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Primary Care Update

Primary Care Update

By Mark Ebell and friends
Three healthily skeptical primary care physicians discuss the latest in primary care medicine. Join Mark Ebell MD, John Hickner MD, Henry Barry MD, and others for this fast-paced weekly update on evidence-based primary care.
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DAPT after stroke, gout, and HRT after 20 years
This week John, Henry and Mark discuss dual antiplatelet therapy after stroke, updated recommendations for management of gout, and long-term follow up of hormone replacement for post menopausal women.
24:30
September 18, 2020
Top COVID-19 research studies, part deux
We review 9 more of the top COVID-19 research studies to date, including studies on transmission, treatment, and prognosis.
33:17
September 5, 2020
Top COVID studies: 9 of the most important COVID-19 studies
In this episode we summarize 9 top COVID-19 studies in a special episode prepared for the Indiana Academy of Family Physicians.
28:06
August 28, 2020
Our (hopefully) last 2 HCQ studies, rehab for COPD, and funny shoes for knee OA
This week, we discuss hopefully the last two studies of hydroxychloroquine for patients with COVID (still doesn't work), pulmonary rehab in patients with COPD, and the use of special footwear in patients with knee DJD.
26:04
August 13, 2020
Israeli school outbreak, antibody tests, going nerveless for HTN, and syncope
This week, a COVID-19 outbreak in an Israeli high school, the accuracy of antibody studies, denervation to treat hypertension, and identifying low-risk patients with syncope. Plus the quiz, and a recommendation. 
29:17
July 31, 2020
COVID-19: vaccines, HCQ for mild illness, and C-19 in kids
This week, an all COVID-19 episode covers 7 new studies in just 24 thrill-packed minutes: 2 phase 2 vaccine trials just out yesterday, outpatient monitoring of patients with COVID-19, hydroxychloroquine in mildly ill patients, and transmission of COVID-19 by children
24:13
July 22, 2020
COVID, overactive bladder, and pro/synbiotics post-op
This week we discuss COVID research on how many are asymptomatic and for how long people are infectious , managing overactive bladder symptoms in men, and perioperative probiotics and synbiotics for patients undergoing abdominal surgery.
25:00
July 17, 2020
COVID prevalence, treating UTI, migraine prophylaxis, and lab values
2  COVID papers on seroprevalence and total vs confirmed cases, treating UTI with telehealth, migraine prophylaxis for kids, and variation in lab values.
27:43
July 2, 2020
COVID-19: 6 studies on steroids, NPI, MIRS in kids, and more
This week, 6 COVID-19 updates: corticosteroids reduce mortality for sickest patients, non-drug approaches to controlling COVID, a review of the multisystem inflammatory syndrome in kids, another study on COVID 19 mortality and race, asymptomatic COVID and a report from the CDC on factors related to hospital and ICU use among patients with COVID-19.
26:06
June 17, 2020
Convalescent plasma, patient self-testing, pneumothorax, and colic
This week on Primary Care Update: 2 COVID-19 studies (convalescent plasma RCT and accuracy of patient self-sampling), plus managing pneumothorax, and something that seems to work for infantile colic. 
22:51
June 8, 2020
Last call for HCQ: we cover 6 COVID-19 studies
A lot to cover: remdesivir updates, the effect of cancer treatment on COVID mortality, hypertensive medications, last call for HCQ, and racial disparities.
22:15
June 1, 2020
COVID news, cellulitis diagnosis, and COPD
This week on primary care update: safety of convalescent sera, two social distancing studies, cellulitis diagnosis, and treating COPD exacerbations. Plus a bonus beer POEM.
23:32
May 27, 2020
Two COVID-19 studies, OA guideline, and choosing insulins
This week: salivary testing for COVID, COVID immunity, ACR guidelines for managing patients with degenerative joint disease, and the use of old forms of insulin in managing patients with type 2 diabetes.
27:06
May 13, 2020
Episode 46: remdesivir trials, fecal shedding, and more
In episode 46 we again cover all things COVID-19: 2 trials of remdesivir, news on viral shedding, COVID mortality, thrombotic events and risk of infection among COVID contacts. You can get all of our research briefs on COVID-19 here: https://www.aafp.org/journals/afp/explore/covid-19-daily-briefs.html
26:30
May 4, 2020
Primary Care Update Episode 45
This week, 2 new COVID-19 studies (doi:10.1001/jama.2020.6771 and doi: 10.1001/jama.2020.6775), an effective treatment for irritable bowel syndrome (https://www.ncbi.nlm.nih.gov/pubmed/31852769), and trends in prostate cancer screening (https://www.ncbi.nlm.nih.gov/pubmed/31794057).
24:08
April 27, 2020
Primary Care Update Episode 44 (COVID-19 edition)
This week, research updates about COVID-19: the largest trial to date of hydroxychloroquine (https://doi.org/10.1101/2020.04.10.20060558), the first serosurvey results (https://doi.org/10.1101/2020.04.14.20062463), doing telehealth (www.bmj.com/content/368/bmj.m1182), masks (https://doi.org/10.17226/25776), the effect of temperature (https://doi.org/10.1101/2020.04.14.20062463) and viral shedding / infectiousness (https://doi.org/10.1038/s41591-020-0869-5).
25:33
April 21, 2020
Primary Care Update Episode 43
This week, a couple of COVID-19 updates, plus POEMs on breast cancer prevention (https://www.ncbi.nlm.nih.gov/pubmed/31839281) and a cool new (old) way to reduce bad things after an MI (https://www.ncbi.nlm.nih.gov/pubmed/31733140).
22:14
April 15, 2020
Primary Care Update Episode 42: COVID-19 edition
All COVID-19 all the time this week with 6 updates: 2 HCQ studies, the new antibody tests, case fatality rates, whether handwashing really works, and an editorial from NEJM. We'll be doing regular podcasts focused on COVID-19, plus our regular podcasts covering all the rest.
21:42
April 7, 2020
Primary Care Update: COVID-19 briefs, clavicle fractures, and acetaminophen
This week: 3 brief summaries of breaking research on COVID-19 (convalescent sera, hydroxychloroquine, and risk stratification); whether you really need surgery for a mid-clavicular fracture (https://www.ncbi.nlm.nih.gov/pubmed/30835150); and whether acetaminophen does anything (https://www.ncbi.nlm.nih.gov/pubmed/31892511). 
22:28
March 31, 2020
Primary Care Update Episode 40
This week: preventing food allergies (https://www.ncbi.nlm.nih.gov/pubmed/31633778), choosing the right BP target long-term after stroke (https://www.ncbi.nlm.nih.gov/pubmed/31355878), and improving uptake of colorectal cancer screening (https://www.ncbi.nlm.nih.gov/pubmed/30915656).
26:59
March 21, 2020
Primary Care Update Episode 39
This week: the results of screening for autism (https://www.ncbi.nlm.nih.gov/pubmed/31562252), does soccer cause dementia (https://www.ncbi.nlm.nih.gov/pubmed/31633894), and the best way to diagnose hip OA on exam (https://www.ncbi.nlm.nih.gov/pubmed/31846019).
27:40
March 1, 2020
Primary Care Update Episode 38
We finish our top 20 from 2019: bleeding risk with different DOACs (https://www.ncbi.nlm.nih.gov/pubmed/30512099), whether higher doses of ibuprofen are better than low (https://www.ncbi.nlm.nih.gov/pubmed/31383385), a comparison of Shingrix with Zostavax (https://www.ncbi.nlm.nih.gov/pubmed/30361202), and whether exercise really prevents falls (https://www.ncbi.nlm.nih.gov/pubmed/30592475). Plus, an update on the COVID-19 epidemic.
23:12
February 19, 2020
Primary Care Update Episode 37: Top 20 POEMs Part 2
Part 2 of our review of the top 20 POEMs of 2019. This week infections (ruling out CAP, typical duration of RTI in kids, and 5 vs 10 days for strep throat) and colorectal cancer screening (yield of FIT over 10 years ~ colonoscopy, no need to stop NSAID or anticoagulant, and family history effect on risk). 
24:18
February 4, 2020
Episode 36: Top 20 Part 1
In part 1 this week, we discuss 10 of 2019's top 20 POEMs. POEMs address hypertension, lipid management, behavioral medicine, and aspirin. This is the best of the best of the best for 2019...enjoy!
24:40
January 23, 2020
Primary Care Update Episode 35
This week: Dapagliflozin...for heart failure, not T2DM? (https://www.ncbi.nlm.nih.gov/pubmed/31535829) Do muscle relaxants add anything to NSAIDs for back pain? (https://www.ncbi.nlm.nih.gov/pubmed/30955985) And early vs delayed surgery for gallstone pancreatitis (https://www.ncbi.nlm.nih.gov/pubmed/31268184). Plus the quiz and a recommendation. 
26:13
January 8, 2020
Primary Care Update Episode 34
Happy Holidays... we hope our listeners are getting some downtime. This week, we discuss the benifits (or not) of treating subclinical hypothroidism,  the benefits (or not) of atorvastatin for patients with rheumatoid arthritis, and the best preventive strategy for patients with coronary artery disease and atrial fibrillation.
23:31
December 26, 2019
Primary Care Update Episode 33
Happy Holidays! This week we talk about whether adding ibuprofen and codeine improves pain control (https://pubmed.ncbi.nlm.nih.gov/31378383); whether or not a colonoscopy is needed to look for cancer after an episode of diverticultitis (https://pubmed.ncbi.nlm.nih.gov/31260589); and why everyone should take their blood pressure meds at night (https://pubmed.ncbi.nlm.nih.gov/31641769). 
25:51
December 12, 2019
Primary Care Update Episode 32 (11/25/19)
Our Thanksgiving episode, we even added theme music! Our 3 POEMs this week address whether to add ticagrelor to ASA in CAD (https://www.ncbi.nlm.nih.gov/pubmed/31475798); how often is a cough caused by an ACE inhibitor (https://www.ncbi.nlm.nih.gov/pubmed/29330882); and how effective is HAART at preventing HIV transmission  (https://www.ncbi.nlm.nih.gov/pubmed/31056293)?
24:54
November 26, 2019
Primary Care Update Episode 31
A whole lotta diabetes goin' on: linagliptin ($780) vs glimepiride ($3) for T2DM (https://www.ncbi.nlm.nih.gov/pubmed/31536101); semaglutide in T2DM + vascular/CKD (https://www.ncbi.nlm.nih.gov/pubmed/31185157); and whether we should care about pre-diabetes (https://www.ncbi.nlm.nih.gov/pubmed/31076416).
28:52
November 14, 2019
Primary Care Update Episode 30
It's Halloween, and we start with a seasonally appropriate study. That's followed by new recommendations re: BRCA mutations (https://www.ncbi.nlm.nih.gov/pubmed/31429902), Dave Slawson with an Atrium BEAT on the value (?) of Sitz baths, fecal transplant for irritable bowel (https://www.ncbi.nlm.nih.gov/pubmed/30908299), and a quick review of the latest pneumonia guidelines.
31:20
November 1, 2019
Primary Care Update Episode 29
A busy pod today: what patients mean when they say "congestion" (https://www.ncbi.nlm.nih.gov/pubmed/31145430); Dave Slawson on why decongestants are safer than we thought; are personal sound amplifiers any good (https://www.ncbi.nlm.nih.gov/pubmed/31095263); and ongoing overtreatment of asymptomatic bacteriuria (https://www.ncbi.nlm.nih.gov/pubmed/31449295). 
22:12
October 15, 2019
Primary Care Update Episode 28
This week, guest host Dr. Dave Slawson joins Henry and Mark. We discuss rapid (< 2 hr) protocols for ruling out MI (https://www.ncbi.nlm.nih.gov/pubmed/31242362); whether tramadol is as safe as it's cracked up to be (https://www.ncbi.nlm.nih.gov/pubmed/31088782); and steroids for pneumonia (https://www.ncbi.nlm.nih.gov/pubmed/29937237). Plus the quiz, and Mark reviews two clinical prediction rules for PE (PERC and YEARS). 
23:53
October 3, 2019
Primary Care Update Episode 27
This week, Dr. Dave Slawson, co-inventor of the POEMs concept, joins us to talk about a new project called "Atrium BEATS" (https://www.iambeats.io). Plus, we discuss new studies in how long to continue dual anti-platelet therapy after PCI, whether rimegapant works for migraine, and a possible alternative to ceftriaxone for gonorrhea.
29:08
September 22, 2019
Primary Care Update Episode 27
Special guest Dave Slawson, plus 3 POEMs: 1 vs 12 months of DAPT following PCI; rimegepant for migraine; and the best treatment for clinically suspected gonorrhea and chlamydia.
28:56
September 20, 2019
Primary Care Update Episode 26
This week: how accurate is clinical gestalt (https://www.ncbi.nlm.nih.gov/pubmed/31208974), canagliflozin and renal outcomes in high risk patients (https://www.ncbi.nlm.nih.gov/pubmed/30990260) and whether oral immunotherapy for peanut allergy is safe and effective (https://www.ncbi.nlm.nih.gov/pubmed/31030987).
26:08
September 6, 2019
Primary Care Update Episode 25
This week: baloxavir (Xofluza) for flu (https://www.ncbi.nlm.nih.gov/pubmed/30184455); a new guideline for subclinical hypothyroidism (https://www.ncbi.nlm.nih.gov/pubmed/31088853); and a great review on treating opioid use disorders in primary care (https://www.ncbi.nlm.nih.gov/pubmed/31088885).
24:30
August 28, 2019
Primary Care Update Episode 24
This week: as needed steroid + LABA for mild asthma (https://www.ncbi.nlm.nih.gov/pubmed/31112386); platelet rich plasma for rotator cuff injury (https://www.ncbi.nlm.nih.gov/pubmed/31000394); and pioglitazone in high risk diabetics who've had a stroke (https://www.ncbi.nlm.nih.gov/pubmed/30734043). 
24:29
August 9, 2019
Primary Care Update Episode 23
This week, John, Henry and Mark talk about adding ultrasound to mammography for screening (https://www.ncbi.nlm.nih.gov/pubmed/30882843), routine labs for patients on an antifungal (https://www.ncbi.nlm.nih.gov/pubmed/30347032), and podiatry interventions to prevent falls (https://www.ncbi.nlm.nih.gov/pubmed/30615052).
24:19
July 23, 2019
Primary Care Update Episode 22
Today we talk about what to do for patients with both coronary heart disease and afib (https://www.ncbi.nlm.nih.gov/pubmed/30883055); a practice changer for the three of us addressing how patient to be with antidepressants (https://www.ncbi.nlm.nih.gov/pubmed/29952277); and whether early or delayed cardioversion is better for afib (https://www.ncbi.nlm.nih.gov/pubmed/30883054).
23:07
July 11, 2019
Primary Care Update Episode 21
This week we talk about ruling out serious bacterial infection in young infants (https://www.ncbi.nlm.nih.gov/pubmed/30776077), whether exercise can prevent falls in the elderly (https://www.ncbi.nlm.nih.gov/pubmed/30592475), and whether statins and BP meds prevent cognitive decline (https://www.ncbi.nlm.nih.gov/pubmed/30814321).
25:02
June 26, 2019
Primary Care Update Episode 20
This week we cover why you should start using automated BP measurement if you're not already (https://www.ncbi.nlm.nih.gov/pubmed/30715088); ablation vs rhythm control for afib (https://www.ncbi.nlm.nih.gov/pubmed/30874766); and the value of early aerobic exercise after sports concussion (https://www.ncbi.nlm.nih.gov/pubmed/30715132). Plus, the value (?) of self-monitoring blood glucose in non-insulin T2DM.
23:44
June 12, 2019
Primary Care Update Episode 19
This week John, Henry and Mark discuss interpretation of FIT tests for CRC screening (https://www.ncbi.nlm.nih.gov/pubmed/30802902); diagnosis of appendicitis (https://www.ncbi.nlm.nih.gov/pubmed/30017693); and treatment of neonatal abstinence syndrome (https://www.ncbi.nlm.nih.gov/pubmed/30667476). Plus, a quiz about metformin.
25:00
May 28, 2019
Primary Care Update Episode 18
Today Mark, John and Henry talk about: how to rule out (and rule in) pneumonia (https://www.ncbi.nlm.nih.gov/pubmed/30850460); an RCT of e-cigarettes for smoking cessation (https://www.ncbi.nlm.nih.gov/pubmed/30699054); and non-drug treatments for IBS (https://www.ncbi.nlm.nih.gov/pubmed/30177784). 
20:54
May 14, 2019
Primary Care Update Episode 17
This week, Henry, Mark and John discuss: statins for primary prevention in the elderly (https://www.ncbi.nlm.nih.gov/pubmed/30712900); beer before wine or vice versa (https://www.ncbi.nlm.nih.gov/pubmed/30753321); and the impact on control on school performance in kids with T1DM (https://www.ncbi.nlm.nih.gov/pubmed/30721295). Plus a beer themed quiz.
22:48
April 29, 2019
Primary Care Update Episode 16
How long does a new knee or hip last (https://www.ncbi.nlm.nih.gov/pubmed/30782340); does subacromial decompression work for chronic shoulder pain (https://www.ncbi.nlm.nih.gov/pubmed/30728120); fentanyl or ketamine intranasally for extremity injury in kids (https://www.ncbi.nlm.nih.gov/pubmed/30592476); and splint or cast for fibular fracture (https://www.ncbi.nlm.nih.gov/pubmed/30674451). 
18:38
April 17, 2019
Primary Care Update Episode 15
This week: is it safe to skip breakfast (https://www.ncbi.nlm.nih.gov/pubmed/30700403), reducing fracture risk in women with osteopenia (https://www.ncbi.nlm.nih.gov/pubmed/30575489), drug therapy for anxiety disorder (https://www.ncbi.nlm.nih.gov/pubmed/30712879 ), and antibiotics for serious asthma exacerbations (https://www.ncbi.nlm.nih.gov/pubmed/30688986). 
24:45
March 27, 2019
Primary Care Update Episode 14
Today we talk about stem cell injections for osteoarthritis (https://www.ncbi.nlm.nih.gov/pubmed/29099618), a rant about mortality outcomes in cancer screening from Mark, omega-3 oils for primary prevention (https://www.ncbi.nlm.nih.gov/pubmed/30415637), and testosterone for depression in men (https://www.ncbi.nlm.nih.gov/pubmed/30427999).
26:41
March 19, 2019
Primary Care Update Episode 13
Today we talk about the impact of more primary care physicians in a population on health outcomes; whether or not probiotics, prebiotics, and antibiotics are helpful for irritable bowel; and the impact of SGLT-2 inhibitors like empagliflozin on cardiovascular outcomes in diabetics with heart disease or at very high risk.
25:15
March 6, 2019
Primary Care Update: Episode 12
Today's topics: what is the safest oral anticoagulant (https://www.ncbi.nlm.nih.gov/pubmed/30512099), new diabetes guidelines (https://www.ncbi.nlm.nih.gov/pubmed/30291106), and the good and the ouch of the new zoster vaccines (https://www.ncbi.nlm.nih.gov/pubmed/30361202).
25:03
February 12, 2019
Primary Care Update - Episode 11
Today we discuss: vitamin D for pain and headache (https://www.ncbi.nlm.nih.gov/pubmed/25261164); chronic diarrhea guidelines (https://www.ncbi.nlm.nih.gov/pubmed/29653941); lorcaserin and T2DM (https://www.ncbi.nlm.nih.gov/pubmed/30293771); and the results of "screening" MRI (https://www.bmj.com/content/363/bmj.k4577).
31:03
February 8, 2019
Primary Care Update: Episode 10
Does linagliptin prevent CV events: ttps://www.ncbi.nlm.nih.gov/pubmed/30418475; does Tai Chi prevent falls and fractures: https://www.ncbi.nlm.nih.gov/pubmed/30208396; treatment of endometriosis pain: https://www.ncbi.nlm.nih.gov/pubmed/30396557; and the benefits of sauna: https://www.ncbi.nlm.nih.gov/pubmed/30486813. 
26:30
January 18, 2019
Primary Care Update: Episode 9
This week: how does the yield for FIT testing compare with colonoscopy (https://www.ncbi.nlm.nih.gov/pubmed/29101260); our take on the new ACC/AHA lipid guidelines (https://www.ncbi.nlm.nih.gov/pubmed/30423391); and what works (or doesn't) for subacute cough (https://www.ncbi.nlm.nih.gov/pubmed/30201828).  
28:34
January 4, 2019
Primary Care Update: Episode 8, 12/20/18
This week we talk about the results of the 3 ASPREE aspirin trials, whether omega-3 oil prevents CV events, and a new biologic agent for migraine. Pubmed abstract links: ASPREE: https://www.ncbi.nlm.nih.gov/pubmed/30221596 ; omega-3: https://www.ncbi.nlm.nih.gov/pubmed/30146932 ; and migraine: https://www.ncbi.nlm.nih.gov/pubmed/30360965
28:38
December 20, 2018
Primary Care Update: Episode 7
Topics: fluids to prevent UTI, deprescribing study, antipsychotics for delitium, and the value of ECG and echo for preparticipation physicals.
26:35
December 5, 2018
Primary Care Update: Episode 6
This week's topics: whether surgery works for shoulder impingement, framing test results positively for patients, vagus nerve stimulation for frequent migraines, and a commentary on shared decision-making. Study links: Impingement: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734212/ ; Vagus nerve stimulation: https://www.ncbi.nlm.nih.gov/pubmed/29907608 ; and Positive messaging: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495144/
22:26
November 20, 2018
Primary Care Update: Episode 5
We discuss recent studies on: antibiotics to treat appys, whether gabapentin is any good for back pain, the accuracy of a single BP measurement, and the best approach to smoking cessation.
24:03
November 8, 2018
Primary Care Update: Episode 4
Mark, John and Henry talk about tamsulosin for helping stones pass (but not all of them), how aspirin and esomoprazole (at the right dose) can reduce mortality in Barrett's esophagus, whether to do HPV only or co-testing in women 30-65 years, and the safety (and effectiveness) of lorcaserin for weight loss.
26:29
October 23, 2018
Primary Care Update: Episode 3
Mark, John and Henry discuss the new aspiring studies (does it really prevent heart disease), a positive (!) vitamin D trial, and whether procalcitonin can help us avoid antibiotics for patients with lower respiratory infection. Plus, the quiz, and John nerds out about vitamin D. In a good way.
29:22
October 8, 2018
Primary Care Update: Episode 2
Today's topics include anticoagulation in patients already taking aspirin, asthma treatment, and getting patients on board with advanced directives. Plus the quiz, and Nerd Alert with Henry.
20:45
September 14, 2018
Primary Care Update: Episode 1
Today's topics: are new basal insulins really any better, the impact of stigmatizing language, the value of adding cytology to HPV testing alone, and the best evidence to date on just how common incidentalomas are with MRI and CT. Plus, the pop quiz, and a segment we call "Preventing Bad Stuff" (today's topic is prostate CA screening).
38:08
August 24, 2018