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Intro: Non-Clinical PA Roles and H.Pylori

December 2019
9min

Did you know that PAs could work as a medical science liaison?  What about in insurance medicine, or communications? There are many different non-clinical career paths a PA could go and Adrian and Kris discuss a few of these and why PAs could be well suited to handle these roles.  Then, they discuss segment on H.Pylori to answer a listener’s question about who to test, how to test, and how to treat this common infection.

Psychiatric Medications in Teens

December 2019
15min

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

Paper Chase #1 - Semaglutide & CV Outcomes in DM2 Patients

December 2019
8min

Evaluate the CV risk of a new oral GLP1 agonist semaglutide.

Gestational Diabetes

December 2019
16min

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.

H Pylori

December 2019
15min

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 setting.

Paper Chase #2 - Smoking Cessation and Risk of CV Disease

December 2019
7min

Evaluate the association between years since quitting smoking and incident CVD.

DVT Nuances: The Essentials

December 2019
13min

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 chats with Salim Rezaie about this topic to reveal some practice changing pearls.

Disabusing Disability (TM)

December 2019
18min

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 notions of what disability means. 

Paper Chase #3 - Overdiagnosis of COPD

December 2019
6min

Describe prevalence of overdiagnosis of COPD and relationship to over treatment.

Hoarseness and Laryngeal Disorders

December 2019
16min

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

DVT Nuances: Advanced Care

December 2019
20min

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 chats with Salim Rezaie about this topic to reveal some practice changing pearls.

Paper Chase #4 - Strategies to Reduce Prescription Drug Costs in DM

December 2019
6min

Examine what strategies are utilized by diabetic patients to deal with high prescription drug costs.

Prostate Tips: Prostatitis vs Abscess

December 2019
13min

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.

Ayurvedic and Traditional Chinese Medicine

December 2019
21min

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.

Paper Chase #5 - PCP Supply and Population Mortality

December 2019
7min

Examine the association between Primary Care Physician density and population-level mortality.

Isolated Alk Phos Elevation

December 2019
6min

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.

Mailbag

December 2019
17min

CMS Student Changes and Common Dental Problems

November 2019
7min

Clinical preceptors will now be able to verify student notes and not have to re-document the entire encounter.  This is a huge win on the PA advocacy front and wide reaching implications for the clinical education of PA students.  Adrian and Kris discuss how this can impact the future of clinical training for students and preceptors, as well as review what they know about medical management of common dental problems in primary care.

Meds in Pregnancy

November 2019
12min

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.

Paper Chase #1 - Opioid Overdose when Prescribed to Family Members

November 2019
6min

To determine whether opioid prescriptions to family members were associated with overdose for individuals who themselves did not have an opioid prescription.

Peripartum Cardiomyopathy

November 2019
18min

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.

Common Outpatient Dental Problems

November 2019
15min

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.

Paper Chase #2 - Sleep and Subclinical Atherosclerosis

November 2019
7min

Assess if there is an association between sleep quality and fragmentation and atherosclerosis.

Cardiac Surgery Pre-Op Part 1

November 2019
25min

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 about (and what our pre-op evaluations should include) when our patients go off to cardiac surgery.

TIDBSI: Dysuria in Men

November 2019
14min

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? 

Paper Chase #3 - CRP to Guide Abx for COPD Exacerbations

November 2019
7min

To assess if point-of-care CRP testing could reduce unnecessary use of antibiotics without harming patients who have acute COPD.

Cardiac Surgery Pre-Op Part 2

November 2019
9min

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 about (and what our pre-op evaluations should include) when our patients go off to cardiac surgery.

Post-Contrast AKI: A Nephrology Perspective

November 2019
24min

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

Paper Chase #4 - Safety Net Hospitals in Maryland's All-Payer Program

November 2019
5min

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.

Benign Ethnic Neutropenia

November 2019
15min

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.

Transitioning from Peds to Adult Providers

November 2019
20min

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 pediatric to adult medical practice.

Paper Chase #5 - Short vs Long Term DAPT in PCI Patients

November 2019
8min

To test the hypothesis of noninferiority of 1-month dual antiplatelet therapy versus 12-months after percutaneous coronary intervention (PCI). 

Mailbag

November 2019
22min

Intro: Reimbursement and Acute Kidney Injury

October 2019
9min

Did you know that the Medicare Payment Advisory Commission recommended to eliminate “incident to” billing for PAs?  What does this mean for the profession? How will it affect your billing? Kris and Adrian discuss the implications of this measure and banter about whether or not post-contrast acute kidney injury is real. 6.2.6

Porphyrias in Primary Care

October 2019
15min

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 George reference. 6.2.6

Oh, Porphyria!

October 2019
3min

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 brought her vocal talent to the collaboration, and voila - ‘Oh, Porphyria!’ was born. 6.2.6

Paper Chase #1: Excess Antibiotic Duration and Adverse Events

October 2019
5min

To examine predictors and outcomes associated with excess duration of antibiotic treatment for pneumonia. 6.2.6

Hospitalist Corner: Inpatient Approach to PCN Allergy

October 2019
23min

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 down with clinical infectious diseases pharmacist extraordinaire, Dr. Emily Heil, for a practical primer on managing PCN allergies in the inpatient setting.  6.2.6

Hemophilias with Dr. Tom DeLoughery, Part 1

October 2019
20min

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

Paper Chase #2: Anticholinergic Exposure and Risk of Dementia

October 2019
8min

To assess associations between anticholinergic drug treatments and risk of dementia in persons 55 years or older. 6.2.6

Post-Contrast AKI

October 2019
27min

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 literature actually tells us about it.  6.2.6

Paper Chase #3: Apixaban vs Warfarin for A-Fib in Body Weight Extremes

October 2019
5min

To assess the efficacy and risk profile for apixaban in different weight groups in patients with atrial fibrillation. 6.2.6

Rotator Cuff Injuries

October 2019
22min

“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 diagnose and treat them like experts. 6.2.6

Hemophilias with Dr. Tom DeLoughery, Part 2

October 2019
14min

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

Human Trafficking

October 2019
15min

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 victims. 6.2.6

Paper Chase #4: Chronic Tramadol Use After Acute Pain

October 2019
7min

To determine the risk of prolonged opioid use in patients receiving tramadol compared with other short acting opioids. 6.2.6

Keto Diet

October 2019
21min

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 particular diet and what we as clinicians need to know about it.  6.2.6

Paper Chase #5: Step Volume & Intensity and Mortality in Older Women

October 2019
8min

To assess associations between number of steps per day, step intensity, and all cause mortality.  6.2.6

Mailbag

October 2019
20min

  6.2.6

VAPI: Vaping Associated Pulmonary Injury

September 2019
17min

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 CDC health alert. Take a listen!

PCN Allergy: Fake News?

September 2019
4min

One of the more common “allergies” we see in clinical practice is penicillin.  But how many of these patients had a true allergic reaction? How many are still allergic now?  What are the consequences of carrying a penicillin allergy on a medical record? Adrian and Kris discuss this segment and talk about their experience with allergies in their medical practice.

Primary Care Late in the Day

September 2019
12min

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. 

Paper Chase #1 - Quality of Bowel Prep in Inpatient Colonoscopies

September 2019
7min

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.

New Asthma Therapies

September 2019
20min

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 helpful IRL.

Hospitalist Corner: Lightning Round #2 - CV Topics

September 2019
18min

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. 

Paper Chase #2 - Antithrombotic Therapy after ACS or PCI in A-Fib

September 2019
5min

Standard-dose apixaban and a P2Y12 inhibitor without aspirin resulted in less bleeding and fewer hospitalizations.

Penicillin Allergy: Fake News?

September 2019
25min

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 the primary care setting. 

Headache in Children

September 2019
20min

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 exam will help make appropriate decisions on further workup and treatment. 

Paper Chase #3 - Serious Adverse GI Events and Sodium Polystyrene Sulfonate Use

September 2019
6min

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.

Penicillin Allergy in Primary Care

September 2019
8min

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 the primary care setting.

Paper Chase #4 - Canagliflozin and Renal Outcomes in T2DM and Nephropathy

September 2019
4min

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. 

Lipid Guideline Update

September 2019
25min

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. 

Choosing a Diet: Where to Begin

September 2019
19min

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 work for them. 

Paper Chase #5 - Clinical Outcomes of Ambulatory Hemodynamic Monitoring

September 2019
5min

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.

Mailbag

September 2019
17min

HIV Management in Primary Care

August 2019
6min

It’s August! A perfect time for sitting on the dock of the bay, watching the clouds roll away and a great time to look back on summer memories. Adrian and Kris take a stroll down medical memory lane and talk about their most memorable summer medicine. Then they highlight our August segment on managing HIV in primary care to summarize the key take-aways from this.   

Neda and Her Friends

August 2019
8min

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

Paper Chase #1 - PE Prevalence in ED Patients with Syncope

August 2019
5min

Study the prevalence of PE among patients presenting to the ED with syncope.

Chagas Disease

August 2019
17min

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 outs of Chagas disease, one of five neglected parasitic infections in the U.S. according to the CDC.

TIDBSI: Antibiotics for Recurrent UTIs

August 2019
11min

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.

Paper Chase #2 - Cardioversion in New A-Fib

August 2019
7min

To determine if immediate cardioversion in recent-onset atrial fibrillation is necessary compared to a wait-and-see approach.

Tobacco Cessation - Part 1

August 2019
20min

Neda and Michael discuss the spectrum of outpatient tobacco cessation treatment including FDA approved pharmacotherapy, innovative strategies, and alternative/complementary treatments. 

HIV Care for the Primary Care Clinician

August 2019
24min

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.

Paper Chase #3 - Diagnosis of PE in Pregnancy

August 2019
5min

To validate a specific diagnostic algorithm in pregnant women with suspected PE.

Pediatric Murmur: Innocent or Not?

August 2019
24min

Pediatric cardiologist Pierangelo Renella discusses with Sol how to distinguish between innocent and pathologic heart murmurs

Tobacco Cessation - Part 2

August 2019
14min

Neda and Michael discuss the spectrum of outpatient tobacco cessation treatment including FDA approved pharmacotherapy, innovative strategies, and alternative/complementary treatments. 

Paper Chase #4 - Low-Value Pre-Op Care Before Cataract Surgery

August 2019
7min

To evaluate a multipronged intervention to reduce low-value preoperative care for patients undergoing cataract surgery and analyze costs from various fiscal perspectives.  

Chronic Pelvic Pain

August 2019
15min

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.

Patient Complaints

August 2019
18min

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 insurance company when litigation is possible. 

Paper Chase #5 - Pregnancy-Adapted YEARS Algorithm for Diagnosis of PE

August 2019
5min

To assess whether a specific pregnancy-adapted algorithm can be safely used to avoid unnecessary diagnostic imaging in suspected PE.

Mailbag

August 2019
16min

PAs, New Residents/Attendings, and Storytelling in Medicine

July 2019
11min

With the start of the new season of medicine (medical students to resident, residents to fellows, fellows to attendings), it a great time to talk about how PAs fit into this training of model for our physician colleagues.  Our host discuss their experiences at teaching institutions and highlight a May 2019 article in the Journal for the American Academy of Physician Assistants. Then, Adrian and Kris tell you a story on how storytelling is important in medicine.

Missing DEA Numbers

July 2019
16min

To review the phenomenon of missing or misused DEA numbers and what to do if it happens to you. 

Genetic Screening in Pediatrics

July 2019
12min

Lisa Patel and Andi Marmor discuss how new advances in genetic testing and personalized medicine raise ethical issues for providers and families. 

Paper Chase #1 - Pneumatic Compression for VTE Prophylaxis

July 2019
6min

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.

First Trimester Bleeding

July 2019
28min

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 understand.

Paper Chase #2 - Nonspecific Symptoms and Infection in Older Patients in the ED

July 2019
5min

To determine if nonspecific symptoms and fever affect probability of acute bacterial infection in older patients.

Obsessive Compulsive Disorders, Part 1

July 2019
23min

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 pearls and management tips with our own Dr. Mizuho Morrison.

Storytelling in Medicine

July 2019
25min

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 learn more about the role of narrative medicine in our work and wellbeing.

Paper Chase #3 - Inpatient Delirium and Hospital Readmission

July 2019
5min

 To determine the association between delirium and 30-day readmission.

Obsessive Compulsive Disorders - Part 2

July 2019
12min

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 pearls and management tips with our own Dr. Mizuho Morrison.

Migraine Headache

July 2019
23min

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.

Paper Chase #4 - SIESTA and Hospital Sleep Disruption

July 2019
6min

Assess changes in nighttime disruptions and patient experience through EHR changes and interprofessional education initiatives.

The Skinny on Weight Loss Programs

July 2019
8min

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 the commercial weight loss programs our patients may be asking about.

Paper Chase #5 - Patient Safety Outcomes and Duty Hour Rules

July 2019
6min

 Allowing program directors flexibility in adjusting duty-hour schedules for trainees did not adversely affect 30-day mortality or patient safety. 

Mailbag

July 2019
24min

Spaced Retrieval

June 2019
11min

Do you remember what was covered in the segments from the AAPA Primary Care Podcast over the past few months?  Have you reviewed the specific segments that could influence your practice? Our hosts review the key points that spoke to them in a challenge bowl style format to utilize spaced repetition to enhance retention. Then listen in as Kris and Adrian take a second July madcap adventure that many of us have been on- the adventure of navigating obesity treatment!     

Fatty Liver

June 2019
14min

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.  

Hospitalist Corner: Lightning Round

June 2019
16min

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.

Paper Chase #1 | Medications for Pain Control in Knee OA

June 2019
5min

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.

Things I Do, But Should I? Codeine for Cough

June 2019
8min

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.

Paper Chase #2 | E-Cigarettes vs Nicotine Replacement Therapy

June 2019
5min

E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support.

Cannabis Use in Pregnancy

June 2019
20min

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 use in pregnancy and breastfeeding, as well as approaches we can use in managing these patients.

Paper Chase #3 | Topical Pain Creams for Chronic Pain

June 2019
4min

Compounded pain creams were not better than placebo for treatment of chronic pain. 

Obesity Medicine for the PCP

June 2019
23min

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 the best evidence behind successful weight loss and how we can best advise our patients to achieve this goal. This is the first of a 3-part series on diet and weight loss. 

Paper Chase #4 | Cost-Effectiveness of Alirocumab

June 2019
6min

The price of alirocumab would have to be reduced considerably to be cost-effective. 

IBD in Primary Care

June 2019
21min

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 gastroenterologists for true primary care needs.

Common Peds Fractures

June 2019
23min

Andi and Miz sit down with PEM doc Ilene Claudius to sort out high yield and “can’t miss” pediatric foot and ankle injuries.

Paper Chase #5 | Aerobic Exercise After Concussion

June 2019
5min

Aerobic exercise speeds recovery and may reduce incidence of delayed recovery in adolescents with sports related concussions.

Informed Consent

June 2019
18min

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 the NPR Health Desk, to get the scoop on informed consent and how we can apply it to our daily clinical practice.

The Summary

June 2019
18min

PA Profession is Number 1!!!!

May 2019
9min

Our PA hosts discuss the US News and World Report that lists the PA profession as the #1 best health job in 2019 and what this can mean for the future of the profession, the projected growth of PAs, and the impact on PA programs.  Then, Kris and Adrian reflect on clinical reasoning and decision making. Yes, it gets pretty meta!  

Mailbag Extravaganza, Continued!

May 2019
16min

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.

Practical Diabetes Care: How Do I Order That?

May 2019
25min

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 diabetic patients, along with tips for injection techniques, common prescribing pitfalls to avoid, attention to insulin pricing, and the new continuous glucose monitor that primary care providers will be prescribing. This segment will change your practice.  

Paper Chase #1 - Bacterial Contamination on Stethoscopes

May 2019
5min

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.

Polycythemia Vera - Part 1

May 2019
21min

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 mass, elevated Hgb/Hct, aquagenic pruritus, erythromelalgia, and/or systemic thrombi (MI, stroke, DVT, etc). Diagnosis is confirmed by presence of the JAK2 gene mutation. Treatment is focused on decreasing RBCs with phlebotomy and/or cytoreductive therapy; symptom control; and treatment/prevention of arterial or venous thrombi.

Croup

May 2019
15min

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. 

Paper Chase #2 - Oral Anticoagulants and PPIs and Upper GI Bleed

May 2019
6min

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.

Polycythemia Vera - Part 2

May 2019
10min

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 mass, elevated Hgb/Hct, aquagenic pruritus, erythromelalgia, and/or systemic thrombi (MI, stroke, DVT, etc). Diagnosis is confirmed by presence of the JAK2 gene mutation. Treatment is focused on decreasing RBCs with phlebotomy and/or cytoreductive therapy; symptom control; and treatment/prevention of arterial or venous thrombi.

OB Potpourri

May 2019
19min

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 for twin pregnancies, and preterm contractions vs labor.

Paper Chase #3 - Vitamin D & Prevention of CA & CV Disease

May 2019
3min

Supplementation with vitamin D did not result in lower incidence of invasive cancer or cardiovascular events than placebo.

Probiotics

May 2019
10min

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.

Incidental Lung Nodules

May 2019
12min

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 nodules and when.

Paper Chase #4 - Outcomes After Hospitalization with Anemia

May 2019
4min

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.

Wandering in Dementia

May 2019
11min

In this segment, Brandon Grove reviews the literature on wandering in patients with dementia and some innovative strategies to help keep these patients safe.

Clinical Reasoning

May 2019
19min

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 Medicine and director of their Introduction to Clinical Medicine course, walks us through systems of thinking and decision making so we can be our best clinical selves.

Paper Chase #5 - CV Outcomes in Previous MI and Mild DM Following Pioglitazone

May 2019
4min

Pioglitazone did not reduce the occurrence of cardiovascular events in patients with mild DM and previous MI.

The Summary

May 2019
12min

PA Residencies: Love Them Or Leave Them?

April 2019
6min

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.

Mailbag Extravaganza!

April 2019
15min

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.  

Dr. Mona: The Flint Lead Crisis and Patient Advocacy

April 2019
20min

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.

Paper Chase #1 - VIPVIZA Trial

April 2019
7min

To investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.

TIDBSI: Doxycycline in Kids

April 2019
8min

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. 

The Patient Experience

April 2019
21min

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.  

Paper Chase #2 - Transitional Care and Self-Management in COPD

April 2019
5min

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

April 2019
20min

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.  

New Concussion Guidelines

April 2019
23min

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. 

Paper Chase #3 - AMACING Trial

April 2019
5min

To evaluate the non-inferiority of NO prophylaxis compared to guidelines recommended prophylaxis in preventing contrast induced nephropathy.

Chronic Rhinosinusitis

April 2019
9min

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.

Evidence-Based Physical Exam

April 2019
20min

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. 

Paper Chase #4 - Triple Therapy for COPD

April 2019
4min

To compare the rate of moderate to severe exacerbations between triple therapy and dual or monotherapy in patients with COPD.

Bursitis

April 2019
8min

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. 

Adrenal Incidentaloma

April 2019
8min

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.

Paper Chase #5 - Alirocumab and CV Outcomes After ACS

April 2019
6min

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.

The Summary

April 2019
17min

PAEA’s Response to White House Report on Reforming America’s Health Care

March 2019
3min

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

March 2019
14min

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.

Sepsis

March 2019
18min

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. 

Paper Chase #1 - Zoliflodacin for Gonorrhea

March 2019
7min

To evaluate if a novel antibiotic Zoliflodacin is effective in treatment of uncomplicated gonorrhea.

Nephrotic Syndrome in Kids

March 2019
15min

Jason Woods digs deep into the diagnosis, complications, and management of nephrotic syndrome with pediatric nephrology doctor Danielle Sorrano. 

Pharmacologic Treatment of Alcohol Use Disorder

March 2019
16min

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.

Paper Chase #2 - COMPASS Trial

March 2019
5min

To evaluate the efficacy of rivaroxaban alone or in combination with aspirin for secondary prevention of CV disease.

Aspirin: The Latest Literature

March 2019
10min

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.

Alcohol Use Disorder: Emerging Therapies

March 2019
9min

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.

Paper Chase #3 - AGA Guideline on Opioid-Induced Constipation

March 2019
5min

To present official recommendations for the medical management of opioid-induced constipation.

Balanoposthitis

March 2019
19min

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.

Management of Borderline Personality Disorder

March 2019
18min

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.

Paper Chase #4 - Kidney Damage Biomarkers and CKD in BP Reduction

March 2019
4min

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.

Acute Rhinosinusitis

March 2019
11min

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.

Feedback in Education

March 2019
13min

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.

Paper Chase #5 - Complications of Indwelling Urethral Catheters

March 2019
6min

To determine the incidence of infectious and noninfectious patient-reported complications associated with the indwelling urethral catheter.

The Summary

March 2019
15min

Advances in Hospice Care for PAs

February 2019
4min

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.  

Female Alopecia

February 2019
18min

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.

Paper Chase #1 - Partial Oral versus IV Antibiotic Treatment of Endocarditis

February 2019
6min

BOTTOM LINE: In patients with left-sided endocarditis in stable condition, changing to oral antibiotics was noninferior to continued intravenous antibiotics.

Asymptomatic Hypertension: ED or No ED?

February 2019
16min

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. 

Personality Disorders Part 1: Tricks of the Trade

February 2019
21min

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.

Paper Chase #2 - Telemedical Management of Heart Failure

February 2019
5min

BOTTOM LINE: Remote telemedical interventions reduced hospital admission days and all-cause mortality.

Eosinophilia

February 2019
15min

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.

Paper Chase #3 - Thyroid Hormone Therapy on QOL in Subclinical Hypothyroidism

February 2019
5min

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

Personality Disorders Part 2: Don't Die, and Document

February 2019
18min

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.

It's the System: Organizational Strategies for Burnout

February 2019
20min

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.

Paper Chase #4 - Statins for Primary CV Prevention

February 2019
4min

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.

DOAC Reversal

February 2019
20min

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?

Starting OCPs

February 2019
18min

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.

Paper Chase #5 - Evaluating Galcanezumab for the Prevention of Episodic Migraine

February 2019
4min

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.

Polymyalgia Rheumatica

February 2019
12min

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.

The Summary

February 2019
16min

New Year, New Plans, New Solutions

January 2019
5min

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.

PPI Deprescribing

January 2019
14min

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.

TIDBSI: OCP Myths

January 2019
17min

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.

Paper Chase #1 | Baloxavir for Uncomplicated Flu

January 2019
7min

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.

Beyond Pixar: Perfectionism, EQ, and the Middle Way

January 2019
22min

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.

Paper Chase #2 | Procalcitonin-Guided Antibiotics in Lower Resp Tract Infection

January 2019
6min

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.

Egg Freezing and Genetic Screening

January 2019
7min

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.

Beyond Pixar: Self-Care and the System

January 2019
15min

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.

Paper Chase #3 | Effect of Pip-Tazo vs Meropenem in Bacteremia

January 2019
5min

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.

Medicolegal Risks of Low Risk Chest Pain

January 2019
22min

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)

Hospitalist Corner: Preventing AKI

January 2019
21min

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.

Paper Chase #4 | Managing Low-Risk PE Patients Without Hospitalization

January 2019
5min

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.

Gastroesophageal Reflux Disease

January 2019
19min

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.

Transient Global Amnesia (TGA)

January 2019
16min

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.  

Paper Chase #5 | Influence of FIT Positivity Thresholds on Cancer Detection

January 2019
7min

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.

The Summary

January 2019
15min