Frankly Speaking About Family Medicine

Recurrent UTIs—Prevention Without Antibiotics - Frankly Speaking Ep 274

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

A Smoke Screen? Is Secondhand Aerosol Exposure From E-Cigarettes harmful? - Frankly Speaking Ep 273

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

Estimating Jugular Venous Pressure: Point-of-Care Ultrasound Can Help - Frankly Speaking Ep 272

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

Cardiovascular Disease and Exercise - Frankly Speaking Ep 271

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

Boosting Weight Loss with Medications: New support for GLP-1 RAs - Frankly Speaking Ep 270

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

Screen Patients Early and Routinely for Prescription Drug Misuse - Frankly Speaking Ep 269

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

PrEP: Are We Educating Patients Effectively? - Frankly Speaking Ep 268

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

Bad News for E-Cigarette Users—Possible Link Between E-Cigarettes And ED - Frankly Speaking Ep 267

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

Fever Free: Acetaminophen or Ibuprofen? - Frankly Speaking Ep 266

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

“Could It Be My Thyroid?” The Quandary of Subclinical Hypothyroidism - Frankly Speaking Ep 241

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