 0-14 weeks vs 9-18 weeks.
Andrew Buelt, DO • Joe Weatherly, DO
Vanessa Cardy’s mom was right all along: applying warm compresses (or teabags) to hordeola, or styes, turned out to be a legit form of treatment. Topical antibiotics or steroids, on the other hand, are not helpful. Chalazia can benefit from intralesional steroid injections or even curettage.
Adrien Selim, MD • Vanessa Cardy, MD
In simulation exercises, as in patient care, it’s easy for team members to feel psychologically distressed. Creating a culture of psychological safety can help team members feel free to ask questions, learn more effectively, and work better together as a team. In this segment, Joe Weatherly …
Jared Henricksen, MD • Joe Weatherly, DO
When Neda met a pregnant, hyperthyroid patient who was new to care, she developed palpitations of her own. In this conversation, Neda and Andrew go through which lab tests to order, how to interpret thyroid function tests in pregnancy, and how to treat depending on the trimester.
Andrew Buelt, DO • Neda Frayha, MD
Tinnitus is the kind of chief complaint that annoys our patients to no end. The constant (or, sometimes, pulsatile) ringing in the ears can affect quality of life and contribute to depression, anxiety, and insomnia. In this segment, Brandon Grove and Neda Frayha discuss the etiologies and types of …
Brandon Grove, MD • Neda Frayha, MD
Elder abuse affects approximately 1 in 10 people and is associated with increased morbidity, mortality, and health care costs. Unfortunately, it is easy for elder abuse to go unrecognized in many health care encounters. Elder abuse may be physical or sexual, but it can also be psychological and …
Jeff Holmes, MD • Matthew DeLaney, MD, FACEP, FAAEM
For patients with acute extremity pain in the ED, there were no differences in pain reduction at 2 hours among single-dose treatment with ibuprofen and acetaminophen or with 3 different opioid and acetaminophen combination.
Andrew Buelt, DO • Joe Weatherly, DO
Thanks to all the imaging studies we order on our patients, we are finding more and more thyroid nodules - and, as a result, diagnosing more thyroid cancer. In this segment, Elizabeth Lamos discusses the evaluation and management of both incidental thyroid nodules and thyroid cancers for the busy …
Elizabeth Lamos, MD • Neda Frayha, MD
When a patient asks, “don’t put this in my record, but…”, what are we to do? In this segment, Neda Frayha and Mike Weinstock explore whether or not to document every single fact we learn about our patients, how to judge when something must be documented, and how to maintain a trusting relationship …
Mike Weinstock, MD • Neda Frayha, MD
While chest pain in the outpatient setting is most commonly due to gastrointestinal, musculoskeletal, or “nonspecific” causes, primary care providers need to assess the likelihood of underlying cardiac disease quickly and effectively. Putting together clues from the history and physical exam …
Heidi James, MD • Spencer Blackman, MD
Parkinson’s Disease (PD) is a progressive movement disorder characterized by bradykinesia, cogwheel rigidity, tremor, and impaired balance. The diagnosis is a clinical one, based on history and physical alone. Symptoms often begin unilaterally and are gradual in onset and progression. Non-motor …
Neda Frayha, MD • Stephen Reich, MD
This simulation modeling study reports that breast cancer mortality reductions in US women were from both advances in screening and adjuvant therapy.
Andrew Buelt, DO • Joe Weatherly, DO
In extended follow-up of obese adults with type 2 diabetes randomized to adding gastric bypass compared with lifestyle and intensive medical management alone, there remained a significantly better composite triple end point (A1c < 7%, LDL < 100 mg/dL, systolic blood pressure < 130) in the surgical …
Andrew Buelt, DO • Joe Weatherly, DO
Parkinson’s Disease (PD) is a progressive movement disorder characterized by bradykinesia, cogwheel rigidity, tremor, and impaired balance. The diagnosis is a clinical one, based on history and physical alone. Symptoms often begin unilaterally and are gradual in onset and progression. Non-motor …
Neda Frayha, MD • Stephen Reich, MD
The use of hysteroscopic sterilization was associated with more complications vs laparoscopic first-time sterilization.
Andrew Buelt, DO • Joe Weatherly, DO
Patient navigation and financial incentives for smoking cessation significantly increased the rates of smoking cessation.
Andrew Buelt, DO • Joe Weatherly, DO
In this month’s Things I Do, But Should I? segment, Vanessa and Adrien take us on a journey through herpetic gingivostomatitis in young children. While this condition is usually self-limiting, in cases of severe symptoms such as fever, inability to take PO, and dehydration, could there be a role …
Adrien Selim, MD • Vanessa Cardy, MD
Broad spectrum antibiotics were not associated with better clinical or patient centered outcomes, but they were associated with higher rates of adverse events. When treating acute sinusitis, otitis media, or strep, aim for narrow spectrum (penicillin, amoxicillin) whenever possible.
Andrew Buelt, DO • Joe Weatherly, DO
In part 2 of this segment on lifestyle and diabetes,Neil and Heidi review yet more evidence pointing toward the effectiveness of weight management and exercise in preventing and managing DM2. As a bonus, Neil concludes his story of how exercise has changed his life and health.
Heidi James, MD • Neil Skolnik, MD
When one of Neda’s former patients sent her a Facebook friend request, she learned more about this person than she ever wanted to know. Neda and Heidi discuss when to become friends with our patients on social media (hint: never!), how to engage with social media in a professional way, the …
Heidi James, MD • Neda Frayha, MD
In this segment, Neda Frayha and Dr. Nicole Brandt, a Professor of Pharmacy and Science at the University of Maryland School of Pharmacy, explore the importance of deprescribing in our elderly patients, common challenges of deprescribing, and a systematic approach to deprescribing medications in …
Neda Frayha, MD • Nicole Brandt, PharmD
Many times patients who present with an inflamed lower extremity are diagnosed with cellulitis. However before we jump to this diagnosis, it’s important to stop and consider other diagnosis. Greg Moran, EM/IM and infectious disease expert shares his insights and reviews recent treatment …
Greg Moran, MD • Matthew DeLaney, MD, FACEP, FAAEM • Mizuho Morrison, DO
In this meta-analysis of randomized clinical trials, the use of calcium, vitamin D, or both was not associated with a lower risk of fractures. We should stop prescribing or recommending them for this purpose.
Andrew Buelt, DO • Joe Weatherly, DO
If a young, healthy woman presents with typical UTI symptoms, should we go ahead and treat empirically? What if the dipstick is negative? According to Bent et al in JAMA, in a woman with typical UTI symptoms, the likelihood of cystitis is 96%! This is high enough to treat empirically. If urinary …
Adrien Selim, MD • Vanessa Cardy, MD
Ferrous sulfate led to a greater increase in hemoglobin concentration at 12 weeks and higher rates of resolution of iron-deficiency anemia compared with iron polysaccharide complex. Good old, tried-and-true ferrous sulfate for the win.
Andrew Buelt, DO • Joe Weatherly, DO
In most of the oral presentations that were studied, conflict of interest statements were missing, displayed too briefly to be read and understood, or not explained by the presenter. Also, lots of people make jokes about their reported conflicts of interest.
Andrew Buelt, DO • Joe Weatherly, DO
Adrien and Eric discuss the potential role of naloxone/buprenorphine (Suboxone) in helping patients manage opioid dependence. They review its pharmacology, indications, contraindications, administrations and potential pitfalls.
Adrien Selim, MD • Eric Contant, MD
In patients with medically treated angina and severe coronary stenosis, PCI did not increase exercise time any more than placebo did. This can be a game-changer, and shows just how important medical optimization is for our patients with CAD.
Andrew Buelt, DO • Joe Weatherly, DO
After their deep dive into the evidence, Jake and Andrew conclude that contralateral prophylactic mastectomies should not play a role in the management of breast cancer for most patients. The risk of recurrence in the contralateral breast is simply too small to justify exposing patients to the …
Andrew Buelt, MD • Jake Anderson, DO
Love it or hate it, vitamin D has been quite the fad of 21st century medicine. Just when we think we have a handle on the most recent literature, a few more studies come out to throw us off our game. In this segment, Brandon Grove shares his reading of the vitamin D tea leaves based on the latest …
Brandon Grove, MD
Tom DeLoughery predicted a new practice pattern in an earlier PC RAP and he turned out to be totally right, so we’re proud to say “you heard it here first.”
Andrew Buelt, DO
In this segment, Casey first gives us a good review of the anatomy of external hemorrhoids and then quickly moves into sharing his approach to managing this extremely painful and fairly common condition. He also shares with us his deep love of busting butt clot. Which would be somewhat disturbing …
Casey Parker, MD
Carotid endarterectomy declined from 1999-2014 and stenting increased until 2006 when it also declined.
Andrew Buelt, DO • Joe Weatherly, DO
Not all relationships are meant to last forever, including the patient-physician relationship. Neda and Heidi discuss a poignant New York Times article in which a patient describes why they thought of leaving their physician. Whether a patient leaves our care, or we excuse a patient from our …
Heidi James, MD • Neda Frayha, MD
Andrew and Heidi review the literature to get a sense of who well - or how badly!- we are doing at discussing code status with our patients. They review articles that suggest ways to improve this conversation, and also discuss different training strategies and novel ways to get providing our …
Andrew Buelt, DO • Heidi James, MD
Non-accidental trauma should be considered in cases where the nature of the fracture is inconsistent with the mechanism described by the provider, which can include severity of the injury, location, or mechanism is inconsistent with child’s development stage.
Jason Woods, MD • Solomon Behar, MD
Patients who had had a recent cryptogenic stroke attributed to PFO had lower stroke recurrence if assigned to PFO closure combined with antiplatelet therapy than those assigned to antiplatelet therapy alone.
Andrew Buelt, DO • Joe Weatherly, DO
The risk of breast cancer was higher in women who were currently or had recently used contemporary hormonal contraceptives when compared to women that never utilized hormonal contraception.
Andrew Buelt, DO • Joe Weatherly, DO
Adrien and Vanessa cover the vexing topic of Gout Prophylaxis in the context of uric acid lowering therapy options. They discuss the pros and cons of using different medications to help prevent a gout flare when starting allopurinol. And because they are badass rebels, they also review NOT using …
Adrien Selim, MD • Vanessa Cardy, MD
There is plenty of rock solid evidence showing the role of exercise and weight loss in preventing DM 2. In fact, in the Diabetes Prevention Program Outcomes Study, participants who were asked to lose 7% of their body weight and exercise 150 minutes/week decreased their risk of developing DM2 by …
Heidi James, MD • Neil Skolnik, MD
ACE inhibitors and statins did not change the albumin to creatinine ratio over time in this study population.
Andrew Buelt, DO • Joe Weatherly, DO
In patients with PFO who had a CVA, closing the PFO was associated with a lower rate of recurrent ischemic strokes than medical therapy alone during the study period.
Andrew Buelt, DO • Joe Weatherly, DO
Lithium is often used to treat bipolar disorder. Dosing begins at 300 mg od and can range up to 1800 daily. Adverse effects are most likely to affect GI, renal, cardiac, neurologic systems as well as the thyroid and parathyroid glands. Toxicity can be either acute or chronic. Regular monitoring …
Adrien Selim, MD
Erectile dysfunction is common,so it behooves primary care providers to be comfortable engaging our patients in conversation about the condition. Many factors can cause erectile dysfunction, including medications, DM, and OSA. It’s important to remember that if blood flow to the penis is …
Andrew Buelt, DO • Vanessa Cardy, MD
In this segment we discuss the ceiling effect of NSAIDs, the max dose at which pain relief is obtained. Higher doses and longer courses can lead to adverse effects without more pain control. The generally accepted ceiling dose for pain control is 600 mg for ibuprofen and 10 mg for ketorolac …
Bryan Hayes, PharmD • Mike Weinstock, MD
Erectile dysfunction is common,so it behooves primary care providers to be comfortable engaging our patients in conversation about the condition. Many factors can cause erectile dysfunction, including medications, DM, and OSA. It’s important to remember that if blood flow to the penis is …
Vanessa Cardy, MD
This branch of the COMPASS trial examined 3 anticoagulation strategies in patients with “stable atherosclerotic disease”: rivaroxaban 5mg BID, ASA 100mg od + placebo BID, ASA 100 BID + rivaroxaban 2.5 mg BID. Casey’s analysis focused on the ASA groups, not the NOAC alone group. He concludes that …
Casey Parker, MD
In this chapter, Malcolm Thaler shares his tips and tricks for the diagnosis and management of contact dermatits and atopic dermatitis. For contact dermatitis, look for causal irritants and allergens. For treatment, Malcolm recommends starting with high potency steroids and tapering to lower …
Heidi James, MD • Malcolm Thaler, MD
this study looked at numerous interventions and their impact on fall reduction in an older adult population. Study participants who received the interventions reported fewer fall than those receiving usual care.
Andrew Buelt, DO • Joe Weatherly, DO
Endometriosis is a common cause of pelvic pain in women of reproductive age. Despite its prevalence it can be difficult to diagnose may resemble a variety of other abdominal and pelvic conditions. In the urgent care setting providers should focus on ruling other other more acute causes of pain and …
Matthew DeLaney, MD, FACEP, FAAEM • Mizuho Morrison, DO
Jake and Andrew break down the data for us on knee OA treatments. Lo and behold, there is not a lot of evidence!
Andrew Buelt, DO • Jake Anderson, DO
Once thought be caused by trochanteric bursitis, GTPS is now understood as an overload tendinopathy of the gluteus medius and minimus muscles. It is characterized by pain over the lateral trochanter area. Diagnosis is made clinically, though in some cases imaging may be beneficial. While GTPS is …
Brandon Grove, MD • Neda Frayha, MD
in patients who develop afib secondary to another medical condition like COPD or ACS, this study demonstrates that the benefit of anticoagulation in not strong and can be associated with a higher risk of bleeding.
Andrew Buelt, DO • Joe Weatherly, DO
Tom Deloughery shares his wisdom on all things cancer and thrombosis. First, he reviews why patients with cancer are more likely to have clots, then reviews some aspects of thrombosis that are unique to this population. Lastly, he discusses treatment standards, nuances and controversies.
Matthieu DeClerck, MD • Tom Deloughery, MD
Sudden cardiac death occurs rarely in competitive sport. This study showed that arrythmia is a more common cuase of SCD than structural heart disease in competitive athletes.
Andrew Buelt, DO • Joe Weatherly, DO
Over the past three months we have had the honor of hearing from Claire Wineland, a remarkable 20 yo woman living with cystic fibrosis. Her perspective on dying stems from her motivation for living. Its a powerful piece, one that you don't want to miss.
Claire Wineland • Mizuho Morrison, DO
Vitamin D is a vitamin in flux, at least with regards to how much we should be recommending our patients take and the frequency with which they should take it. Vaness and Adrien sift through the evidence and conclude that weekly or monthly dose is adequate for most patients. They also remind us …
Adrien Selim, MD • Vanessa Cardy, MD
Patients admitted to a general medicine hospital service were shown a video about resuscitation as part of the code status discussion. Patients who wathced the video were less likely to choose a “full code” status.
Andrew Buelt, DO • Joe Weatherly, DO
High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat intake was related to lower total mortality
Andrew Buelt, DO • Joe Weatherly, DO
Pleural effusions can be broken down into transudative or exudative types. Transudative are caused by dysregulation of the hydrostatic pressure, such as in CHF, or the oncotic pressure, like in cirrhosis or nephrotic syndrome. Imaging and thoracentesis are part of the management of most pleural …
Adrien Selim, MD • Neda Frayha, MD • Vanessa Gervais, MD
With a solid knowledge of SSRIs, SNRIs, and bupropion, Dr. Hersevoort believes that primary care providers can manage 95% patients who have depression. Referral to psychiatry is recommended if you are consider augmenting therapy with anti-psychotics.
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Pleural effusions can be broken down into transudative or exudative types. Transudative are caused by dysregulation of the hydrostatic pressure, such as in CHF, or the oncotic pressure, like in cirrhosis or nephrotic syndrome. Imaging and thoracentesis are part of the management of most pleural …
Adrien Selim, MD • Neda Frayha, MD • Vanessa Gervais, MD
In this review, Jordan discusses the pathogenesis and treatment of spinal stenosis. Depending on your patient’s age and your center’s practice pattern, either a CT or an MRI can be done to help confirm the clinical diagnosis. Conservative treatments include physical therapy and medications such as …
Jordan Roberts, PA-C
Autosomal dominant polycystic kidney disease is broken down into two main subtypes: PKD-1 and PKD-2. PKD-1 leads to renal impairment approximately 20 years before PKD-2. While there is a 50% chance that the offspring of a parent with PKD will have the condition, routine screening before the age …
Neda Frayha, MD • Terry Watnick, MD
Adding Rivaroxaban to aspirin therapy resulted in 1% fewer composite cardiovascular outcomes, but cause a 1% increase in bleeds. Andrew and Joe conclude that Rivaroxaban does not offer benefits above aspirin alone in the study population.
Andrew Buelt, DO • Joe Weatherly, DO
Treatment of Graves disease varies depending on patient characteristics and available options. Methimazole is generally preferred over prophylthiouracil (PTU) though PTU is the drug of choice in the first trimester of pregnancy. Radioiodine ablation may be considered in patients who fail or have …
Heidi James, MD • Tania Gallant, MD
Determining if a patient needs to be off work due to medical reasons can be difficult. Navigating the various public and private insurances involved in facilitating patient taking time away from work. Brandon reviews the Family Medical Leave Act, short term disability and a commonsense approach to …
Brandon Grove, MD
Matt, Miz and Sam discuss the spectrum of presentation for ectopic pregnancy. Everything from minor vaginal bleeding to ruptured ectopic. This is a DO NOT miss diagnosis, and one that depending on your urgent care’s resources, must be not be misappropriately handled.
Matthew DeLaney, MD, FACEP, FAAEM • Mizuho Morrison, DO • Sam Ashoo, MD
In this intro, Neda and Heidi review a case of Fever of Unknown Origin, with attention to differential diagnosis generation and appropriate work up. A female patient in her late 20s presents with recurrent fevers and weight loss. After working through a differential which includes malignancy …
Heidi James, MD • Neda Frayha, MD
The paper Taylor et al compared the effectiveness of oral vs transdermal estrogen in the management of decreased libido in post-menopausal women. Transdermal estrogen appears to be superior in the studied population.
Andrew Buelt, DO • Joe Weatherly, DO
Dollars to donuts, the CETP inhibitors like anacetrapib are not part of your primary care pharmacologic arsenal. And this study shows why they never will be.
Andrew Buelt, DO • Joe Weatherly, DO
Andrew and Adrien review the pathophysiology, diagnosis and treatment of hidradenitis suppurativa. Treatments options are determined in part based on the Hurley staging system. Non-pharmacologic treatments include weight loss and wearing loose fitting clothes. Treatment options include topical and …
Adrien Selim, MD • Andrew Buelt, DO
Autosomal dominant polycystic kidney disease is broken down into two main subtypes: PKD-1 and PKD-2. PKD-1 leads to renal impairment approximately 20 years before PKD-2. While there is a 50% chance that the offspring of a parent with PKD will have the condition, routine screening before the age …
Neda Frayha, MD • Terry Watnick, MD
Deprescribing medications is never more important than it is in the palliative context. Vanessa recommends using the 123 ABC (see written summary) approach to reviewing medications with patients, their families and team members.
Brandon Grove, MD • Vanessa Cardy, MD
Rapid influenza tests are far less sensitive than the gold standard PCR based tests. This limitation should be considered when ordering the test in the clinical setting.
Andrew Buelt, DO • Joe Weatherly, DO
This JAMA article discusses the clinically relevant effect of biotin supplementation on multiple standard laboratory tests. It serves as a reminder to ask our patients about their supplement use and it can impact their lab results.
Andrew Buelt, DO • Joe Weatherly, DO
Mizuho sits down with Claire Wineland a patient with Cystic fibrosis to learn what it is like to live with a chronic progressive terminal illness and helps change the narrative for healthcare workers.
Claire Wineland • Mizuho Morrison, DO
Andrew and Heidi discuss the new AHA Hypertension guidelines that were released in November. Spoiler: even though they try really, really, REALLY hard to keep an open mind, our intrepid podcasters are not impressed. •
Andrew Buelt, DO • Heidi James, MD
Heidi talks about an online cardiovascular risk calculator that revitalized her approach to dyslipidemia management. She also covers the recent CDC and Health Canada guidelines on opioid prescribing. Jordan, who in the throes of a huge concussion trial he’s working on, focusses his attention …
Brandon Grove, MD • Heidi James, MD • Jordan Roberts, PA-C
Ann and Mark review the clinical presentation, natural course and indications for referral for hydrocele and undescended testicles. Hypospadias is also discussed. •
Ann Dietrich, MD • Mark Cain, MD
Millions of people worldwide wear contact lens. Noninfectious and infectious complications of contact lenses are common and vary in severity from clinically inconsequential to potentially vision threatening.
Matthieu DeClerck, MD • Mizuho Morrison, DO
Heidi talks about an online cardiovascular risk calculator that revitalized her approach to dyslipidemia management. She also covers the recent CDC and Health Canada guidelines on opioid prescribing. Jordan, who in the throes of a huge concussion trial he’s working on, focusses his attention …
Brandon Grove, MD • Heidi James, MD • Jordan Roberts, PA-C
This study found that at 12 years, the Roux-en-Y gastric bypass group had improved markers in diabetes, HTN, dyslipidemia compared to the nonsurgical treatment. •
Andrew Buelt, DO • Joe Weatherly, DO
Mizuho sits down with Claire Wineland a patient with Cystic fibrosis to learn what it is like to live with a chronic progressive terminal illness. Claire opens up about her experience. •
Claire Wineland • Mizuho Morrison, DO
Graves disease is an autoimmune condition and is the most common cause of hyperthyroidism. If suspected based on clinical presentation and history, diagnosis is made by checking TSH (which will be low) and T3/T4 (which will be elevated) and ordering appropriate thyroid imaging, which may including …
Heidi James, MD • Tania Gallant, MD
This study looked at whether tracheal intubation during adult in-hospital arrest was associated with survival. And, it wasn’t. That’s right, tracheal intubation within the first 15 minutes of an arrest is associated with less likelihood of surviving.
Andrew Buelt, DO • Joe Weatherly, DO
When taken daily, pre-exposure prophylaxis for HIV can prevent up to 99% of HIV infections in high risk individuals. Truvada, which consists of emtricitabine and tenofovir, is generally well tolerated, with rare incidence of GI side effects and renal impairment. Remember to screen for other STIs in …
Amy Stulman, AGNP-BC • Jess Pinder, AGNP-BP • Spencer Blackman, MD
The DETO2X trial has turned management of acute MI on its head. This study showed that treating not-hypoxemic MI patients with oxygen therapy vs room air made ABSOLUTELY no difference on mortality at one year. •
Andrew Buelt, DO • Joe Weatherly, DO
Symphyseal fundal height is best used in conjunction with a charting or graphing tool to plot the growth. Typically, the SFH increases by 1cm per week. Measuring SFH is more adept at detecting IUFGR than macrosomia. •
Adrien Selim, MD • Vanessa Cardy, MD
This study looks at the secondary endpoints of the LEADER trial to find the renal benefit to taking Liraglutide in type 2 diabetic patients. Compared to placebo, this GLP-1 resulted in lower rates of progression to chronic kidney disease. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss the presentation, causes, and historical features of Saturday Night Palsy. •
Casey Parker, MD
Santa Claus is not a healthy fellow! Andrew and Heidi stuff your stockings with brief updates on obesity, high sugar diets, soot wart, lung cancer screening, effect of long work hours, cardiovascular risks of stimulants and surgery for OSA.
Andrew Buelt, DO • Heidi James, MD
The Objective of this study was to understand clinician rationale for ordering monitoring lipid panels among patients on statin therapy and to determine how often treatment changes occur as a result of testing. For their bottom line, Joe and Andrew conclude that most monitoring of lipid profiles …
Andrew Buelt, DO • Joe Weatherly, DO
Dr Sacchetti reviews the different types of vaccines and adverse reactions. •
Heidi James, MD • Solomon Behar, MD
Dr. Deloughery reviews his approach to the incidental thrombocytopenia. He reviews the differential in sick and well appearing pt. He describes the major causes of thrombocytopenia and suggests a stepwise approach to evaluation.
Heidi James, MD • Tom Deloughery, MD
Hypercalcemia is a relatively common electrolyte abnormality and is usually attributable to hyperparathyroidism. Be sure to order an albumin level to help caculate the ionized calcium and rule out a false positive. If Calcium remains elevated on repeat testing, order a PTH level. If the PTH level …
Heidi James, MD • Malcolm Thaler, MD
There are many good reasons to teach students and residents. In this segment we review these as well as provide a practical framework for teaching in the clinic setting. We review the One Minute Preceptor and SNAPPs model.
Brandon Grove, MD • Heidi James, MD
Screening for EBV DNA is plasma allows for earlier detection of nasopharyngeal cancers, often detecting them before they would have been clinically apparent. Catching these cancers earlier will optimistically lead to higher survival and decreased morbidity rates. •
Andrew Buelt, DO • Joe Weatherly, DO
Vanessa goes to town busting myths left, right and centre concerning diverticulitis management. Do all patients need a CT? NO! Does absolutely everyone need antibiotics? NO! Does everyone need a C-scope after a bout of diverticulitis? NO! • Mind Blown. And hopefully no ‘tics perfed. •
Vanessa Cardy, MD
SGLT-2 inhibitor canagliflozin is associated with lower cardiovascular events but greater amputation rates than placebo.
Andrew Buelt, DO • Joe Weatherly, DO
Spider bites of clinical consequence are rare. In North America there are only a few spiders whose bites cause clinically relevant pathology requiring medical treatment beyond basic wound care. These species and the clinical picture resulting from their bites are reviewed in this segment. •
Matthieu DeClerck, MD • Mizuho Morrison, DO
This 19 month trial did not find any clinically significant changes in cognitive functioning in patients taking evolucomab compared to placebo. •
Andrew Buelt, DO • Joe Weatherly, DO
Andrew and cardiologist Dr. Paul Vaikus discuss bridging oral anticoagulation in several clinical contexts (peri-operative, anticoagulation initiation in thrombosis, anticoagulation initiation in atrial fibrillation). Current evidence does not support routine bridging with parenteral …
Andrew Buelt, DO • Paul Vaikus, MD
High-dose NOACs provide overall efficacy and safety similar in atrial fibrillation patients with or without valvular heart disease. •
Andrew Buelt, DO • Joe Weatherly, DO
JME accounts for 5-10% of epilepsy syndromes. It predominantly affects adolescents and young adults. The hallmark symptoms are absence seizures, myclonic jerks, and later, generalized tonic-clonic seizures.
Adrien Selim, MD • Jordan Roberts, PA-C
Neda and Dr. Rettener discuss the Affordable care act. The start with it’s origins, review the positive and negative impact it’s had on health care in the USA since it’s inception, and discuss the attempted modifications over the past year. •
Neda Frayha, MD • Norman Retener, MD
Among healthy children aged 1 to 5 years, daily administration of 2000 IU compared with 400 IU of vitamin D supplementation did not reduce overall wintertime upper respiratory tract infections.
Andrew Buelt, DO • Joe Weatherly, DO
Placebos are potent stuff! This article discuss the effect of different placebo characteristcs on patient perception and clinical outcomes. We promise, you will never look at placebos the same! •
Andrew Buelt, DO • Joe Weatherly, DO
Andrew and Heidi talk about the potential role of ASA in preventing colorectal cancer, compare fracture risks associated with common anticoagulants, and go on a bit of a tirade about lung cancer screening. •
Andrew Buelt, DO • Heidi James, MD
Electroconvulsive therapy (ECT) and trans-cutaneous (TMS) magnetic stimulation are important therapeutic modalities in psychiatric care. ECT is performed in a hospital type setting and can help treat refractory mental illness, and is exceptionally useful in treating severe depression in pregnancy …
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Our paperchasers looked at this study and concluded that exercise stress testing is overused in the low risk chest pain patient who has no EKG changes and no troponin rise. •
Andrew Buelt, DO • Joe Weatherly, DO
Aripiprazole is slightly more effective than buproprion at achieving remission at 12 weeks.
Andrew Buelt, DO • Joe Weatherly, DO
Simple febrile seizures are common and they are terrifying for parents. In this chapter, Casey reviews the AAP’s 2011 guidelines, reviews appropriate evaluation, discusses follow up recommendations, and emphasizes the importance of parental education and reassurance.
Casey Parker, MD
Just about any injury to the head can result in post-traumatic headache. The phenotype varies depending in part on the mechanism of injury. Treatment should be tailored to the presenting symptoms or phenotype. Physical modalities, medications, and cognitive behavioural therapy may all be …
Jordan Roberts, PA-C
The large majority of wounds will heal without any specific intervention within three weeks. After this time period wounds begin to enter a chronic phase. •
Charles Khoury MD, FACEP, FAAEM • Matthew DeLaney, MD, FACEP, FAAEM
Sore elbows abound in the primary care clinic, and often epicondylitis is to blame. Vanessa and Adrien review the evidence around two commonly used braces - the wrist extension splint and the counter-force forearm brace. Turns out neither has a clear advantage and may not even be better than …
Adrien Selim, MD • Vanessa Cardy, MD
Lithium use in pregnancy is associated with a lower risk of cardiac malformations than previously thoughts. Practitioners and patient should have informed discussion about the benefits and risks of continuing this medication in pregnancy.
Andrew Buelt, DO • Joe Weatherly, DO
More and more research is showing that inferior vena cava filters may just be the Tools of Satan. At least Hematologist Tom Deloughery thinks. In this chapter, Tom and Heidi discuss a recent article on the diminishing role of IVC filters in thrombosis management.
Heidi James, MD • Tom Deloughery, MD
HIV PEP is highly effective and far less cumbersome than it once was. Current regimes used Truvada and an anti-retroviral such as raltegravir. PEP should be initiated within 72 hours of exposure and is typically continued for 1 month. •
Brandon Grove, MD • Mizuho Morrison, DO • Sanjay Arora, MD
Due to exorbitant drug costs, many are choosing to purchase their medications from Mexico and Canada. This paper looks at the factors contributing to this phenomenon and explores possible solutions. •
Andrew Buelt, DO • Joe Weatherly, DO
Fatigue is a very common symptom in primary care. Unfortunately, the cause is rarely found. Taking a thorough history and doing a physical exam may identity the cause of the fatigue or help direct further investigations. The differential is wide and encompasses many cardiovascular, respiratory …
Heidi James, MD • Neda Frayha, MD
CIDP is a bit of a mysterious condition. While it is more common than ALS, it’s underrecognized. It’s an auto-immune mediated condition and has been referred to as chronic Guillain-Barre. Treatments include IVIG, steroids, plasmapheresis and cytotoxic medications. •
Adrien Selim, MD • Heidi James, MD
Radiofrequency denervation combined with an exercise program is no better at improving chronic low back pain than exercise alone.
Andrew Buelt, DO • Joe Weatherly, DO
As it the case with many ill-understood conditions, there is no one medication or therapeutic approach that stands heads or shoulders above the rest in IBS. Newere medication show some promise, but are very expensive and not without their significant side effects. •
Andrew Buelt, DO • Jake Anderson, DO
The SWITCH 1 trial compared rates of hypoglycemia in patients with Type 1 DM taking either insulin degludec and or insulin glargine U100. While degludec treatment was associated with fewer instances of hypoglycemia than glargine, as it was also the case in patients with DM 2, Joe and Andrew do not …
Andrew Buelt, DO • Joe Weatherly, DO
The SWITCH 2 trial compared rates of hypoglycemia in patients with Type 2 DM taking either insulin degludec and or insulin glargine U100. While degludec treatment was associated with fewer instances of hypoglycemia, Joe and Andrew do not feel it is clinically significant. •
Andrew Buelt, DO • Joe Weatherly, DO
In Part 1 of this two part segment, Jake and Andrew review the diagnosis and subtypes of irritable bowel syndrome, the possible causes of the condition, as well as first line therapies. •
Andrew Buelt, DO • Jake Anderson, DO
Hypokalemia is a potentially very serious electrolyte abnormality. It usually occurs in the context of co-morbid magnesium depletion, so be sure to replace Magnesium as well. Oral potassium supplements taste terrible, so Dr. Slovis recommends repleting potassium (and magnesium) stores by eating …
Brandon Grove, MD • Corey Slovis, MD • Heidi James, MD
How many leaflets are in the tricusp….kidding. That’s too easy. Instead, which of the following is not a potential physical finding in severe tricuspid insufficiency.
Jordan Roberts, PA-C
This study found that triamcinolone knee injections were inferior to saline injections as measured by the WOMAC scale every three months over a two year period. Triamcinolone was also associated with a statistically significant decrease in amount of knee cartilage.
Andrew Buelt, DO • Joe Weatherly, DO
Low and iso-osmolar IV contrast for CT scanning is not associated with an increased incidence of acute kidney injury. •
Andrew Buelt, DO • Joe Weatherly, DO
It can be tricky to distinguish bacterial from viral conjunctivitis. In this segment, Adrien and Vanessa review diagnostic tips and the evidence behind different treatments for conjunctivitis. Antibiotic treatment of bacterail conjunctivitis may speed up return to work, though does not …
Adrien Selim, MD • Vanessa Cardy, MD
Miz and Declerk speak to two experts regarding imposter syndrome and how it can affect your clinical practice and career path. •
Arlene Chung, MD • Matthieu DeClerck, MD • Mizuho Morrison, DO • Neda Frayha, MD
Motivational interviewing can be a powerful tool to help patients make changes to improve their health and wellbeing. The OARS acronym (Open-ended questions, Affirmation, Reflective listening, Summarizing) is a useful framework for these visits. Patients are more likely to achieve goals discussed …
Brandon Grove, MD • Heidi James, MD
Dr. Deloughery (The Delorean as I like to call him) is back, and this time he’s reviewing what we know about thrombosis risk in transgendered patients on hormone therapy. Transgendered medicine as a discipline has grown exponentially in the past decade, but the hematologic consequences are still …
Heidi James, MD • Tom Deloughery, MD
Latent TB is common in many parts of the world and amongst certain populations in North America. Diagnosis is made by tuberculin skin test or by interferon gamma release assay testing. Treatment gold-standard is nine month of isoniazid (INH). •
Devang Patel, MD • Neda Frayha, MD
Andrew and Heidi answer listener mail and discover that 1) if you’re not doing whispered pectoriloquy as part of your exam, that’s ok. 2) aspirating non-inflamed joints to diagnose gout is not supported in the literature 3) immunotherapy for warts works!! Go ahead and inject some yeast or mumps …
Andrew Buelt, DO • Heidi James, MD
ADHD is not just for kids! We review the diagnosis and treatment of ADHD in Adults. •
Elizabeth Haskins, MD • Heidi James, MD
There are no shortage of medications to choose from in the management of Type 2 diabetes! We review the pharmacologic classes with attention to their unique features and drawbacks. •
Heidi James, MD • Mizuho Morrison, DO • Neil Skolnik, MD
In this Paperchase Super Duper Deep Dive, Joe and Andrew do an exhaustive literature search and conclude that HPV testing ALONE is all we need to be doing for cervical cancer screening. •
Andrew Buelt, DO • Joe Weatherly, DO
No study is perfect. But when you are a landmark trial that changes the recommended treatment for a chronic condition (in this case, Chronic Fatigue Syndrome), you’d better hope you got the numbers and your conclusions right! Andrew and science write Julie Rehmeyer poke holes left, right and …
Andrew Buelt, DO • Julie Rehmeyer
Molluscum contagiosum is a common dermatologic condition. Treatment options include watchful waiting, occlusive dressings, curretage, cryotherapy and cantharidin. Imiquimod should be reserved for refractory cases. •
Adrien Selim, MD • Vanessa Cardy, MD
Miz and Matt discuss approach to patients for STD evaluation. They review most recent CDC guidelines on treatment of common STD’s.
Matthieu DeClerck, MD • Mizuho Morrison, DO
The small bowel is usually home to small amounts of bacteria. SIBO is characterized by a profusion of bacteria which can lead to bloating, diarrhea, abdominal pain and malabsorption, among other symptoms. It’s associated with various medical conditions and anatomical anomalies. While it’s diagnosis …
Heidi James, MD • Vanessa Cardy, MD
Depression in pregnancy should be taken very seriously due to possible maternal and fetal harms. Our expert discusses best treatments. •
Rob Orman, MD • Shawn Hersevoort, MD, MPH
ADHD is not just for kids! We review the diagnosis and treatment of ADHD in Adults. •
Elizabeth Haskins, MD • Heidi James, MD
Miz and Matt discuss approach to patients for STD evaluation. They review most recent CDC guidelines on treatment of common STD’s. •
Matthieu DeClerck, MD • Mizuho Morrison, DO
There has been so much inaccurate information about DRY DROWNING, that we felt the need to demystify the fears. Two Pediatric Emergency medicine experts, Dr.Sol Behar and Dr.Semple-Hess discuss the real facts about drowning. Take a listen.
Janet Semple-Hess, MD • Mizuho Morrison, DO • Solomon Behar, MD
Litigation-related stress is also known as medical malpractice stress syndrome (MMSS). • Identifying it and making it more acceptable amidst us as colleagues is important to minimize its havoc that it can cause in our personal and professional lives. •
Carlo Reyes, MD, JD • Mike Weinstock, MD • Mizuho Morrison, DO
This is crazy expensive drug will lower your LDL to crazy low levels. But does it actually make a difference in mortality? •
Andrew Buelt, DO • Joe Weatherly, DO
Does exposure to serotonergic antidepressants in utero lead to increased chancen of an autism spectrum diagnoses? Yes. But not in the statistically significant sort of way.
Andrew Buelt, DO • Joe Weatherly, DO
Learn practical tips on potty training for typical and atypical developing children.
Ann Dietrich, MD • Cody Hostutler, PhD • Melissa Winterhalter, MD • Solomon Behar, MD
Go for it! Get your back adjusted. It will help your pain...at least according to this study. •
Andrew Buelt, DO • Joe Weatherly, DO
In this 2-part segment, Heidi and Colonel Douglas Maurer review the diagnosis and management of asthma. We start with spirometry diagnosis, discuss updates in the recent guidelines and then move into medical management. We cover the proper use of LABAs, the emerging role of leukotriene receptor …
Colonel Doug Maurer, DO • Heidi James, MD
Finally! An evidence based screening guideline for retinopathy in type 1 diabetes that will save a ton of money AND catch advanced disease sooner.
Andrew Buelt, DO • Joe Weatherly, DO
Andrew and Jake tackle recent literature comparing efficacy of oral and topical NSAIDs. And, GOOD NEWS! Topical NSAIDs can be used to treat many conditions without the systemic side effects associated with oral NSAIDs.
Andrew Buelt, DO • Jake Anderson, DO
This article adds to the body of literature discussing the role of oral steroids in treating pharyngitis. The paperchase guys are split on wether or not this will change their practice. •
Andrew Buelt, DO • Joe Weatherly, DO
Who knew that a such a tiny bit of tissue could cause such contention? Practitioners are split on the question of “do babies with ankyloglossia require frenotomy?”. Casey brings us evidence and opinion from both camps. •
Casey Parker, MD
In this patient interview, we explore one patient’s narrative on aging. She models “successful aging”; adapting to increasing frailty and decreasing independence, finding purpose and maintaining a sunny disposition. We examine the impact of grief and loss as well as the importance of connectedness …
Brandon Grove, MD • Heidi James, MD
Neda and endocrinologist Kashif Munir tell us when to suspect and how to diagnose Addison’s disease. From presentation to complications, they bring us all the pearls. •
Neda Frayha, MD
In this 2-part segment, Heidi and Colonel Douglas Maurer review the diagnosis and management of asthma. We start with spirometry diagnosis, discuss updates in the recent guidelines and then move into medical management. We cover the proper use of LABAs, the emerging role of leukotriene receptor …
Colonel Doug Maurer, DO • Heidi James, MD
Ilene Claudius MD brings us practical advice on adolescent depression, suicide red flags and other relevant topics.
Ilene Claudius, MD
This study added to the body of evidence showing that pregabalin is not effective for the treatment of pain caused by acute or chronic sciatica. •
Andrew Buelt, DO • Joe Weatherly, DO
Evidence links living in poverty to disease like heart disease and many types of cancer. Primary Care physicians are uniquely positioned to help their patients living in poverty, both by addressing their individual situations and by advocating for and creating change at the broader community level …
Gary Bloch, MD • Vanessa Cardy, MD
Andrew and Jake give us an update on all that’s new in the land of HPV vaccination. Makers of the mono and quadri-valent will be shortly withdrawing them from the market, leaving the nine-valent vaccine as the only option. Increased valency means broader coverage for wart and cervical causing …
Andrew Buelt, DO • Jake Anderson, DO
Dermatology is a never ending source of wonderment. In this segment, Heidi and Andrew review the treatment of keratosis pilaris, intra-lesional injections for nail psoriasis, Baboon syndrome, and Bowen Disease. Keratosis Pilaris is best treated with aggressive moisturizing, creams containing …
Andrew Buelt, DO • Heidi James, MD
This studied showed an increase in soft coronary artery plaque volume after 1 year of testosterone supplementation. A surrogate end point, yes, but there is an association between soft plaque volume and coronary artery disease. •
Andrew Buelt, DO • Joe Weatherly, DO
Many conditions can be mistaken for lower extremity cellulitis including deep vein thromobosis, peripheral vascular disease, dermatitis. Misdiagnosis can lead to unecessary admission to hospital, medication treatment, and failure to treat real cause of presentation. This studies quantifies these …
Andrew Buelt, DO • Joe Weatherly, DO
Atrial fibrillation is a very common arrhythmia characterized by an irregularly irregular pulse. Evaluation and treatment can be done in the outpatient setting unless the patients is hemodynamically unstable. Anticoagulation to prevent stroke is top priority and this can be done with NOACs or …
Malcolm Thaler, MD • Rob Orman, MD • Vanessa Cardy, MD
Casey Parker synthesizes the recommendations from prostate cancer screening guidelines around the world and provides us with a patient centred approach. He recommends providing patients with paper handouts or web sites with clear and realistic data about screening. At a follow-up visit, the harms …
Casey Parker, MD
In this Things I Do But Should I segment, Vanessa and Adrien review the use of absorbable sutures in pediatric patients AND the use of tap water to irrigate wounds before suturing. Evidence strongly supports the use of absorbable sutures with no concern re decreased cosmesis. This is good news …
Adrien Selim, MD • Vanessa Cardy, MD
While is most commonly occurs in the prepartum period, preeclampsia can occur up to 6 wks postpartum. In this chapter, we review as case of pre-eclampsia that occurred 6 days post-partum. The etiology of pre-eclampsia is not well understood. Symptoms and signs include headache, vision changes …
Mizuho Morrison, DO • Sam Ashoo, MD
Dr. Smith reviews the latest studies and guidelines concerning ondansetron in the treatment of hyperemsis gravidarum. Given potential, though unlikely, concerns about congenital cardiac malformations and maternal QT prolongation, it should be considered as a second line option, but definitely an …
Clay Smith, MD • Mizuho Morrison, DO
Multiple Sclerosis is a common neurological condition with diverse presentations including focal neurological symptoms. Symptoms lasting 24-48 hours and occurring over 30 days apart could be indicative of MS. Evaluation includes MRI with gadolinium of the head and C-spine. On MRI, classic …
Bob Shin, MD • Neda Frayha, MD
This systmatic review finds that linicians overestimate the benefits of treatment, screening and tests while underestimating potential associated harmds.
Andrew Buelt, DO • Joe Weatherly, DO
A two-dose regime of non-valent HPV vaccine is at least as effective as the traditionally recommended 3 dose regime.
Andrew Buelt, DO • Joe Weatherly, DO
Andrew and Vanessa bring us what’s hot in medical news this month: the USPSTF revamps its prostate cancer guidelines, people are overdosing on anti-diarrheal medications (no, we’re not full of it), and the FDA warns against codeine and tramadol use in children.
Andrew Buelt, DO • Vanessa Cardy, MD
Bipolar disorders are broadly broken into three groups: bipolar 1, bipolar 2, and cyclothymia. Each is characterized by varying degrees of vascilation between the poles of mania and depression. Bipolar 1 is characterized by episodes of mania, Bipolar 2 by hypomania, cyclothymia by greater than …
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Non-celiac gluten sensitivity (NCGS) is a controversial emerging clinical entity. Individuals without celiac disease or wheat allergy can describe IBS-like gastrointestinal symptoms as well as other manifestations like brain fog when they consume gluten containing foods. While the …
Heidi James, MD • Robert Berger, MD • Vanessa Cardy, MD
Brandon brings us interesting research showing the bacteria that colonize our bowels may be big players in everything from our dietary preferences to autoimmune diseases and beyond. Increased levels of pro-inflammatory bacteria have been found in patients with chronic fatigue syndrome …
Brandon Grove, MD • Heidi James, MD
This study showed that getting patients to a pre-determined BNP level prior to discharge might affect re-admission rates. •
Andrew Buelt, DO • Joe Weatherly, DO
In this study, PPI use was associated with a higher risk of CHF and death, but not ischemia. Further research is needed to clarify this relationship.
Andrew Buelt, DO • Joe Weatherly, DO
This study showed that Health coaching has a role to play in helping patients effects long term change in their lives.
Andrew Buelt, DO • Joe Weatherly, DO
Gastric by-pass surgery was superior to medical management in lowering A1C below 6.0 •
Andrew Buelt, DO • Joe Weatherly, DO
Andrew and Jake review the body of evidence and conclude that there is a role for corticosteroids as an adjunctive treatment for patients hospitalized because of pneumonia. •
Andrew Buelt, DO • Jake Anderson, DO
Jordan Roberts provides an overview of concussion management in the non-athletes. The guiding principal is to gradually increase the amount of activities patients do, being very mindful to take a step back if symptoms worsen. Return to work and regular life activities will take time and it is wise …
Jordan Roberts, PA-C • Vanessa Cardy, MD
The vast majority of knee and hip replacements are still functional 20 yrs post implantation. Given this, perhaps joint replacement surgeries could be considered in younger patients than is typical. •
Andrew Buelt, DO • Joe Weatherly, DO
Burnout is very common amongst physicians. Dr. Shoenberger provides several ideas to help address this epidemic. These include 1) make a meaningful human connection with at least one patient per day and 2) focus on aspects of your work that you enjoy. •
Heidi James, MD • Mizuho Morrison, DO • Vanessa Cardy, MD
Vanessa and Adrien break Heid’s toenail surgery loving heart and discuss conservative treatments for ingrown toenail and review the evidence for each. Salt water soaks, manually pushing the skin away from the nail fold, high potency topical steroids, taping, inserting a pledget under the nail …
Adrien Selim, MD • Vanessa Cardy, MD
Review the indication for tympanostomy tubes as well as trouble-shooting potential complications. •
Ann Dietrich, MD • Heidi James, MD • Kris Jatana, MD
This month on the Hot Sheet, Joe and Andrew celebrate baseball season by pitching us their take on three fresh off the presses studies: subclinical hypothyroidism in older adults, what’s new in bronchopulmonary dysplasia, NOAC vs ASA in extended VTE treatment. It’s a triple play of EBM spoon-fed …
Andrew Buelt, DO • Joe Weatherly, DO
In this study, neither topiramate nor amitriptyline were superior to placebo at preventing pediatric migraine. •
Andrew Buelt, DO • Joe Weatherly, DO
Toxicity from essential oils is most dangerous when these substances are ingested. Infants and young children should not be slathered in essential oils because their skin integrity can allow for transdermal absorption. Aromatherapy is probably safe, but not proven to be efficacious. •
Sean Nordt, MD, PharmD, FAAEM • Solomon Behar, MD
The USPSTF does not recommend screening for obstructive sleep apnea in asymptomatic adults. •
Andrew Buelt, DO • Joe Weatherly, DO
Celiac disease is an autoimmune condition which affects roughly 1% of the population. Diagnosis is made through a combination of clinical suspicion, laboratory testing, and duodenal biopsy. Treatment is a gluten-free diet. Patients with celiac disease are at higher risk for other autoimmune …
Heidi James, MD • Robert Berger, MD
Lyme disease is the most common tick-borne illness in North America. Infections peak in the spring and summer months. Preventing tick-bites and checking oneself for ticks after time spent outdoors in endemic areas is key. Prophylaxis should be given (doxcycyline 200 mg x 1 dose) if patient had a …
Heidi James, MD • Mizuho Morrison, DO • Neda Frayha, MD
A three day course of azithromycin added to inhaled and/or parenteral steroids did not shorten the length of nor improve the symptoms of asthma exacerbations. •
Andrew Buelt, DO • Joe Weatherly, DO
Data from the Danish mammographic screening program suggests that advanced cancers (tumours over 20mm in size) are just as common in screened as in unscreened women. It also found that roughly a third of all tumors found by screening represented “overdiagnosis”, meaning radiographically present …
Andrew Buelt, DO • Joe Weatherly, DO
Synthetic cannabinoid, AMB-FUBINACA, use is associated with Zombie-like presentation, right down to the groaning and slow limb movement
Andrew Buelt, DO • Joe Weatherly, DO
Thirst is a common symptom in the end-of-life setting. Management includes facilitating access to liquids, re-evaluating medications and therapies that may be contributing, as well as hydrating mouth washes, saliva substitutes and lipbalms. Keeping preferred fluids at the bedside allows family and …
Vanessa Cardy, MD
Celiac disease is an autoimmune condition which affects roughly 1% of the population. Diagnosis is made through a combination of clinical suspicion, laboratory testing, and duodenal biopsy. Treatment is a gluten-free diet. Patients with celiac disease are at higher risk for other autoimmune …
Heidi James, MD • Robert Berger, MD
Plantar warts are a frequently seen in the primary care office. Drs. Buelt and Anderson review the literature around the more common place, and the obscure, treatment options. From doing to nothing, to duct tape, to topical immunomodulators, options are varied and broad. •
Andrew Buelt, DO • Jake Anderson, DO
Andrew, PC RAP’s resident myth buster, and Heidi tackle 3 murky areas in antibiotic use: • Antibiotic resistance in bacteria: bacteria from a cave untouched by humans was found to be resistant to all of our antibiotics, indicating that exposure to these drugs is not the only factor which can …
Andrew Buelt, DO • Heidi James, MD
Antipsychotics are frequently used to treat mental health conditions. They are associated with several common side effects that primary care physicians needs to be family with. These include, metabolic syndrome, hyperprolactinemia, akathisia, acute dystonia, neuroleptic malignant syndrome …
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Adrien and Vanessa review an approach to screening patients for cardiac contraindications to sports participation, with a focus on sudden cardiac death. They discuss points to look for on history, family history and physical exam. The evidence for and against routine EKGs is also discussed.
Adrien Selim, MD • Vanessa Cardy, MD
This month, Andrew and Joe suffer from some entertaining loosening of associations as they connect obscure March holidays to recent studies on flexible sigmoidoscopy, lung cancer screening, and metformin in chronic kidney disease. (Spoiler: Awkward Moment Day is an actual thing.) •
Andrew Buelt, DO • Heidi James, MD • Joe Weatherly, DO
A diagnosis of pre-diabetes was weakly associated with increased risk of cardiovascular disease and all cause mortality. There are some flaws in the study that call these results into question. •
Andrew Buelt, DO • Joe Weatherly, DO
Red flags to consider in examining the pediatric red eye include: pain, vision loss, severe photophobia, profuse discharge, a chronically (>2 wks) red eye, irregularly shaped pupil.
Gil Benenbaum, MD • Solomon Behar, MD
Evaluating a pediatric patient with a traumatic red eye is critical. Do not miss diagnoses such as an open globe, acute glaucoma, traumatic iritis and other findings are important. •
Gil Benenbaum, MD • Solomon Behar, MD
Pallpitations are a common symptom seen in the outpatient setting. While most are benign, it is important to rule out more serious and potentially deadly causes. A family history of sudden cardiac death and certain EKG findings should alert the provider to high risk patients.
Malcolm Thaler, MD • Rob Orman, MD
In this nursing home population, the use of cranberry supplements was not associated with a decrease in either bacteriuria or pyuria. •
Andrew Buelt, DO • Joe Weatherly, DO
Vertebral compression fractures are the most common osteoporotic fractures. They can be caused by low force activities, such as coughing, straining at stool, or as in this case, trying to open a frozen front door. Plain films are the diagnostic modality of choice, although CT and MRI may also be …
Adrien Selim, MD • Joe Weatherly, DO
There are over 70 known parasomnias. The most clinically important occur during non-REM and REM sleep. Non-REM parasomnias include confusional arousals, sleep walking and sleep terrors and occur more frequently in young adults. These events are not recalled REM stage sleep disorders are more …
Joe Weatherly, DO • Jordan Roberts, PA-C
Onychomycosis is most commonly a dermatophytic or yeast infection of the nails complex. Confirmation of diagnosis by nail culture is recommended prior to treatment. Topical treatments include ciclopirox and efinaconazole. Terbinafine is the preferred oral agent. •
Andrew Buelt, DO • Jake Anderson, DO
The colon has up to several hundred epiploic appendages; their role in the body is unknown at this time. Epiploic appendagitis is an uncommon cause of acute abdominal pain. These appendages have their own blood supply, and can tort on their stalk resulting in acute inflammation and pain …
Angus MacDonald, MD • Heidi James, MD
Checking for proteinuria and glycosuria is standard of care in many institutions as a means to screen for pre-eclampsia and gestational diabetes. A review of the evidence suggests that we have other, much better screening tests (check blood pressure for pre-eclampsia and oral glucose tolerance …
Adrien Selim, MD • Vanessa Cardy, MD
Quantity limits for blood glucose test strips was not associated with worsening short-term outcomes, suggesting that these policies can reduce costs associated with test strips without causing patient harm. •
Andrew Buelt, DO • Joe Weatherly, DO
Benzodiazepines are commonly used to treat anxiety. While a recent Cochrane review showed that maybe they are not as harmful as we’ve traditionally believed, many patients would be better served by not being on these medications. The article reviewed in this peice reviews a taper approach that …
Andrew Buelt, DO • Heidi James, MD
In this study population of patients with heart failure, caffeine consumption was not associated with cardiac arrhythmias. •
Andrew Buelt, DO • Joe Weatherly, DO
Dr. Heidi James and Dr. Brandon Grove bring you a teen with cancer who starts a kindness revolution and the Brits kill what little joy there is in toast.
Brandon Grove, MD • Heidi James, MD
This randomised trial sought to determine if routine point of care CRP testing in acutely ill pediatric patients would help clinicians rule out serious underlying etiology. Casey Parker dissects the article and concludes CRP is not helpful in this clinical setting. •
Casey Parker, MD
Marijuana use is an emerging area of research in mental health. It has been linked to increased risk of psychosis in vulnerable individuals, paranoia, amotivation syndrome, and IQ loss. Many patients use it to self-treat anxiety and depression symptoms. Currently, there is not enough evidence to …
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Hyperhidrosis is a common condition characterized by excessive sweating, most often occurring in the axilla. Treatment options include high concentration aluminum antiperspirants, botox injection, water iontophoresis, laser and surgery. •
Heidi James, MD • Joe Weatherly, DO
Whole brain radiotherapy (WBRT) and dexamethasone are widely used to treat brain metastases from non-small cell lung cancer. This study aimed to establish whether WBRT could be omitted without a significant effect on survival or quality of life. Authors concluded that WBRT provides little …
Andrew Buelt, DO • Joe Weatherly, DO
Hepatic encephalopathy is a frequent neuropsychiatric complication of end stage liver disease caused by accumulation of ammonia and other neuro-toxins. It begins with subtle symptoms including sleep disruption and progresses to confusion, disorientation and potentially coma. Three year mortality …
Andrew Buelt, DO • Heidi James, MD
Semaglutide was found to be non-inferior to placebo in the secondary prevention of fatal and nonfatal MI or stroke in composite primary endpoints.
Andrew Buelt, DO • Joe Weatherly, DO
Post-viral coughs are a common cause of visits to health care providers. While there is little evidence to direct treatment, many recommend short acting beta agonists and inhaled corticosteroids. The study reviewed in this chapter shows the superiority of nebulized ipatropium and salbutamol in …
Adrien Selim, MD • Vanessa Cardy, MD
Get to know a little bit about one of our favorite contributors from the North, Vanessa Cardy. •
Heidi James, MD • Vanessa Cardy, MD
Mike and Nate discuss a practical approach to the evaluation of a patient who presents with diarrhea. Pointing out key features that make certain patients high risk for infectious versus inflammatory causes, as well as management discussion.
Mike Weinstock, MD • Nathan Finnerty, MD
In the PRECISION trial, celecoxib was found to be noninferior to ibuprofen or naproxen in cardiovascular safety when used at typical doses. •
Andrew Buelt, DO • Joe Weatherly, DO
Generic versions of many sample closet medications are available at a far less expensive price. •
Andrew Buelt, DO • Joe Weatherly, DO
Aortic stenosis is a common,acquired valvular disease characterized by dyspnea, angina and fatigue. Evaluation includes history, physical exam, and echocardiogram. Surgery is indicate for severe disease and symptomatic patients. •
Jordan Roberts, PA-C
There are several benign rashes seen in the newborn period. The most common ones are erythema toxicum neonatorum, neonatal acne, milia, miliaria, seborrheic dermatitis, pustular melanosis, cutaneous marmorata, and harlequin syndrome.
Danelle Fisher, MD • Solomon Behar, MD
Long-term supplemental oxygen treatment did not result in longer survival than no use of supplemental oxygen among patients with stable COPD and moderate resting desaturation (Spo2, 89 to 93%) or moderate exercise-induced desaturation. •
Andrew Buelt, DO • Joe Weatherly, DO
Herpes simplex, Blueberry Muffin Baby caused by TORCH infections and varicella, ichthyosis, and epidermolysis bullosa are the “do not miss” rashes in newborns.
Danelle Fisher, MD • Solomon Behar, MD
What do Princess Leia, peanut butter, price-gouging and Ebola have in common? This Month’s Hot Sheet, of course! •
Andrew Buelt, DO • Heidi James, MD
Hemorrhoids are common. As Casey Parker reviews, the generally respond well to conservative management, but sometimes a visit to the local general surgeon is in order. •
Casey Parker, MD • Joe Weatherly, DO
Psychiatrist Shawn Hersevoort touches on some of the legal, medical, financial and emotional concerns that arise as someone loses the ability to care for themselves. •
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Rob and Malcolm Thaler discuss evaluation and management of patients with resistant and secondary hypertension. •
Malcolm Thaler, MD • Rob Orman, MD
An in depth look at the who, why, what, and when of adult vaccinations with focus on: MMR, Tdap, varicella, pneumococcus, hepatitis, and meningococcus.
Dan Smyth, MD • Heidi James, MD
At a median of 10 years, prostate-cancer–specific mortality was low, irrespective of the treatment assigned, with no significant difference among treatments. •
Andrew Buelt, DO • Joe Weatherly, DO
Mike Weinstock and Ann Dietrich discuss with a pediatric radiologist, Dr Brian Coley, the concept of ALARA and ways to minimize radiation exposure for children.
Ann Dietrich, MD • Brian Coley, MD • Mike Weinstock, MD
Who should care about osteoporosis? Everybody. It affects 1 in 3 women and 1 in 5 men. Dr. Heidi James and Dr. Sylvie Ouellette discuss the evaluation and treatment of patients at risk for, and who have, osteoporosis. •
Heidi James, MD • Sylvie Ouellette, MD
There was a statistical correlation between hormonal contraception and dx of depression with antidepressant use.
Andrew Buelt, DO • Joe Weatherly, DO
Prophylactic ICD implantation in patients with symptomatic systolic heart failure not caused by coronary artery disease was not associated with improved care.
Andrew Buelt, DO • Joe Weatherly, DO
Median prostate-related cancer death at 10 years was low, irrespective of treatment assignment, with no significant difference between any of them. •
Andrew Buelt, DO • Joe Weatherly, DO
When faced with a patient who is allergic to penicillin, it can create a management conundrum when selecting which antibiotic is safe to give. Bryan Hayes, Heidi James and Vanessa Cardy discuss the myths and facts about penicillin cross reactivity to cephalosporins.
Bryan Hayes, PharmD • Heidi James, MD • Vanessa Cardy, MD
Who should care about osteoporosis? Everybody. It affects 1 in 3 women and 1 in 5 men. Dr. Heidi James and Dr. Sylvie Ouellette discuss the evaluation and treatment of patients at risk for, and who have, osteoporosis.
Heidi James, MD • Sylvie Ouellette, MD
Despite many discussions about THC causing DM, this review finds that Marijuana use is associated with lower or the same odds of developing diabetes than non-use. •
Andrew Buelt, DO • Joe Weatherly, DO
Andrew and Heidi talk about medical marijuana legislation, new statin guidelines, and the diabetes drug that has everyone talking.
Andrew Buelt, DO • Heidi James, MD
For older adults at high risk for falls, treadmill training plus virtual reality led to a reduced fall rate compared with treadmill training alone. •
Andrew Buelt, DO • Joe Weatherly, DO
Malcolm Thaler reviews which patients may benefit from the information gleaned out of CRP testing and coronary artery calcium scoring. •
Malcolm Thaler, MD • Rob Orman, MD
Physicians tend to overestimate the minimum evidence of efficacy required of new drugs. Similarly, many misinterpret the term breakthrough. •
Andrew Buelt, DO • Joe Weatherly, DO
Higher Free T4 levels were associated with increasing risk of sudden cardiac death.
Andrew Buelt, DO • Joe Weatherly, DO
What’s the idea mattress stiffness to recommend to patients? Rob and Andrew uncover the facts. •
Andrew Buelt, DO • Rob Orman, MD
Part two of Shawn Hersevoort's Guide to Managing Dementia in Depression. In this segment we focus on: use of stimulants, medications directed at slowing dementia, and managing depression associated with Parkinson's Disease. •
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Rob and Dr. Shawn Hersevoort discuss a psychiatric approach to evaluating and managing depression in patients with dementia. •
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Cancer screening is supposed to save lives, but does it actually meet that goal?
Andrew Buelt, DO • Vinay Prasad, MD
Exposure to scrambled, poached or fried eggs at 4-6 months of age lowered the risk of egg allergy at 1 year of age.
Andrew Buelt, DO • Joe Weatherly, DO
Casey Parker sees more than his fair share of acute otitis media in the Australian hinterlands. Here are his tips and tricks for smooth as silk managment. •
Andrew Buelt, DO • Casey Parker, MD • Rob Orman, MD
When is hyponatremia not treated like the usual hyponatremia you see in Grandma from the nursing home? When it is in a patient running 50 miles and drinking a LOT of water, that is when! •
John Anderson, MD • Rob Orman, MD
Delayed prescriptions were associated with slightly greater but clinically similar symptom burden and duration. Compared to an immediate prosecution strategy, delayed prescriptions had substantially reduced antibiotic use. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss neurologic assessment and distinction between concerning focal findings for stroke/TIA vs atypical migraine. •
Colin Kaide, MD • Mike Weinstock, MD
This month, Andrew and Heidi scoured the web for all things fitness and diabetes related and found.
Andrew Buelt, DO • Heidi James, MD
In patients with stroke or TIA, ticagrelor was NOT found to be superior to aspirin in preventing subsequent stroke, MI, or death. •
Andrew Buelt, DO • Joe Weatherly, DO
What to do when a patient has statin intolerance? Stop the med forever? All's not lost. Malcolm Thaler provides an easy approach to addressing this common issue. •
Malcolm Thaler, MD • Rob Orman, MD
Antihypertensive treatment reduces the risk of mortality and cardiovascular morbidity in people with diabetes mellitus and a systolic blood pressure more than 140 mm Hg. If systolic blood pressure is less than 140 mm Hg, however, further treatment is associated with an increased risk of …
Andrew Buelt, DO • Joe Weatherly, DO
The USPSTF provides clarity for recommending low dose aspirin for primary prevention. Gender based decisions are out. Risk based decisions are in. •
Andrew Buelt, DO • Heidi James, MD
When it comes to colon cancer screening, colonoscopy isn't the only answer. The best test most patients is the one they are most likely to have completed. •
Dave Sharkis, MD
Lynn Kisch discusses effective strategies to get evidence based relevant answers to clinical questions. She reviews strategies to locate guidelines and Cochrane reviews. •
Lynn Kysh, MLIS • Michael Cosimini, MD
A review of the 2016 GOLD COPD guidelines with a focus on managing stable disease and acute exacerbations. •
Heidi James, MD • Rob Orman, MD
The receving of industry sponsored meals was associated with an increased rate of perceiving the ‘brand name’ medication being promoted. •
Andrew Buelt, DO • Joe Weatherly, DO
In this chapter of things I do but should I: A patient with low INR, to bridge or not to bridge with heparin; How often should patients with stable INR be monitored; what’s the proper warfarin starting dose; when starting warfarin, do we need to bridge with heparin until the INR is therapeutic? •
Adrien Selim, MD • Vanessa Cardy, MD
The majority of deaths in ancioagulied a fib patients was NOT stroke!
Andrew Buelt, DO • Joe Weatherly, DO
Heart failure may present with symptoms ranging from acute respiratory distress to simply a cough. •
Mike Weinstock, MD • Nathan Finnerty, MD
Patients present with hip pain and how you approach a patient should be methodical. Matt and Sarah discuss a step by step approach to hip pain, including how to evaluate intra-articular and extra-axial causes of hip pain and how to evaluate for referred pain as well. •
Mizuho Morrison, DO
This month we have a little bit of everything for the October 2016 Hotsheet; Vulvar CA, Atypical Antipsychotics, EKG's, Accountability and how Caffeine Improves Lung Function, who knew!
Heidi James, MD • Rob Orman, MD
Discuss evidence based dietary and medication restrictions prior to fecal occult blood testing, based on the article by Konrad, Gerald, and Alan Katz. "Are medication restrictions before FOBT necessary? Practical advice based on a systematic review of the literature." Canadian Family Physician 58.9 …
Adrien Selim, MD • Vanessa Cardy, MD
Discuss utility of mandibular devices on mitigating sleep apnea.
Andrew Buelt, DO • Rob Orman, MD
Discuss management of that patient who has suffered a spontaneous miscarriage with focus on confirming that the miscarriage has completed as well as how long patients should wait post miscarriage before attempting conception again.
Adrien Selim, MD • Vanessa Cardy, MD
Discuss diagnosis and management of ureteral stones.
Adrienne Carmack, MD • Mike Weinstock MD
To review the evidence on whether or not exercise has an effect on the likelihood of suffering symptoms of upper respiratory tract infection, it's duration, or severity of illness.
Heidi James, MD • Shumona De, MD, CCFP
Obstructive sleep apnea (OSA) is common. Too obvious? In the first of a two part series, The Shark gives a primer on OSA. •
Dave Sharkis, MD
Part two of our sleep apnea series. Sleep medicine specialist Tim Walter reviews diagnosis (both in the sleep lab and via home test), different treatment options and how to start CPAP. •
Dave Sharkis, MD • Tim Walter, MD
Discuss findings from the recent article by Stempel, David A., et al. "Serious Asthma Events with Fluticasone plus Salmeterol versus Fluticasone Alone." New England Journal of Medicine 374.19 (2016): 1822-1830. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss findings from the recent article by Gomez, Borja, et al. "Validation of the “Step-by-Step” Approach in the Management of Young Febrile Infants." Pediatrics (2016): e20154381. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss findings from the recent article by Self, Wesley H., et al. "Procalcitonin as an early marker of the need for invasive respiratory or vasopressor support in adults with community-acquired pneumonia." Chest (2016). •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss an open access scheduling model where patients can make (only) same day appointments. •
Dan Hines • Heidi James, MD
To review common medical indications for children to stay home from school or daycare. •
Julie Kardos, MD, FAAP • Naline Lai, MD, FAAP • Solomon Behar, MD
Discuss findings from the recent article by Prigerson, Holly G., et al. "Chemotherapy use, performance status, and quality of life at the end of life." JAMA oncology 1.6 (2015): 778-784. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss findings from the recent article by Fournier, Jay C., et al. "Antidepressant drug effects and depression severity: a patient-level meta-analysis." Jama 303.1 (2010): 47-53. •
Andrew Buelt, DO • Joe Weatherly, DO
The Big Story... EpiPens have skyrocketed in price. The manufacturer has come out with a generic option, which costs around $300 per two pack. That’s half the price of the brand name, but still several times more expensive than the product used to be.
Andrew Buelt, DO • Rob Orman, MD
Discuss strategies for managing opiate detoxification and acute withdrawal symptoms.
Ken Starr, MD • Rob Orman, MD
Review an approach to the neonate with a sacral dimple.
Adrien Selim, MD • Vanessa Cardy, MD
Sol and Nick discuss the health effects of divorce on children and approaches to these issues. •
Nick DeBlasio, MD • Solomon Behar, MD
From the Festival of Saturn in ancient Rome to the water supply in Flint, Michigan, lead toxicity has been a scourge of humanity for millennia. •
Rob Orman, MD • Sean Nordt, MD, PharmD, FAAEM • Stuart Swadron, MD, FAAEM
Mike and Miz consult Dr.Carmack to discuss presentation and evaluation of acute prostatitis. Age groups affected, underlying organisms to consider and management of this infectious/inflammatory process as well as other differential diagnosis to consider. •
Adrienne Carmack, MD • Mike Weinstock MD • Mizuho Morrison, DO
Hypertensive urgency is common, but the rate of major adverse cardiac events in asymptomatic patients is very low. In this study, visits to the emergency department were associated with more hospitalizations but not improved outcomes. •
Andrew Buelt, DO • Joe Weatherly, DO
A discussion on the health benefits of walking and running with specific recommendations for patients.
Andrew Buelt, DO • Robert Pepper, MD
Patients in sinus rhythm with heart failure (and reduced ejection fraction) treated with β blockers had reduced risk of death and hospital admission. •
Andrew Buelt, DO • Joe Weatherly, DO
Hollands, Gareth J., et al. "The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis." bmj 352 (2016): i1102.
Andrew Buelt, DO • Joe Weatherly, DO
A terminal diagnosis doesn’t mean the same thing to all patients (or doctors).
Heidi James, MD • Rob Orman, MD
In the news… • -Rosuvastatin goes generic • -Live attenuated nasal influenza may be ineffective • -Does cupping work?
Andrew Buelt, DO • Rob Orman, MD
Psychiatrist Shawn Hersevoort is back! This time, it’s all about somatic symptoms.
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Triple therapy (methotrexate plus sulfasalazine plus hydroxychloroquine) and most regimens combining biologic DMARDs with methotrexate were effective in controlling disease activity, and all were generally well tolerated in both methotrexate naive and methotrexate exposed patients. •
Andrew Buelt, DO • Joe Weatherly, DO
This study found no statistically significant change in heart failure in type 2 diabetes patients on DPP4 therapy. •
Andrew Buelt, DO • Joe Weatherly, DO
The visceral reaction to a patient with ‘functional pain’ can be that it is 100% psychological. While there is certainly a mental component, there may also be physical aspects. •
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Prescribing patterns vary widely among providers when it comes to managing biliary colic. Opiates are often the first line, but NSAIDS are a viable alternative. •
Adrien Selim, MD • Vanessa Cardy, MD
Perioperative statin therapy did not prevent postoperative atrial fibrillation or perioperative myocardial damage in patients undergoing elective cardiac surgery. Acute kidney injury was more common with rosuvastatin. •
Andrew Buelt, DO • Joe Weatherly, DO
Reflexive ordering of the pre-op “everything panel” might not be such a good idea.
Andrew Buelt, DO • Jonathan Settle, MD
Knowing how to educate new parents on starting a baby’s diet can be challenging. Miz sits down with Tanya Altmann to discuss the latest AAP recommendations for starting and advancing diets in children. Everything from peanuts, milk alternatives, egg whites and arsenic in rice cereal?! Oh yes, we …
Mizuho Morrison, DO • Tanya Altmann, MD
The final stop on our anemia deep dive. When the MCV gets over 100, it’s time to start looking for pathology.
Rob Orman, MD • Tom Deloughery, MD
What's your favorite restless legs pharmacotherapy? Iron, dopamine agonists? Rob and Andrew go head to head and see what works and what doesn't. •
Andrew Buelt, DO • Rob Orman, MD
Patients with Parkinson’s Disease psychosis treated with pimavanserin had decreased psychosis scores compared to those given placebo. •
Andrew Buelt, DO • Joe Weatherly, DO
What’s that 800 point gorilla doing in your living room? That’s your job. Managing the gorilla isn’t as hard as you think, but it takes a strategy and commitment. •
Dike Drummond, MD • Rob Orman, MD
This month we look at two amazing animals and how their naturally occurring chemical defenses have reshaped the medical world.
It’s not just cancer patients who suffer from nausea and vomiting. CHF, chronic kidney disease, and AIDS patients can also have it (to name a few). •
Vanessa Cardy, MD
Our first story is about the gila monster (pronounce HEE-LA). Its venom, which it doesn’t primarily use for defense, has become invaluable to some Type-2 diabetes patients.
Our second story is about the horseshoe crab, one of the oldest animals on the planet. A quart of its blue blood is worth a small fortune and plays a key role in medical sterilization.
Fluconazole use in pregnancy was associated with increased risk for cleft lip palate CLP and d-transposition of the great arteries. •
Andrew Buelt, DO • Joe Weatherly, DO
Rob gives you and up close and personal look at Shawn Hersevoort.
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Pennsylvania passes a ‘sugar tax’ • Chemotherapy studies often use surrogate endpoints • Olanzapine helps chemotherapy related nausea • The Rocket AF study gets rocked, sort of
Andrew Buelt, DO • Rob Orman, MD
Medication allergies occur in about 1% of patients. Dr. Ferdman discusses the clinical features of medication allergies. The best strategy to avoid this complication is to avoid giving antibiotics for viral infections. We delve into desensitization to medications, DRESS syndrome, and …
Ronald Ferdman,MD • Solomon Behar, MD
Our first amazing story of self-surgery involves Dr. Jerri Nielsen who, soon after arriving in Antarctica, discovers an urgent medical issue.
Endocrinologist Tanya Gallant gives the endocrinologist's perspective on diagnosing and treating hypothyroidism.
Heidi James, MD • Tania Gallant, MD
Quitting smoking abruptly is more likely to lead to lasting abstinence than gradual reduction. •
Andrew Buelt, DO • Joe Weatherly, DO
Review evidence in favor of utilizing low dose double agents rather than high dose single agent for management of hypertension. •
Adrien Selim, MD • Vanessa Cardy, MD
Can we predict which UTI patients will get better without antibiotics?
Andrew Buelt, DO • Joe Weatherly, DO
This study found a 22% higher risk of death for each 30 mg/dL (0.78 mmol/L) reduction in serum cholesterol.
Andrew Buelt, DO • Joe Weatherly, DO
Discuss current guidelines on lung cancer screening.
Andrew Buelt, DO • Jhanelle Gray, MD
Dementia is common, and it is devastating. Contrary to popular belief, it is NOT a normal part of aging. Approx 5.2 million Americans over the age of 65 have dementia and this number increases as the boomer generation ages. After the age of 65, the lifetime risk of developing dementia is around …
Heidi James, MD • Rob Orman, MD
They say doctors make the worst patients, but what happens when you are your own patient? Vanessa Cardy brings us two incredible stories of self-surgery.
In this study, use of antipsychotics was associated with a significantly increased mortality risk in patients with Parkinson Disease. •
Andrew Buelt, DO • Joe Weatherly, DO
Part 2 of our conversation with Spencer Blackman on his group’s approach to ASCVD risk management including: specific cases, the role of niacin, and shared decision making. •
Rob Orman, MD • Spencer Blackman, MD
Endocrinologist Tanya Gallant gives the endocrinologist's perspective on diagnosing and treating hypothyroidism.
Heidi James, MD • Tania Gallant, MD
Dr. Leonid Rogozov finds himself in a similar predicament to Dr. Nielsen. Stranded in Antarctica with an urgent medical condition, there’s only one doctor who can help him—himself.
Several medications may be effective for short-term management of painful diabetic neuropathy, although their comparative effectiveness is unclear. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss an evidence based approch to atheroscelotic cardiovascular disase risk managment. •
Rob Orman, MD • Spencer Blackman, MD
Roy Benaroch reviews a preliminary study concerning the potential carcinogenicity of cell phones and brain cancer.
Roy Benaroch, MD
We review the natural history and therapeutic options for a variety of fungal skin infections. •
Danelle Fisher, MD • Solomon Behar, MD
Heidi James sits down with infectious disease specialist Dan Smythe to break down C Diff infection: Are some antibiotics worse than others when it comes to causing C Diff? What’s the ideal first line treatment? How often do patients relapse?
Dan Smyth, MD • Heidi James, MD
Discuss utility of topical antibiotic ointment on small wounds; review recent updates to acne guidelines.
Andrew Buelt, DO • Rob Orman, MD
Sometimes an email isn't a problem of making blood, it;s a problem of breaking blood. •
Rob Orman, MD • Tom Deloughery, MD
This month we bring you two stories of dangerous medical devices that were once commonplace in early-to-mid 20th century as well as the FDA’s journey to establish the modern classification system that’s in place today.
Our next story follows two doctors with an ambitious dream and a plan to classify and cure almost every disease. The problem? There wasn’t much science involved. Thanks in part to their dubious and questionable medical efforts, we have the modern FDA device classification system in place today.
Statin treatment for five years was associated with a legacy benefit with improved survival and a substantial reduction in cardiovascular disease outcomes over a 20-year period. •
Andrew Buelt, DO • Joe Weatherly, DO
Vanessa Cardy brings us the story of our first dangerous medical device, a machine so common that it likely affected millions of people in the 20th century, many of them children.
Discuss findings from the recent study by Gomm, Willy, et al. "Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis." JAMA neurology (2016).
Andrew Buelt, DO • Joe Weatherly, DO
We learn a lot about how to care for medical conditions, but not always the person who has them. •
Frank J. Weinstock, MD, FACS • John Shufeldt, MD, JD, MBA, FACEP • Mike Weinstock, MD
Resection of a torn meniscus has no added benefit over sham surgery to relieve knee catching or occasional locking •
Andrew Buelt, DO • Joe Weatherly, DO
The refusal of vaccines for various reasons including concerns regarding vaccine safety and religious objections. Options are discussed for encouraging vaccination and the ethical issues involved with dismissal of patients from a practice who refuse vaccinations. •
Louay Keilkani MD • Solomon Behar, MD
Many believe that aspirin has no role in atrial fibrillation thromboprophylaxis. •
Andrew Buelt, DO • Joe Weatherly, DO
Guidelines give conflicting recommendations on whether or not to use PSA for prostate cancer screening. David Sharkis gives his approach, recommendations, and scripting for shared decision making. •
Dave Sharkis, MD
In patients with low serum vitamin D levels and knee pain, vitamin D supplementation did not result in significant differences in change in tibial cartilage volume or knee pain. •
Andrew Buelt, DO • Joe Weatherly, DO
When is the right time to switch patients from IV to PO antibiotics?
Adrien Selim, MD • Vanessa Cardy, MD
A recent NEJM article found that liraglutide worked well for weight loss, but with a significant side effect profile. Also, when averaging out net pounds dropped per dollar spent, it cost over $500 to lose a pound. Is it worth it? Maybe, maybe not. Andrew Buelt gives the lowdown.
Andrew Buelt, DO • Rob Orman, MD
This month we dive into the history of placebos and explore their evolution from sham treatments to the modern medical control we have today.
Think twice before prescribing oral fluconazole in pregnancy.
Andrew Buelt, DO • Joe Weatherly, DO
Picking up atypical presentations of ACS is challenging. Mike and Amal discuss a case that the UC receptionist identified and notified the RN.
Amal Mattu, MD • Genny Messick, MD • Mike Weinstock MD • Mizuho Morrison, DO • Susan Williams
Does a history of lawsuit make future malpractice claims more likely?
Andrew Buelt, DO • Joe Weatherly, DO
Using evidence based algorithms – do they protect you? What are they? Who wants cookbook medicine? Do they help or harm you in med mal cases? Dealing with the non-believers (patients and providers).
John Shufeldt, MD, JD, MBA, FACEP • Mike Weinstock, MD
What happens when we pit placebos vs. placebos? Do they really show clinical effects on patients? A few researchers battle through the controversy.
More evidence suggesting that medical expulsive therapy might not work.
Andrew Buelt, DO • Joe Weatherly, DO
Sol Behar and Dr. Fisher discuss the most common skin conditions in children and basic approaches to management.
Danelle Fisher, MD • Solomon Behar, MD
In the 19th century placebos were defined as “any medicine adapted more to please than to benefit the patient.” And sham medicine makers weren’t the only ones prescribing snake oil at the time—doctors often administered placebos as well.
Sometimes the only treatment needed for a sexual issue is talking about it. • Issue is to talk about it.
Danielle Duplassie MA, PhD • Heidi James, MD
Dupuytren's’ contracture can cause significant disability, but 10% will resolve spontaneously. •
Heidi James, MD • Rob Orman, MD
As research in the 20th century became more advanced, the sham treatments of the 19th century began to fade. Placebos made their way into randomized control trials and changed the way we study treatments. At the same time, scientists began to question the effects of the placebos themselves.
The first part in a series on a dermatologist's approach to pretty much every type of anemia. •
Rob Orman, MD • Tom Deloughery, MD
Encouraging patients to stop smoking is one of the most life saving things you can help your patients do. •
Mike Weinstock, MD • Rob Crane, MD
Pregabalin is a commonly used medication in back pain. Should it be?
Adrien Selim, MD • Vanessa Cardy, MD
Just published in the February 2016 edition of Chest, "Antithrombotic Therapy for VTE Disease" sheds some light on a few of the confusing aspects of VTE management. In this short, we discuss outpatient management of pulmonary embolism; what to do when a patient is therapeutic on an oral …
Andrew Buelt, DO • Rob Orman, MD
Evidence suggests that screening asymptomatic, low risk women for ovarian cancer does not reduce the risk of cancer specific mortality. •
Casey Parker, MD • David Cohn, MD
Steroids for cellulitis? It sounds counterintuitive, but there is some evidence that they might be helpful in certain patients. •
Andrew Buelt, DO • Rob Orman, MD
Understanding the dark side of social media is important to understand what risks our adolescent patients are exposed to. Cyber-bullying, sexting, and being vulnerable to sexual predators online are all very real and potentially silent risks. As caregivers to teens and their families it is vital we …
Diane Tanaka, MD • Mizuho Morrison, DO • Solomon Behar, MD
Discuss the recent article by Zhao, Di, Ze-Mu Wang, and Lian-Sheng Wang. "Prevention of atrial fibrillation with renin-angiotensin system inhibitors on essential hypertensive patients: a meta-analysis of randomized controlled trials." Journal of biomedical research 29.6 (2015): 475. •
Andrew Buelt, DO • Joe Weatherly, DO
Treating family members without proper evaluation in a clinical setting (ie: without vital signs, examination, or other variable tests) is frankly an injustice to our loved ones. Mike discusses with many practitioners the dangers of doing this, and how at the end of the day it's frankly hard to be …
Dave Sharkis, MD • Kurt Marks, PA-C • Mel Herbert, MD • Mike Weinstock, MD
Paracetamol (acetaminophen) had no effect on viral shedding, temperature or clinical symptoms in patients with PCR-confirmed influenza.
Andrew Buelt, DO • Joe Weatherly, DO
References • Ahovuo‐Saloranta, Anneli, et al. "Antibiotics for acute maxillary sinusitis in adults." The Cochrane Library (2016). • Rosenfeld, Richard M., et al. "Clinical Practice Guideline (Update) Adult Sinusitis Executive Summary." Otolaryngology--Head and Neck Surgery152.4 (2015): 598-609.
Andrew Buelt, DO • Rob Orman, MD
Discuss the recent article by Harrington, Rebecca A., et al. "Prenatal SSRI use and offspring with autism spectrum disorder or developmental delay." Pediatrics 133.5 (2014): e1241-e1248. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss the recent article by Wong, S. S. C., and M. G. Irwin. "Peri‐operative cardiac protection for non-cardiac surgery." Anaesthesia 71.S1 (2016): 29-39. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss diagnosis and management of inguinal and “sports” hernias.
Heidi James, MD • Paul Goobie, MD
A toddler who had hand, foot, mouth disease a month ago presents to the ED with shedding of his finger and toenails. What’s going on here? It’s another case of onychomadesis. •
Brittney DeClerck, MD • Paul Jhun, MD • Ryan Raam, MD
Evidence suggests that screening asymptomatic, low risk women for ovarian cancer does not reduce the risk of cancer specific mortality. •
Casey Parker, MD • David Cohn, MD
Part 2 of our talk on the diagnosis and management of inguinal and “sports” hernias with Heidi James and Paul Goobie. •
Heidi James, MD • Paul Goobie, MD
Is there any downside to giving acetaminophen after vaccination? This question was addressed in Lancet 2009. The authors’ interpretation of results: Although febrile reactions significantly decreased, prophylactic administration of antipyretic drugs at the time of vaccination should not be …
Andrew Buelt, DO • Rob Orman, MD
Review different modalities of testosterone delivery, testosterone monitoring, goal testosterone levels.
Andrew Buelt, DO • Margaret Wierman, MD
‘Low T’ by itself is not an indication for testosterone supplementation.
Andrew Buelt, DO • Margaret Wierman, MD
Bryan Hayes weighs in on why he never invites tramadol to dinner parties.
Bryan Hayes, PharmD • Rob Orman, MD
What has changed in the treatment of Bell’s palsy in the last decade - we go down memory lane to find out! •
Mel Herbert, MD • Stuart Swadron, MD, FAAEM • William Mallon, MD
Sometimes MRSA just won’t go away. KEvin and Mike review the evidence on decolonization. •
Kevin Wineinger, MD • Mike Mooney, MD
Oxford researchers turned their lab into a Penicillin factory, but still couldn’t produce the massive amounts of antibiotics needed to treat infection. Their last hope? A dumpster-diving bacteriologist from Peoria, IL.
Allopurinol was initiated at low doses during an acute gout attack did not prolong the acute, treated attack.
Andrew Buelt, DO • Joe Weatherly, DO
There is is limited quality data on which therapy is best for varicose veins. Symptomatic relief with compression, elevation and weight loss carries little risk. •
Heidi James, MD • Rob Orman, MD
Joe’s review article of the year! What’s his take home? “ A set of research criteria is warranted to address the use of long term medications.” •
Andrew Buelt, DO • Joe Weatherly, DO
During WWI infection was killing more people than bullets, but the antiseptics of the time were doing little to help. Cue Scottish researcher Alexander Fleming who accidentally changed medicine forever.
Co-management of CKD3+ was associated with increased stage-appropriate monitoring and ACE/ARB prescribing, but not improved blood pressure control. •
Andrew Buelt, DO • Joe Weatherly, DO
Any medication we prescribe or recommended is essentially a selective poison, and NSAIDS are no exception. Current data suggests that most NSAIDS increase vascular risk (especially coronary events) with a number needed to harm of 3 in 1000. •
Bryan Hayes, PharmD • Rob Orman, MD
Obese patients with low testosterone may get significant benefit from weight loss.
Joe Weatherly, DO • Margaret Wierman, MD
A long last, a therapy that really helps expel ureteral stones. At least we hope so.
Andrew Buelt, DO • Joe Weatherly, DO
Should we avoid prescribing NSAIDS to our patients taking antidepressants?
Bryan Hayes, PharmD • Rob Orman, MD
Happy accidents often lead to amazing discoveries. This month we bring you the story of one of the happiest accidents of all time: Penicillin.
A patient you're caring for, but don’t know very well, dies in the hospital. You feel awkward about writing a condolence letter since there isn’t much of a relationship with the family. Should you write one? Will it bring up unpleasant memories for the family? Eric Lamotte and Susan Merel explore …
Among patients with a first episode of unprovoked pulmonary embolism who received 6 months of anticoagulant treatment, an additional 18 months of treatment with warfarin reduced the composite outcome of recurrent venous thrombosis and major bleeding compared with placebo. •
Andrew Buelt, DO • Joe Weatherly, DO
B12 deficiency is common yet often misunderstood. Hematologist Tom Deloughery gives his opinion on testing, etiology, and management. •
Rob Orman, MD • Tom Deloughery, MD
Are COX-2 inhibitors a good NSAID choice for elderly patients with pain issues? Sometimes yes and sometimes no. In a new recurring segment, Vanessa Cardy and Adrian Selim explore GI, renal, and cardiovascular risks of selective and nonselective NSAIDs. •
Adrien Selim, MD • Vanessa Cardy, MD
In patients treated with clopidogrel after successful drug-eluting stents implantation, the concomitant administration of PPI was associated with high platelet reactivity and a greater rate of adverse outcomes during long-term follow-up. •
Andrew Buelt, DO • Joe Weatherly, DO
No area of medicine may be more rife with myths than allergy. Kevin Wineinger sits down with allergist David Stuckus to clear the air on IgE and IgG testing, peanut allergies, and the connection between food and atopic dermatitis. •
Kevin Wineinger, MD
Have you ever gone a week in clinic without seeing a patient with dyspepsia? Some have true structural disease like peptic ulcers or even cancer. Most, however, will end up with no discernible cause of their symptoms and end up with the diagnosis of ‘functional dyspepsia’. In this segment, we …
Andrew Buelt, DO • Rob Orman, MD
Non-fasting LDL-C has similar prognostic value as that of fasting LDL-C.
Andrew Buelt, DO • Joe Weatherly, DO
In patients with knee osteoarthritis, unilateral total knee replacement followed by nonsurgical treatment resulted in greater pain relief and functional improvement after 12 months than did nonsurgical treatment alone. •
Andrew Buelt, DO • Joe Weatherly, DO
To know the differential diagnosis of petechiae in infants and children.
Solomon Behar, MD • Stuart Swadron, MD, FAAEM
When evaluating patients with subjective complaints, it is important to rule out organic causes. There are many critical diagnosis that are non-neurological as well as neurological that should be considered including transient ischemic attack, stroke, hypoglycemia, intracranial hemorrhage and other …
Mike Weinstock, MD • Mizuho Morrison, DO
Part two of our conversation with allergist David Stuckus. In this session we review proper management of home-use injectable epinephrine, management of chronic urticaria, how an allergist treats poison ivy, and the origin story of shellfish allergy equalizing allergy to IV contrast •
Kevin Wineinger, MD
Put on your stupid caps while Mel and Rob take you on a personal journey of all things dumb.
Multitarget Stool DNA testing detected significantly more cancers than did FIT testing •
Andrew Buelt, DO • Joe Weatherly, DO
Protein electrophoresis is one of the most commonly ordered lab tests, but what do the results mean? Hematologist Tom Deloughery reviews indications for testing and interpretation of (the sometimes confusing) results. •
Rob Orman, MD • Tom Deloughery, MD
Of the many real life zombies in the world, this ranks as one of the most disgusting. Cheers!
Patients with type 2 diabetes at high risk for cardiovascular events who received empagliflozin, as compared with placebo, had a lower rate of the primary composite cardiovascular outcome and of death from any cause when the study drug was added to standard care. •
Andrew Buelt, DO • Joe Weatherly, DO
We delve into the bizarre dancing plague of 1518 where citizens of Strasbourg created an unforgettable living dead flash mob that predated Michael Jackson’s “Thriller” by 500 years.
Palliative care can be interpreted as minimal or no care, but it is anything but.
Vanessa Cardy, MD
Is surgery the only option for patients with high grade esophageal dysplasia?
Andrew Buelt, DO • Joe Weatherly, DO
Unprovoked venous thromboembolism raises concern for occult neoplasm. How hard should we look for cancer?
Andrew Buelt, DO • Casey Parker, MD
When a patient says, “There’s something not right with my vagina,” what’s the first thing that comes to mind? Vaginitis is probably at or toward the top of the list. Heidi James sits down with women’s health specialist Amy Brennan for an immersive discussion on infectious and overgrowth …
Amy Brennan, MD • Heidi James, MD
A new (and accurate!) test for diagnosing cognitive impairment in patients with small vessel disease. •
Andrew Buelt, DO • Joe Weatherly, DO
When compared to medical management ,immediate prophylactic carotid endarterectomy seemed to offer a minimum net benefit in terms of fatal or disabling stroke-free survival over a 5-year period. The benefit, however, was small. Really small. Super small. And why were they screening asymptomatic …
Andrew Buelt, DO • Joe Weatherly, DO
Does your mission statement account for provider happiness?
Dike Drummond, MD • Rob Orman, MD
You and your cat may have a very special relationship you didn’t even know about. Sure, it involves a potentially brain-damaging protozoa, but at least now you have something to talk about.
Grab your champagne glasses and help us celebrate the New Year with an unlikely topic: Zombies!
Short stature is a common complaint for the general pediatrician. Dr Ben-Isaac defines and reviews the 4 main causes and features of short stature (genetic, familial, constitutional, and pathological), and discusses the indications for growth hormone therapy. •
Eyal Ben-Isaac, MD • Solomon Behar, MD
In this study, vulvovaginal swabs were significantly better than endocervical swabs at detecting chlamydia in women with and without symptoms suggestive of sexually transmitted infections. •
Andrew Buelt, DO • Joe Weatherly, DO
What sort of counseling do you give patients who have recently had a stroke? Secondary prevention strategies? Help with ADLs? Rehab? Those are all important, but something that often gets missed is the profound fatigue that commonly accompanies the post stroke period. Vanessa Cardy gives the …
Vanessa Cardy, MD
Mel and Rob serve up their visions of the future of medicine. Their discussion touches on automation, data networks, robots, and of course, Star Trek. • It's mostly Star Trek.
Grab your AudiCores and plug in to the Hippo Neural Network. It's time to visit the year 2065.
Discuss workup and management of proteinuria.
Kate Wesseling-Perry, MD • Solomon Behar, MD
Discuss utility of the complete blood count as a screening test in asymptomatic patients. •
Erica Mehl, MD • Heidi James, MD
Discuss findings from the article by Douketis, James D., et al. "Perioperative bridging anticoagulation in patients with atrial fibrillation." New England Journal of Medicine 373.9 (2015): 823-833. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss evidence, guidelines and current opinion on administering seasonal influenza vaccination to those with egg allergy.
Andrew Buelt, DO • Rob Orman, MD
Discuss utility of rheumatoid factor testing ANA. Review a target management approach to gout. •
Kevin Wineinger, MD • Paul Sufka, MD
Discuss when hematuria is concerning and when workup is warranted.
Kate Wesseling-Perry, MD • Solomon Behar, MD
Discuss findings from the article by Narod, Steven A., et al. "Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ." JAMA oncology (2015). •
Andrew Buelt, DO • Joe Weatherly, DO
Imagine, if you can, that you're traveling all the way to the year 1999! What a vision. The possibilities of the future seem endless. But how did we get here? And where are we going? We take a look at how past predictions stack up to our modern world.
Identify hypertensive emergencies from non-emergencies, and what workup (if any) is indicated in the UC.
Stuart Swadron, MD, FAAEM
Discuss clues in the history and physical that can aid in the diagnosis of ankylosing spondylitis, rheumatoid arthritis and Sjogren’s syndrome. •
Kevin Wineinger, MD • Paul Sufka, MD
Discuss findings from the article by van Tunen, J. A., et al. "Optimization of analgesics allows patients with knee osteoarthritis and severe pain to participate in exercise therapy." Osteoarthritis and Cartilage 23 (2015): A370-A371. •
Andrew Buelt, DO • Joe Weatherly, DO
The future is now! Rob Orman and Haney Mallemat talk about medical drones, just one of the amazing medical innovations happening all around us right now.
Discuss findings from the article by Auquer, F., et al. "Single‐dose ciprofloxacin versus 3 days of norfloxacin in uncomplicated urinary tract infections in women." Clinical microbiology and infection 8.1 (2002): 50-54. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss findings from the article by Tinetti, Mary E., et al. "Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults." JAMA internal medicine 174.4 (2014): 588-595. •
Andrew Buelt, DO • Joe Weatherly, DO
Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mmHg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause. The downside, there was a …
Andrew Buelt, DO • Joe Weatherly, DO
Does getting more sleep really decrease the chance of getting a cold? Yes!
Andrew Buelt, DO
We often err on the side of treating patients suffering minor infectious illness (hello otitis media!) with amoxicillin. Would we be better off not treating at all? Amox causes candidiasis in 1 out of 27 patients, diarrhea in at least 1 out of 10. Are we just writing a prescription for …
Andrew Buelt, DO • Joe Weatherly, DO
Managing neonatal hyperbilirubinemia is seems so simple, but can also be incredibly complex. Guidelines and algorithms can help decide which infant needs what kind of treatment, but there are myriad possibilities of underlying pathology that can lead to the final destination of jaundice.
Benjamin Mati, MD • Todd Flosi, MD
Summary: Pulmonary hypertension can insidiously sneak up on us and our patients. Consider the diagnosis in the dyspneic patient, especially those who are high risk.
Heidi James, MD • Rob Orman, MD
Discuss findings from the recent article Basaria, Shehzad, et al. "Effects of Testosterone Administration for 3 Years on Subclinical Atherosclerosis Progression in Older Men With Low or Low-Normal Testosterone Levels: A Randomized Clinical Trial." JAMA 314.6 (2015): 570-581. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss findings from the recent article Fildes, Alison, et al. "Probability of an obese person attaining normal body weight: Cohort study using electronic health records." American journal of public health 105.9 (2015): e54-e59. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss findings from the recent article Pecina, Jennifer, Gregory M. Garrison, and Matthew E. Bernard. "Levothyroxine dosage is associated with stability of thyroid-stimulating hormone values." The American journal of medicine 127.3 (2014): 240-245. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss methods for managing sleep cycles in night shift work, combating jet lag, insomnia in pregnancy, and indications for sleep studies. •
Rob Orman, MD • Shawn Hersevoort, MD, MPH
When D-dimer was first introduced as a screening test to rule out pulmonary embolism, there was one cutoff for everybody, no matter their risk or age. The more we learn about this test, the more we see that it might not be a ‘one size fits all’ •
Andrew Buelt, DO • Joe Weatherly, DO
Quentin Tarantino fills his classic movie with vintage hair styles, vintage clothes, vintage dialogue, and even vintage medical procedures. In this famous medical scene, Dr. John Travolta, M.D. administers a very dangerous, and very questionable, dose of cardiac epinephrine to an overdosing Uma …
You're watching a movie when suddenly a character starts to say and do medical things. Uh-oh. This month we break down some famous movie moments of amateur doctoring in search of the medical pearls within.
Discuss a patient's perspective on being diagnosed with cardiac sarcoidosis and undergoing cardiac transplant.
Taunia Curtis • Vanessa Cardy, MD
In the post-apocalyptic future of Mad Max, characters are forced to fend for themselves when it comes to food, fashion, aqua-cola (aka water), and medical care. There's a Gas Town and a Bullet Farm, but unfortunately no Doctorville. In this environment, how does one properly treat a pneumothorax …
Rambo solves most of his problems with a giant gun, so when he takes up amateur cautery to seal a wound, it's no surprise that he turns to his trusty weapon for help.
Introduce a new virus transmitted to humans via mosquito vector known as Chikungunya and the clinical relevance to this disease.
Stuart Swadron, MD, FAAEM • William Mallon, MD
Some aspects of hyperbilirubinemia management are cookbook and just a matter of plugging numbers into a computer. Clinical judgment, often downplayed in the era of decision tools, still has a role in helping these patients. •
Benjamin Mati, MD • Todd Flosi, MD
Treating obesity hinges on diet and exercise. Unfortunately, those don’t always have the desired results and we’re left with a decision to treat (or not to treat) with medications targeted at weight loss. Is this the right thing to do? •
Kevin Wineinger, MD • Mike Mooney, MD
Phlebotomy might be an old school therapy, but it’s still the best for hemochromatosis. •
Rob Orman, MD • Tom Deloughery, MD
Your patient gets a pneumococcal vaccination, when can they get the next one? 1 year, 6 months? Which vaccine did they get first? It can get confusing. The CDC has just released new guidelines in attempt to simplify the process. • For low risk elderly patients (aged ≥65), no matter which vaccine …
Andrew Buelt, DO
Discuss diagnosis and management of scabies. •
Brittney DeClerck, MD • Stuart Swadron, MD, FAAEM
Discuss differential diagnosis for dizziness and vertigo, HINTS exam, characteristics and treatment of vestibular neuritis. •
Vanessa Cardy, MD
Discuss management and treatment of Monosymptomatic Enuresis both primary and secondary types.
Elizabeth Jackson, MD • Mizuho Morrison, DO • Nick DeBlasio, MD
Are you practicing defensive medicine? Do you feel pressured to dole out antibiotics hoping it will increase patient satisfaction? We are often faced with the antibiotic conundrum. How will you practice, and will you succumb to the pressures of your patient’s expectations? •
Genny Messick, MD • Kirk Hummer, DNP, MBA, CNP • Mike Weinstock, MD
Objectives:Discuss findings from the recent article Delitto, Anthony, et al. "Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis: A Randomized Trial." Annals of internal medicine 162.7 (2015): 465-473.
Andrew Buelt, DO • Joe Weatherly, DO
Discuss findings from the recent article Molero, Yasmina, et al. "Varenicline and risk of psychiatric conditions, suicidal behaviour, criminal offending, and transport accidents and offences: population based cohort study." bmj 350 (2015): h2388. •
Andrew Buelt, DO • Joe Weatherly, DO
PCOS can be found in up to 10% of the young female population. The physical and menstrual irregularities are well known, but depression is an under-recognized issue that can hamper long term health. •
Heidi James, MD • Tania Gallant, MD
Hindsight is 20/20 so OBVIOUSLY you shouldn’t remove the hippocampus and amygdala to stop epileptic seizures! Why? Because that’s where you turn short turn memories into long term memories. Of course we wouldn’t know that if someone hadn’t done that to Henry Molaison back in 1957. Here’s how a …
It’s starting to seem like PPIs do more harm than good. This seemingly innocuous medication should have regular review to see if it can be taken out the a patient’s medication program (unless they absolutely need it)
Andrew Buelt, DO • Joe Weatherly, DO
Discuss findings from the recent article Park, Tae Woo, et al. "Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study." bmj 350 (2015): h2698. •
Andrew Buelt, DO • Joe Weatherly, DO
We can all agree that war is a bad idea. But widespread killing and maiming also led to some great medical ideas that we use today during peace times. Thanks, war.
Discuss the patient experience of schizophrenia, depot haloperidol therapy. •
Heidi James, MD • Rob Orman, MD
Is it a good idea to listen to podcasts while doing surgery? No! Because there’s no such thing as multitasking, silly! Still, you might learn some clinical pearls that could come in handy. This month’s theme is all about making lemonade…aka good ideas that came out of bad ideas.
This new medication has some impressive lipid lowering numbers, but does it make a difference in patient outcome? •
Andrew Buelt, DO • Joe Weatherly, DO
Mizuho Spangler and Liza Kearl talk about the tricks to make your Halloween a safe and happy one!
Mizuho Morrison, DO • Yvette Liza Kearl, MD
The 2015 CDC sexually transmitted disease updates have arrived and our in house toxico-pharmacologist Bryan Hayes is here to break down what’s new...
Bryan Hayes, PharmD • Rob Orman, MD
Depressed? Tired of the usual grind? Classical music feels your pain but also lifts you up - like a symphonic explosion of ice cream sundaes right in your brain..
Tired? Overworked? Unmotivated? Well, so was Beethoven...at some point...probably. Even if you’re not a musical genius, this month we have a classical music cure for each of your medical anxieties.
Discuss the recent article Siddiqui, Mohummad Minhaj, et al. "Vasectomy and risk of aggressive prostate cancer: a 24-year follow-up study." Journal of Clinical Oncology 32.27 (2014): 3033-3038. •
Andrew Buelt, DO • Joe Weatherly, DO
There is no “best way” to manage autism. Parental training, though, may be a good start. •
Andrew Buelt, DO • Joe Weatherly, DO
When it comes to exercise, a little bit goes a long way.
Ari Melmed, MD • Rob Orman, MD
Tetanus in developing nations still accounts for hundreds of thousands of death worldwide. Vaccination in the developed world has made tetanus extremely rare. •
Ran Ran, MD • Rob Orman, MD
Sometimes the best medicine has nothing to do with medication.
Andrew Buelt, DO • Joe Weatherly, DO
Worried about losing your early adopter mindset? Modern music helps keep you innovative. Let the magic of atonal weirdness unlock parts of your brain that you never knew existed.
Discuss the recent article Ornstein, Katherine A., et al. "Association Between Hospice Use and Depressive Symptoms in Surviving Spouses." JAMA internal medicine (2015). •
Andrew Buelt, DO • Joe Weatherly, DO
Overwhelmed by the onslaught of the daily post information age data dump? Maybe it’s time to turn off your smart phone, take a break from your fitbit, and let the chants and non-percussive drones of early church music help you meditate on simpler times.
Should all post MI patients be on a beta blocker?There are benefits like decreased rate of angina and repeat MI. The downside, though, is that beta blockers increase the risk of heart failure and cardiogenic shock. •
Andrew Buelt, DO • Joe Weatherly, DO
Disorganized? Having trouble keeping your patients straight? Well let the well structured stylings of Baroque help get you back on track.
“Prediabetes” is often called a risk factor for a risk factor. Whatever your opinion of the term, finding a borderline A1c elevation can spark conversation about improving lifestyle. •
Kevin Wineinger, MD • Mike Mooney, MD
Can masturbation protect patients from prostate cancer?
Brian Murphy, MD • Rob Orman, MD
Discuss utility and pitfalls of using PSA for prostate cancer screening, grading and management of prostate cancer, alternate methods of screening •
Brian Murphy, MD • Rob Orman, MD
Jaded? Need a dose of inspiration? You've come to the right place. The romantics will whisk you away into a fantasy world and fill you with passion and/or dread. But at least you’ll feel something.
Medicine is rife with testing and treatments that are not beneficial (and potentially harmful). The Choosing Wisely movement is sweeping the globe as we begin to focus in on what does and does not benefit our patients. •
Casey Parker, MD • Justin Coleman, MD
Nothing is perfect, not even contraception. And sometimes, there’s no contraception to speak of. Preventing pregnancy, however, doesn’t need to be complicated. Copper IUDs and oral agents like ulipristal are effective and relatively easy methods of preventing unintended pregnancy. To help make …
Jan Shoenberger, MD, FAAEM • Stuart Swadron, MD, FAAEM
When did UTI’s become so complex? The increasing frequency of extended spectrum beta lactamase (ESBL) bacteria has made treatment of cystitis confusing and challenging. Infectious disease specialist Greg Moran breaks down ESBL treatment options.
Greg Moran, MD • Rob Orman, MD
Discuss insomnia in the elderly, effects of different sleep medications, algorithm for escalating potency of sleep medications. •
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Mindfulness therapy may be just as good as antidepressants in relapse prevention. •
Andrew Buelt, DO • Joe Weatherly, DO
Drink Gatorade. Just kidding, it’s a little more complicated (slightly). Rob O gives us the breakdown in this liquified bolus of information. A little sugar and salt makes the medicine go down….
Rob Orman, MD
Do you use gel during speculum exams? If not, it may be that you were taught gel would interfere with Pap results. This paper suggests that is not the case.
Andrew Buelt, DO • Joe Weatherly, DO
Discuss reasons for and barriers to initial of basal insulin in type 2 diabetes.
Vanessa Cardy, MD
There are some big decisions to make with a transgender child.Puberty blockers? Hormone therapy? One thing that’s not a mystery is that acceptance is the most important aspect. Rejection can lead to horrible consequences.
Lee Ann Conard, DO • Nick DeBlasio, MD
To discuss the sensitive topic of transgenderism and how to best approach a child or family curious or concerned about transgenderism. What workup is recommended and when to refer to a specialist. •
Lee Ann Conard, DO • Nick DeBlasio, MD
Discuss use of Melatonin, management of different varieties of insomnia (such as difficulty falling asleep, early awakening), effect of medications and alcohol on REM, sleep, sleep hygiene. •
Rob Orman, MD • Shawn Hersevoort, MD, MPH
We've all been there: hammered at the 40 year high school reunion, trying to impress that classmate we had a crush on who’s still not paying attention and now has a family, when the topic of Haiti and the cholera outbreak after the 2010 earthquake comes up. Now’s our moment to shine, “It’s the damn …
No, this segment is not about the troubled, yet honorable Lord Commander of the Night’s Watch, nor is about John Snow the English cricketer who played for Sussex in the 1960s and 70s. The John Snow we’re talking about was the British Physician often called the Father of Epidemiology who changed the …
It’s August! Which comes from the latin onomatopoetic word describing the sound of vomiting (partially true). It’s also National Water Quality month! What do these two fascinating facts have to do with each other? It’s this month’s theme! Find out what it is in less than 90 Seconds (or just look at …
Discuss recent literature evaluating the risk of aneurysmal subarachnoid hemorrhage in those with first degree relatives suffering the same disorder. •
Heidi James, MD • Rob Orman, MD
Fusobacterium is a common cause of pharyngitis and associated with the horrendous Lemierre’s disease. Does that mean that we should antibiose everyone with sore throat, even if they have a negative strep test?
Kevin Wineinger, MD • Mike Mooney, MD
Summary: We’re not trained in conflict resolution, but angry patients are a reality in any practice. Listening and empathy can go a long way in this situation. • Link to detailed explanation and video description of the upset patient protocol …
Dike Drummond, MD • Rob Orman, MD
Does early exposure to high lipids lead to increased chance of vascular disease later in life? •
Andrew Buelt, DO • Joe Weatherly, DO
To bring to light the fact that pizza is one of the leading unhealthy foods in our children's diets and how it can dramatically add calories, saturated fats and sodium to their daily intake. •
Mizuho Morrison, DO
Discuss the article Graudal, Niels, et al. "Compared with usual sodium intake, low-and excessive-sodium diets are associated with increased mortality: a meta-analysis." American journal of hypertension 27.9 (2014): 1129-1137. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss the article Elmore, Joann G., et al. "Diagnostic concordance among pathologists interpreting breast biopsy specimens." JAMA 313.11 (2015): 1122-1132. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss the article Huo, Yong, et al. "Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial." JAMA 313.13 (2015): 1325-1335.
Andrew Buelt, DO • Joe Weatherly, DO
We want to improve our patients’ health with smoking cessation, but we don’t want to harm them in the process. Varenicline has been linked with an increase in neuropsychiatric events such as depression and suicidal ideation. This meta-analysis suggests that that is not the case. •
Andrew Buelt, DO • Joe Weatherly, DO
Discuss the article Begot, Isis, et al. "A Home-based Walking Program Improves Erectile Dysfunction in Men with an Acute Myocardial Infarction." The American Journal of Cardiology (2014).
Andrew Buelt, DO • Joe Weatherly, DO
Does a 50 item problem list give you angina just thinking about it? The multi-morbidity patient is by definition complex, but there is a way to improve both patient and provider experience in the clinic. •
Vanessa Cardy, MD
Myasthenic patients live in a delicate balance between movement and paralysis. Certain medications, like antibiotics and steroids, can tip them over the edge. •
Bryan Hayes, PharmD • Rob Orman, MD
Do you cringe with the thought of having to work-up young females in your practice for dysfunctional uterine bleeding? Do you know when to consider “abnormal” from normal menstruation. Let’s hear from Diane Tanaka M.D., an expert on the topic for helpful hints on how to tackle this bloody mess! •
Diane Tanaka, MD • Mizuho Morrison, DO • Solomon Behar, MD
Our medical knowledge takes us only so far in a clinical interaction. Empathy is equally, if not more important. •
Casey Parker, MD
Our pediatric GYN consultant, Diane Tanaka, is back with some tips on managing abnormally heavy menstruation.
Diane Tanaka, MD • Mizuho Morrison, DO • Solomon Behar, MD
ACE-I plus ARB used to mean two great things that go great together. These days, not so much.
Anne Peters, MD • Mel Herbert, MD
Alcohol can reduce cardiovascular risk in certain patients, but it’s also a strong carcinogen. All things in moderation, but what does that mean when considering the benefits and harms of a glass of wine? •
Christina Miller, MD • Rob Orman, MD
Overview of pertussis and importance of immunization and re-vaccination of adolescents for pertussis.
Ilene Claudius, MD
Sometimes a runny nose is just a runny nose. While we often can't cure non-allergic rhinitis, there are some measure we can recommend to limit the symptoms.
Heidi James, MD
Did you know discipline can start in the newborn? And that it actually is much more effective when it is used as an opportunity to positively reinforce good behavior, rather than always shaming a child for their bad behavior? Here are tips from Dr.Nick Deblasio on how to handle discipline in all …
Mizuho Morrison, DO • Nick DeBlasio, MD • Solomon Behar, MD
Aggressive blood pressure control in the elderly may be a game of diminishing returns. •
Andrew Buelt, MD • Joe Weatherly, MD
Do sunblocks work. What is SPF, does UV-A matter, can dark skinned people get sunburn? This and more in our timely Rap segment. •
Mel Herbert, MD
Everyone knows cars can get really hot on hot sunny days. This greenhouse effect is actually much worse than people think and not knowing the details can be deadly!
Mel Herbert, MD
There are more combinations of oral diabetic medications than bricks in the Great Wall of China. OK, that’s hyperbole. But there are a lot of drug choices without a clear, absolute best second choice after metformin.
Anne Peters, MD • Mel Herbert, MD
Are some antidepressants better (or worse) than others when it comes to suicidal behavior? •
Andrew Buelt, MD • Joe Weatherly, MD
The basics of discipline don’t change much as a child matures. It’s all about clear expectations. •
Mizuho Morrison, DO • Nick DeBlasio, MD • Solomon Behar, MD
It used to be that all we could do was watch patients with hepatitis C get sicker. New drugs are changing that, but with a cost in the 10s of thousands of dollars, are they worth it? •
Dan Smyth, DO • Heidi James, MD
It's June and we're throwing our buddy, the Sun, a 4.6 billionth birthday party! Join the celebration.
Is hormone replacement therapy worth the increased risk of ovarian cancer?
Andrew Buelt, MD • Joe Weatherly, MD
There is no ‘one ring to rule them all’ when it comes to treating acne.
Heidi James, MD • Rob Orman, MD
Do you find that patients with borderline personality are some of the most challenging in your practice. You’re not alone! We’ve been taught to put up barriers to avoid manipulation and frustration, but there is a better way. •
Marion Koch, MD • Vanessa Cardy, MD
A disorder with fever and rash, no big deal. Internal organ inflammation, big deal. 10% mortality?!? Now you’ve got my attention. • When is a rash not just a rash? When it’s DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) -a potentially fatal drug reaction to meds we …
Vanessa Cardy, MD
Do we have it all wrong with ingrown toenails? Some feel that we should be describing it as overgrown skin rather than an issue with the nail itself. This may seem like a quibble of semantics, but it has major implications on management. The Vandenbos procedure is a removal of periungual skin with …
Heidi James, MD
Discuss when to consider precocious puberty, how to make the diagnosis and differentiate between central versus peripheral puberty, and what workup is needed by the primary care physician before referral to endocrinology.
Mizuho Morrison, DO • Nancy Crimmins, MD • Nick DeBlasio, MD • Rob Orman, MD
Should all patients with portal vein thrombosis be anticoagulated? Our hematology expert weighs in. •
Rob Orman, MD • Tom Deloughery, MD
Aspirin has been a cure all for seemingly every disease (except of GI bleeding). This paper questions its utility for primary prevention.
Andrew Buelt, MD • Joe Weatherly, MD
Discuss differences between acute, somatic pain and chronic pain; maladaptive self treatments for chronic pain. •
Rob Orman, MD • Shawn Hersevoort, MD, MPH
How do you differentiate between corneal abrasions and corneal erosions? Do you recall the management differences of these and other common ophthalmologic presentations? We discuss how to avoid missing diagnoses which will permanently impact sight. And we help tease out which require prompt …
Ken Beckman, MD • Mike Weinstock, MD
Obese patients who have surgery are at higher risk for bad outcomes, but that may be outweighed by long term benefit when it comes to bariatric procedures.
Andrew Buelt, MD • Joe Weatherly, MD
Can induction of labor result in better maternal and fetal outcome?
Andrew Buelt, MD • Joe Weatherly, MD
Chronic pain can be frustrating for both the patient and provider. Antidepressants and anticonvulsants may help with long term improvement and return to function. •
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Can stacking antihypertensives help patients with heart failure?
Andrew Buelt, MD • Joe Weatherly, MD
Is Morgellons Syndrome real? In the end, does it really matter at the bedside? A “disease" made famous by Joni Mitchell is in the news again and we give it our take. •
Mel Herbert, MD
Discuss 10 actions that can be taken to improve care in a patient returning for a repeat visit. •
Mike Weinstock, MD • Mizuho Morrison, DO
Discuss etiology and treatment options for chronic urinary tract infections. •
Heidi James, MD • Rob Orman, MD
PFT reports are like a box of chocolates, you never know what you want to get and most of it you’d rather not know. •
Gene Breau, MD • Heidi James, MD
Discuss iron metabolism, differential diagnosis of microcytic anemia and utility of different laboratory tests in the evaluation of iron deficiency. •
Rob Orman, MD • Tom Deloughery, MD
Review common presentations of the painful elbow in the pediatric population.
Mizuho Morrison, DO • Solomon Behar, MD • Yu-Tsun (Yo) Cheng, MD
Discuss how to make the diagnosis of diabetes, influence of diet and lifestyle. •
Anne Peters, MD • Mel Herbert, MD
Discuss ways to differentiate iron deficiency from anemia of chronic disease, iron supplementation, disorders associated with iron deficiency.
Rob Orman, MD • Tom Deloughery, MD
Most of us will face some degree of burnout during our careers. The trick is to recognize it and grow from there.
Dike Drummond, MD • Rob Orman, MD
Atrial fibrillation rate control is part science and part guessing. It can be hard to know which one has more impact. •
Bryan Hayes, PharmD • Rob Orman, MD
Would you ever consider NOT giving antibiotics to a patient with strep throat?
Casey Parker, MD
What really matters in a critical situation when you have no medical resources?
Aaron Bright, MD • Jan Shoenberger, MD, FAAEM
Strep throat is associated with serious complications, but they’re rare.
Casey Parker, MD
Your patient won’t feel short IUD strings, but a penis sure will.
Amy Brennan, MD • Heidi James, MD
Are all these statins really making people healthier?
Anne Peters, MD • Heidi James, MD • Rob Orman, MD
Aside from abstinence, IUDs are one of the most effective forms of contraception.
Amy Brennan, MD • Heidi James, MD
The pendulum has swung away from rhythm control for chronic a fib.
Dave Bauer, MD • Rob Orman, MD
Is there really an epidemic of vitamin D deficiency. If there is, does it matter?
Casey Parker, MD
Clindamycin has lost the crown as the cure all for soft tissue infections.
Bryan Hayes, PharmD • Rob Orman, MD
Why do patients and their families get up in our grill? This true story should bring new perspectives on this age old question! •
Louise Aronson, MD • Mel Herbert, MD
The rise of MRSA changed the game in soft tissue infections, but does it mean a change in how we manage cellulitis? •
Bryan Hayes, PharmD • Rob Orman, MD
Flu season is upon us with a vengeance, and when influenza is at play, pneumonia may be soon to follow. What’s the best antibiotic for influenza or post-influenza pneumonia? Are antivirals indicated?
Rob Orman, MD
Measles is the most contagious of the vaccine preventable diseases.
Gregory Wallace, MD • Mizuho Morrison, DO
Tupperware, jet aircraft, microwave ovens, and the Holter monitor are all from the 1940s. The Zio patch is a new concept in cardiac event monitoring. Is it a better mousetrap or a flash in the pan? •
Mizuho Morrison, DO
It’s not always easy preventing migraines, but some agents are better than others. And some, well, they’re just plain worthless. •
Casey Parker, MD
It may seem like most patients wouldn’t want to discuss end of life issues, but the opposite is true. •
Jean Abbott, MD • Vanessa Cardy, MD
Do statins help reduce likelihood of cardiovascular events in low risk patients?
Dave Newman, MD • Rob Orman, MD
Screening mammography was once a cornerstone of health maintenance in women under 50, but recent data casts a shadow on its utility.
Allison Blaze, MD
Some of the old school treatments are just as effective as the newer and more expensive drugs. •
Casey Parker, MD
No Pap smears for women under 21! Sometimes cervical cancer screening can do more harm than good. •
Allison Blaze, MD • Michelle Yates, MD
Some meds are helpful for asthma but there are others that can kill (and some of your patients may be taking!)
Dave Newman, MD
What would you rather have, an ankle sprain or an ankle fracture?
Matt Baird, MD • Mizuho Morrison, DO
Some anxiety we’re born with and some we pick up along the way.
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Alprazolam can cool down intense anxiety but may soon become more problem than therapy.
Rob Orman, MD • Shawn Hersevoort, MD, MPH
When treating depression with meds, start small. Patients feel side effects before benefits. •
Rob Orman, MD • Shawn Hersevoort, MD, MPH
Most patients with chest pain don’t have serious disease, but always consider the life threats. •
Mike Weinstock MD
Part of treating anal fissures is for stool to be like a soft, fluffy cloud - it just floats out, no straining. •
Megan Cavanaugh MD • Mel Herbert, MD • Rob Orman, MD
The taper for stopping antidepressants should be as slow, if not slower, than the build up. •
Rob Orman, MD • Shawn Hersevoort, MD, MPH
A new drug is FDA-approved for Type 2 diabetes. It is an SGLT-2 inhibitor and joins the other two already on the market. We've got a short review for you!
Mel Herbert, MD
Thyroid nodules are a common problem in primary care practice. What do you do when you get an inconclusive biopsy result in a low risk patient? We discuss some current literature.
Heidi James, MD • Mel Herbert, MD • Vanessa Cardy, MD
Are the new oral anticoagulants worth it for treating a-fib?
Dave Bauer, MD • Rob Orman, MD
There are many flavors of ADHD
Rob Orman, MD • Stephanie D’Augustine, MD • Todd Flosi, MD
What can we share with a handshake? C Diff, influenza, the common cold, and Ebola to name a few. •
Dave Bauer, MD • Rob Orman, MD
Some patients carry all of their stress in the anus.
Megan Cavanaugh MD • Mel Herbert, MD • Rob Orman, MD
Is that mild tremor something to worry about?
Aaron Bright, MD • Jan Shoenberger, MD, FAAEM
How do we treat patients who have overwhelming inattention, hyperactivity and impulsivity? Why, stimulants, of course!
Rob Orman, MD • Stephanie D’Augustine, MD • Todd Flosi, MD
“Doc, it hurts when I move my shoulder like this.” “Well, stop doing it.”
Brian Tollefson, MD • Mizuho Morrison, DO
The PARADIGM-HF trial has just been published in the NEJM. A study with, at first glance, remarkable findings but already with much controversy. Dr. Mel Herbert M.D. gives a brief overview.
Mel Herbert, MD
A new "old" virus has shown up in the US and is wreaking havoc on kids, especially kids with asthma. Dr. Greg Moran M.D. our favorite triple-boarded ID expert gives us an update.
Greg Moran, MD • Mel Herbert, MD
Why would we vaccinate a child for an STD if they’re not sexually active?
Ellen Brooks, MD • Rob Orman, MD
It turns out that everything we learned about treating abscesses was pulled out of a magician’s hat in the middle ages. In other words, smoke and mirrors. New evidence is showing what actually makes a difference (and what doesn’t) when it comes to pus. •
Anand Swaminathan, MD • Rob Orman, MD
A vaccine for genital warts and cervical cancer. Is there a downside?
Allison Blaze, MD • Michelle Yates, MD • Rob Orman, MD
HIV post exposure prophylaxis isn’t just for occupational needle sticks and eye splashes. •
Rob Orman, MD • Sheila Neese, MD
Viral load is the canary in the immunosuppression coal mine.
Rob Orman, MD • Sheila Neese, MD
Maybe having vials of concentrated nicotine lying around the house isn’t such a good thing. •
Mel Herbert, MD • Sean Nordt, MD, PharmD, FAAEM • Stuart Swadron, MD, FAAEM
Pre-exposure prophylaxis is the new frontier of HIV prevention.
Rob Orman, MD • Sheila Neese, MD
Classic cardiac chest pain was first described in the 1700s. What have we learned since then? •
Mike Weinstock MD • Rob Orman, MD
Greg Moran, MD is board-certified in internal medicine, infectious disease, and emergency medicine. Listen to him break down the recent Ebola outbreak like he's breaking down a lego castle... that's piece by piece by the way.
Greg Moran, MD • Mel Herbert, MD
New research suggests we might have a problem Houston. Should you pay attention?
Sean Nordt, MD, PharmD, FAAEM • Stuart Swadron, MD, FAAEM
Who should get the hypercoagulable workup after developing a clot? The answer isn’t ‘everybody’ and some would say the answer is ‘nobody’, but the truth probably lies somewhere in between.
Rob Orman, MD • Sean Nordt, MD, PharmD, FAAEM • Tom Deloughery, MD
OK, I’m going to do the workup. What tests that I forgot to memorize in medical school should I send? Are they reliable?
Rob Orman, MD • Tom Deloughery, MD
Let’s talk about the controversial topic of returning to play after a head injury. When is it safe?
Matt Baird, MD • Mizuho Morrison, DO
Nothing ruins a wedding like a bloody nose. From diagnosis to treatment to what we should worry about, Aaron and Jan clear up the confusion and turn epistaxis from a bad day to smiles all around.
Aaron Bright, MD • Jan Shoenberger, MD, FAAEM
Flu vaccination works, but maybe not in ways that we think. Your patients will benefit, but it’s not a panacea. And it turns out that oral antivirals may be a more effective remedy for normal bowel patterns than influenza.
Dave Newman, MD
If essential hypertension is so essential, why do we treat it? The new JNC 8 blood pressure guidelines have all the drama, intrigue, politics and excitement of a Shakespearean play (at least we think so). What BP limits got to stay and which ones were on the chopping block?
Heidi James, MD • Rob Orman, MD
You’re going where to do what? Take a listen to Dr. Bauer and Dr. Orman as they drop some pearls of wisdom on the topic of travel medicine and how to help your patients stay safe in the wild.
Dave Bauer, MD • Rob Orman, MD