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Our PA hosts look into post graduate residency programs for PAs and discuss some of the reasons for choosing to apply to one and some of the reasons individuals go right into practice without completing residencies. After the Primary Care RAP segments, Adrian and Kris reflect on tick bites, Lyme disease and indications for using doxycycline in specific scenarios and populations.
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.
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. They talk about how to become a more effective patient advocate, and how to face situations that feel scary but ultimately benefit our patients.
To investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.
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.
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.
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.
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.
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.
To evaluate the non-inferiority of NO prophylaxis compared to guidelines recommended prophylaxis in preventing contrast induced nephropathy.
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.
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.
To compare the rate of moderate to severe exacerbations between triple therapy and dual or monotherapy in patients with COPD.
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.
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.
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.
Adrian and Kris discuss PAEA’s response to the current administration's report on reforming America’s healthcare system and how this federal support can improve the access patients can have to PAs across the country. This is another huge step in the right direction for PAs! Since both Kris and Adrian are educators, what better segment to discuss then learner feedback. They breakdown the segment with Dr. Neda Freya and Dr. Nikki Southall on providing quality feedback to learners and why you shouldn't “feed them a sandwich.”
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.
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.
To evaluate if a novel antibiotic Zoliflodacin is effective in treatment of uncomplicated gonorrhea.
Jason Woods digs deep into the diagnosis, complications, and management of nephrotic syndrome with pediatric nephrology doctor Danielle Sorrano.
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.
To evaluate the efficacy of rivaroxaban alone or in combination with aspirin for secondary prevention of CV disease.
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.
To present official recommendations for the medical management of opioid-induced constipation.
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.
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.
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.
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 becoming pros at the feedback discussion.
To determine the incidence of infectious and noninfectious patient-reported complications associated with the indwelling urethral catheter.
In this episode, Kris & Adrian discuss the 2018 legislature that (finally) included PA’s in the management of their patients referred to hospice care. This is a huge win for AAPA and their lobbying team, to recognize the work that PAs do in managing end-of-life-care for hospice patients.
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, our own Mizuho Spangler and Neda Frayha look to the scalp and provide an overview of how to diagnose and manage female alopecia.
BOTTOM LINE: In patients with left-sided endocarditis in stable condition, changing to oral antibiotics was noninferior to continued intravenous antibiotics.
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 Morrison and Matt DeLaney about the outpatient management of severe asymptomatic hypertension.
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.
BOTTOM LINE: Remote telemedical interventions reduced hospital admission days and all-cause mortality.
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.
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 hypothyroidism
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 epidemic of burnout.
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 cause mortality.
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 block, andexanet alfa? What does the evidence show about their safety and efficacy?
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, stepwise approach to understanding and prescribing OCPs.
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.
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 pathophysiology, diagnosis and treatment of this condition.
2019 is here and the AAPA Primary Care RAP team is ready to help you face it like a new year champ! In this episode, we cover the latest changes to the NCCPA blueprint, both content and question style to keep you prepared and informed on all things C in your PA-C! We also reflect on (read: gush-over) the insightful segments hosted by Dr. Neda Fraya where she talks with former Pixar CFO, Lawrence Levy as well as internist and educator, Dr. Todd Cassesse about the challenges that health care providers face.
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.
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.
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. Evidence for the development of decreased susceptibility to baloxavir after treatment was also observed.
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 narrative of medicine being out of sync with the reality of medicine, perfectionism, emotional intelligence, and how Eastern philosophy’s The Middle Way can apply to all of our lives.
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.
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.
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 than “checkbox meditation,” and how to change the system while also working on ourselves to find joy in our work.
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 setting.
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, nonspecific and normal aren’t to be dismissed, repeat ECG’s, compare with old ones,
Hx: don’t be deterred to workup bc of age, women (gender bias)
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.
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.
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.
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 stroke or TIA? How long does it take to resolve? Can it happen again? In this segment, Tom Robertson and Neda Frayha help us become more A&O to this fascinating diagnosis.
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 generalizability surrounding availability of emergent echocardiography.
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