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As 2018 comes to a close, Adrian and Kris do some end-of-the year reflecting. They discuss unexpected things when they became PAs. Concepts like autonomy levels, bureaucracy, unspoken administration hurdles, professional identity, and emotional lessons are discussed.
Our listeners are always asking for more Hematology content. They are also always asking for more Ob/Gyn content! In this segment, Neda and Rob address the two together with a few cases featuring both hypercoagulability and contraception.
BOTTOM LINE: Diclofenac poses a cardiovascular health risk compared with non-use, paracetamol use, and use of other traditional NSAIDs
There are four main types of hypertensive disorders in pregnancy, and there are nuances to how each should be managed differently. In this segment, Drs. Megan Jones and Neda Frayha walk us through these four categories, how to tell them apart from one another and how to manage them, including when to consider early delivery.
Kids can have strokes?! Did you know that pediatric strokes are actually more common than pediatric brain tumors? Miz speaks to Emily Rose MD, Pediatric Emergency Medicine specialist on the topic of pediatric stroke. They explore the underlying causes, when to suspect it and how management differs compared to adults.
BOTTOM LINE: Among other recommendations, the USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years, and screening every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) in women aged 30 to 65 years.
Tremor is the most common movement disorder in primary care, and the vast majority of tremors can be evaluated and managed by primary care providers. Differentiating between causes of tremor is, for the most part, clinical – and it matters because treatments differ. In this segment, Drs. Paul Simmons and Neda Frayha discuss the major categories of tremor, clinical pearls to distinguish one from the other, and management.
Notalgia paresthetica and meralgia paresthetica are common sensory neuropathies that cause paresthesias in specific anatomic locations. If you’re anything like our team, these disease entities may sound vaguely familiar but maybe not totally memorable from your school days. In this segment, Dr. Molly Heublein provides us with a practical overview of these two parestheticas and how to diagnose and manage them.
Aspirin use prevented serious vascular events in persons who had diabetes and no evident cardiovascular disease at trial entry, but it also caused major bleeding events.
Observation care may be one of the most confusing topics in medicine. What is it? Who qualifies for it? What are the financial and clinical implications? In this segment, Drs. Steve Biederman and Tom Robertson take us on a tour of observation care and all that it means.
BOTTOM LINE: Overall, apixaban was found to be the safest drug, with reduced risks of major, intracranial, and gastrointestinal bleeding compared with warfarin. Rivaroxaban and low dose apixaban were associated with increased risks of all cause mortality compared with warfarin
1 in 5000 Americans has sickle cell disease, and these patients are at high risk for a variety of complications. Mizuho sits down with Jessica Osterman and Katie Harter to discuss sickle cell disease, pain crisis and emergencies.
Andrew Buelt has often wondered why clinicians are so quick to prescribe ACE inhibitors over ARBs. In this segment, he looks at the literature to investigate whether or not this is actual best practice.
BOTTOM LINE: There is moderate- to high-quality evidence that anticonvulsants are ineffective for treatment of low back pain or lumbar radicular pain. There is high-quality evidence that gabapentinoids have a higher risk for adverse events.
Kris and Adrian discuss benefits and difficulties of obtaining a doctorate degree and whether the PA profession necessitates them.
When PC RAP listener Lisa wrote us that she’s observed different clinicians manage superficial thrombophlebitis in lots of different ways, from doing absolutely nothing to serial ultrasound to anticoagulation, our own Rob Orman couldn’t wait to put his love of hematology to use. In this segment, he and Neda Frayha discuss the management of the superficial vein clot and inflammation
What do you do if a patient comes in with a big, swollen parotid gland? How can we tell the difference between suppurative vs nonsuppurative parotitis? And should we be worried if we suspect the suppurative kind? Dr. Tom Robertson has us covered in this segment about the workup and treatment of parotitis.
There was no mean length for age difference at 1 year of age, among children born to supplemented or non-supplemented mothers.
Dr. Rana Awdish, a pulmonary and critical care physician in Detroit, Michigan, wrote an incredibly powerful, bestselling memoir (In Shock) about her own experiences as a critical care patient. In this segment, she sits down with Neda Frayha to talk about healing, the ways the giant medical education industrial complex contributes to provider burnout, and the redemptive power of connection.
Insulin pumps are an amazing technological advancement that makes control of blood sugar so much more accurate and titratable. However when the gadget goes awry it is important to know what to do. Matt sits down with Ryan Pedigo MD to discuss troubleshooting the insulin pump when its not working correctly.
Aspirin is not like a baseball cap and does not appear to be a “one size fits all”.
The latest guidelines on the workup and management of syncope are over 278 pages long. Good thing Hippo Education is here to distill all that down into a Primary Care RAP segment! Dr. Sam Ashoo joins our own Mizuho Spangler to give us all a little spoon-fed loveliness. In this segment, they talk about red flags to look for in the history, physical exam, and EKG.
A listener asked for a review of menopause treatment options, especially given the controversial findings of the Women’s Health Initiative. So, in this segment, Drs. Molly Heublein and Neda Frayha discuss an evidence-based approach to the treatment of menopause symptoms.
The latest guidelines on the workup and management of syncope are over 278 pages long. Good thing Hippo Education is here to distill all that down into a Primary Care RAP segment! Dr. Sam Ashoo joins our own Mizuho Spangler to give us all a little spoon-fed loveliness. In this segment, they talk about risk stratification of patients, workup, and early management.
The incidence in this cohort of sudden cardiac death was 0.38% of the players monitored.
When a patient needs an oral contraceptive pill AND happens to have acne, which pill should we prescribe? Are any particular OCPs better than others? In this installment of Things I Do But Should I, Drs. Adrien Selim and Vanessa Gervais walk us through the OCP management of contraception and acne.
Insomnia is a common primary care complaint. Sure, we can all prescribe benzos, but isn’t there something else we can do first? In this segment, our own Aisha Lofters and Neda Frayha discuss the evidence surrounding different non-pharmacological treatment options.
When a PC RAP listener wrote us with a question about the differences among service animals, emotional support animals, and therapy animals, our own animal lover Brandon Grove looked into the indications, uses, and legal protections (or lack thereof) afforded to each group. In this segment, he brings us his findings.
After 6 months of combination triple therapy or usual care, those with combination pill had 9 points lower SBP.
Adrian & Kris discuss where we get our professional identity? Who do you turn to at work when you need a work-friend? Does it matter if there are other PAs there? What are you turning to them for?
Our co-hosts for the episode, Neda Frayha and Aisha Lofters, are used to seeing patients with necrotizing pancreatitis in the hospital. But in the outpatient setting? Not so much. In this segment, Aisha and Neda review the literature on optimal timing and techniques for debridement and necrosectomy in these potentially very sick patients.
Dr. Paul Offit is a world-renowned expert on the safety and efficacy of vaccines. He has authored over 160 articles, co-invented the rotavirus vaccine, and been featured on shows like “60 Minutes,” “The Daily Show,” and “The Colbert Report,” among many others. In this segment, Sol Behar and Neda Frayha pick Dr. Offit’s brain about why our patients may be skeptical about vaccines and how best to communicate with them for the safety and wellbeing of all our patients.
Among women undergoing cervical cancer screening, the use of primary HPV testing compared with cytology testing resulted in a significantly lower likelihood of CIN3+ at 48 months.
It’s a med ed podcast mashup! In this segment, The Curbsiders join Neda for a discussion of some recent articles that caught their attention.
38% of adults surveyed were on medications with depression as a possible adverse event and those that took 3 or more of these medications were 10.3% more likely to have depression.
When a patient comes to us saying, “my colonoscopy found diverticulosis. What should I do?”, what do we say? Should we recommend fiber? Is there any evidence that avoiding nuts and seeds is actually helpful? New contributor Paul Simmons and Neda Frayha walk through an evidence-based review of the management of diverticulosis in this segment.
It’s time for Hematology Rounds with Dr. Tom DeLoughery! In this segment, he and our own Matt DeClerck review the indications for and potential benefits and pitfalls of the direct oral anticoagulants (DOACs).
Pretreatment with mifepristone followed by treatment with misoprostol was way better and likely this should change your practice.
While widely prescribed, fluoroquinolones have been associated with a large number of adverse events and are the focus of multiple lawsuits against providers.
Currently there are FDA warnings regarding quinolone use and the risk of tendinitis, tendon rupture and peripheral neuropathy. More recently studies have shown an increased risk of aortic dissection and aneurysm in patients who are taking quinolones. Providers need to consider and document these potential risks when using these medications.
This study, funded by AstraZeneca, Sanofi and Bristol Meyers and Squibb and others, showed a flat risk of 6.4% over the 5 years following a TIA or minor ischemic event.
Post intensive critical care syndrome is a phenomenon that can affect up to half of all ICU survivors and cause long-lasting consequences like impaired memory, depression, and weakness. In this segment, Dr. Steve Biederman takes us on a tour of PICS, including risk factors, prevention, and possible treatment.
In patients with minor ischemic stroke or high-risk TIA, those who received a combination of clopidogrel and aspirin had a lower risk of major ischemic events but a higher risk of major hemorrhage at 90 days than those who received aspirin alone.
Kris & Adrian discuss the current climate of the PA world: academic challenges and dynamic changes occuring in practice patterns.
A listener wrote in wondering if and when she should refer her patients with IVC filters to have these filters removed. Andrew Buelt and Neda Frayha look to the literature for some answers.
There was a statistical reduction in the percent of premature children with recurrent wheezing at 12 months in those who received vitamin D supplements.
The new IDSA/SHEA practice guidelines on Clostridium difficile infection have a few changes from what we’re used to, mostly about the diagnostic algorithm and first-line treatment options. In this segment, Drs. Devang Patel and Neda Frayha review the new guidelines and how they impact our clinical practice.
Miz and Jenny discuss diagnosis and management of hyperemesis gravidarum. Given recent concerns raised about the safety profile for Ondansetron
in both maternal and fetal health, Miz and Jenny review the most recent ACOG guidelines for treatment regimens as well as referral indications.
If you want your patient to fill their P2y12 inhibitor, then give them something they can afford, aka clopidogrel.
Idiopathic pulmonary fibrosis has been a devastating diagnosis with limited mean survival time. In this segment, pulmonologist Dr. Nirav Shah and our own Neda Frayha review how to diagnose this disease, when we should consider biopsy, and some new FDA-approved therapies with some encouraging evidence behind them.
Maternal glyburide resulted in more perinatal complications vs maternal insulin.
Infertility affects 1 in 8 couples in the U.S., and patients often present first to their primary care providers. In this segment, reproductive endocrinologist and fertility specialist Dr. Lauren Roth takes us through the workup and treatment algorithm of patients with infertility, including treatment risks and success rates.
Sam and Miz discuss the diagnosis of calciphylaxis, which are indolent lesions involving the thighs commonly in dialysis patients. Typically gradual in onset, we need to consider calciphylaxis (CUA) if a necrotic core is present. This disease is rare but has a high mortality rate associated, hence this life threatening condition requires immediate initiation of therapy.
ADA guidelines for management of cardiovascular disease in diabetics have several grade A recommendations that we will cover in this paperchase.
E-cigarettes and vaping are everywhere these days, and they’re becoming more and more popular with adolescents and teenagers. Are they safe? What are the risks of electronic cigarettes? And have they been shown to help people quit smoking traditional cigarettes? In this segment, Brandon Grove walks us through the literature to date on e-cigarettes.
When a listener wrote us that he’s been noticing a lot of incidental thoracic aortic aneurysms on his patients’ calcium scoring CT scans, our Andrew Buelt couldn’t wait to dig into the literature on how best to monitor and manage these incidental TAAs. In this segment, he shares everything he learned with us. Spoiler alert: while he’s at it, he may even share some thoughts on those calcium scoring CT scans.
Among children and adults with Lennox–Gastaut syndrome, the addition of cannabidiol at a dose of 10 mg or 20 mg per kilogram per day to a conventional antiepileptic regimen resulted in greater reductions in the frequency of drop seizures than placebo.
Kris & Adrian discuss the current climate of the PA world. Academic challenges & dynamic changes occuring in practice patterns.
What do you do if you’re on a flight, someone gets sick, and a flight attendant asks, “is there a doctor on board?” Brandon Grove and Neda Frayha walk you through a play by play of what to expect, which actions to take, and what the law says about it all.
Bottomline: If you don't want to have increased risk of diabetes, then lose the weight before the age of 13, otherwise the risk persists into adulthood. Start good habits early!
There are over 140 different types of interstitial lung disease, all with their own acronym. This adds up to a complex alphabet soup that can be hard to keep straight in our daily practice. In this segment, pulmonologist and medical educator Dr. Nirav Shah provides us with a broad framework for understanding ILD and how to approach the workup and early supportive treatment.
What are the main disease processes we should look for in every post-syncope ECG? What can’t we afford to miss? Which subtle signs can point to a sinister diagnosis? In this segment, Malcolm Thaler and Matt Delaney review the most common and dangerous cardiac causes of syncope and how they may show up on ECG.
Bottomline: Varied benefits of antidepressants. Amitriptyline was most effective for acute treatment of depression. Agomelatine and fluoxetine were the most acceptable and only ones with fewer dropouts than placebo.
When a listener wrote in wondering how she can best advise her female patients in their 40s who gain weight for seemingly no reason, the PC RAP team jumped all over this request. Endocrinologist and weight loss specialist Dr. Ava Port reviews why weight creep happens in aging women, as well as successful strategies for all our patients to achieve healthy weight loss.
Bottomline: The unpublished data from the trial demonstrated a statistically significant decrease in all-cause mortality but not in the primary endpoint - sudden cardiac death.
Miz and Matt interview Dr.Brittney DeClerck on the diagnosis and management of diaper dermatitis.
Skin tags, or acrochordons, are benign but annoying skin lesions.
Mononucleosis is a common viral illness that often presents with fatigue, lymphadenopathy and sore throat. While most patients with mono have a benign self-limited course, providers need to be vigilant for patients with splenomegaly who are at risk of possible rupture.
Bottomline: Volunteer patients with CVD that sustained plant-based diets for a mean of 3.7 years, experienced a low rate of cardiac events with some seeing reversal in their coronary artery disease.
Bottomline: If you want to quit smoking when you get out of the hospital, then it is best that you don't try to use E-Cigarettes as a crutch.
Autosomal dominant polycystic kidney disease is broken down into two main subtypes: PKD-1 and PKD-2. PKD-1 leads to renal impairment approximately 20 years before PKD-2. While there is a 50% chance that the offspring of a parent with PKD will have the condition, routine screening before the age of 18 is not recommended due to to potential emotional or psychological impact and impact on insurability. Extra renal manifestations include polycystic liver disease and intracranial aneurysms. Hypertension management is key, with ACE or ARB being first line to keep BP below 130/80. Tolvaptan, a vasopressin 2 receptor antagonist, has recently been approved in the European Union, Canada, and Japan for the treatment of PKD, and it may be approved soon in the United States.
Andrew and Adrien review the pathophysiology, diagnosis and treatment of hidradenitis suppurativa. Treatments options are determined in part based on the Hurley staging system. Non-pharmacologic treatments include weight loss and wearing loose fitting clothes. Treatment options include topical and oral antibiotics, hormonal therapy, intralesional injections, topical resorcinol, oral retinoids, biologics and surgery.
Tom Deloughery shares his wisdom on all things cancer and thrombosis. First, he reviews why patients with cancer are more likely to have clots, then reviews some aspects of thrombosis that are unique to this population. Lastly, he discusses treatment standards, nuances and controversies.
Jake and Andrew break down the data for us on knee OA treatments. Lo and behold, there is not a lot of evidence!
Many times patients who present with an inflamed lower extremity are diagnosed with cellulitis. However before we jump to this diagnosis, it’s important to stop and consider other diagnosis. Greg Moran, EM/IM and infectious disease expert shares his insights and reviews recent treatment recommendations.
Parkinson’s Disease (PD) is a progressive movement disorder characterized by bradykinesia, cogwheel rigidity, tremor, and impaired balance. The diagnosis is a clinical one, based on history and physical alone. Symptoms often begin unilaterally and are gradual in onset and progression. Non-motor features of PD that can be debilitating to patients are autonomic dysfunction, such as orthostatic hypotension, constipation, and erectile dysfunction; sleep disturbances like REM sleep behavioral disorder and insomnia; and mood disorders such as anxiety and depression. While there are several medications available to treat the symptoms of PD, the mainstay of treatment is levodopa, which is paired with carbidopa in a combination pill. The timing of doses is critical to the drug’s success, and should be taken into account if a patient with PD is hospitalized.
Thanks to all the imaging studies we order on our patients, we are finding more and more thyroid nodules - and, as a result, diagnosing more thyroid cancer. In this segment, Elizabeth Lamos discusses the evaluation and management of both incidental thyroid nodules and thyroid cancers for the busy primary care clinician.
Trigeminal neuralgia is one of the most bothersome, painful conditions our patients may experience. In this segment, Drs. Matt Delaney and Malcolm Thaler review the causes of trigeminal neuralgia, how to work up these patients, and which treatments may offer some relief.
Most of us order normal saline for our inpatients as easily as we breathe the air around us. But it’s not always the best choice for our patients, even in resuscitation scenarios. In this segment, Maj Cina and Neda Frayha discuss the evidence behind colloids vs crystalloids and then, within crystalloids, emerging evidence in favor of balanced fluids instead of normal saline.
Are you a fan of your annual physicals, or are you moving away from them in your practice? In this segment, Neda and our new PC RAP contributor Aisha Lofters debate the merits and drawbacks of the annual physical. Spoiler alert: Aisha wins!
Heidi James sits down with psychiatrist Shawn Hersevoort to review the spectrum of trauma related disorders. They break down the diagnostic criteria, differences among disorders, and major treatment options.
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