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Kris and Adrian discuss different principles clinicians use when faced with the uncertainty and ambiguity of medicine and how these can help with clinical decision making. It all gets wrapped up with a good review on mumps and its vaccination recommendations.
How comfortable are you with uncertainty? Super comfortable? Great! Then there’s absolutely no reason to listen to this month’s intro conversation, in which Neda and Paul talk about how they’ve coped with all the uncertainty of the covid-19 pandemic and dive into the literature to find some solutions.
Use of low-dose aspirin was associated with significantly lower risk of hepatocellular carcinoma and lower liver-related mortality in patients with chronic viral hepatitis.
Ilene Claudius reviews for us the classification of burns in pediatric patients and how this affects management. Criteria and referral to a burn center is discussed as well as the treatment of burns for outpatient vs. inpatient management.
Compared with implantable loop recorders, the diagnostic yield of detecting Afib improved with increased number of screenings and duration of screenings.
We’ve talked about IV contrast and the kidneys, but what about the gadolinium-based contrast agents we use for MRIs? Are they safe in kidney disease? Neda and Paul break down nephrogenic systemic fibrosis and how we should think about the GBCAs.
Do you automatically refer to a urologist when a patient asks about a vasectomy? Have you ever considered that this procedure can actually be done in the primary care office? Our own Paul Simmons discusses this with Dr. Lyrad Riley in the first installment of a new series on procedural tips and tricks called: “Proceed with Confidence.”
Treatment-limiting POLSTs were significantly associated with lower rates of ICU admission compared with full-treatment POLSTs. However, 38% of patients with treatment-limiting POLSTs received intensive care that was potentially discordant with their POLST.
How much do you know about Neonatal Abstinence Syndrome? Whether you work in hospital medicine or in the clinic, it’s important to be aware of the risks of substances on neonates and understand what happens after they’re born. In this segment, Dr. Michael Baca-Atlas and Dr. Matt Zeitler take a deep dive into NAS while they work through a case together.
Have you ever ordered a lab and then been baffled by the results? Paul Simmons starts a new series called, “What’s That Lab” in which he teaches us what we need to know about common laboratory tests. First up: Ferritin.
A score of <3 on the PEN-FAST clinical decision rule was associated with a high NPV and could be used to identify low risk PCN allergies.
We all learned about mumps in school, but how often is it on your differential? In this segment, Dr. Micaela Robb Bowers takes Neda through a crash course on mumps, including complications and fertility concerns.
Colon cancer screening guidelines seem to be changing constantly. For the newest updates, tune in to Paul and Neda’s conversation with GI guru, Dr. Sandra Quezada.
Insured adults have been visiting PCPs less often and nearly one half had no PCP visits in a given year by 2016.
Medical tests can lie. X-rays are simply a test. The purpose of any test is to affect our pre-test probability - it is not to make a diagnosis. Any test result (positive or negative) must be placed in the clinical context it is being used. We should have an expectation of any test before we order it. Neda and Matt sit down with Orthopedic expert Dr.Arun Sayal to discuss best use of radiographic films in our workup.
In recent weeks, many of our medical organizations have released official statements declaring racism to be a public health crisis. In this introduction to Hippo Education’s new Race and Medicine audio series, Dr. Jay-Sheree Allen sits down with Primary Care RAP host Dr. Neda Frayha for a candid conversation exploring the definition and types of racism, the historical and present-day manifestations of racism in medicine, and potential strategies we all can incorporate into our daily practices to go beyond the hashtag and become true allies.
Drs. Brian Lin and Mike Weinstock discuss alterations to our usual practice patterns of laceration repair in the setting of the COVID pandemic, which include increasing patient throughput through faster closure techniques, reducing total points of contact with the healthcare system by using techniques to obviate the need for a return visit, and habit changes during closure to minimize exposure risk during face-to-face contact.
How are you coping with all of the death around us these days? In this Hippo Education update, Primary Care RAP host Dr. Neda Frayha interviews Dr. BJ Miller, a hospice and palliative care specialist at the University of California, San Francisco whose TED talk on what really matters at the end of life has been viewed over 10 million times. Along with Shoshana Berger, Dr. Miller is the co-author of the book, A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death and founder of the Center for Dying and Living. In this conversation, he helps us come to terms with our own mortality and provide better support to our patients at the end of life.
Oh oh, ohohoh, oh oh oh oh, oh oh, ohohoh, the RIGHT STUFF! Remember New Kids on the Block? Everyone’s the new person sometimes! A snappy 90s pop song might help, but in case you need more, Kris and Adrian examine a few of the important things to keep in mind when it’s your turn to be the new kid on the block. They also dive into what organizations can do well when onboarding. It all gets wrapped up with their take on the continuous glucose monitoring segment. This is one you can’t miss!
Does the thought of completing a death certificate scare you half to death? In this month’s intro segment, Neda and Aisha get into the nitty gritty of how to accomplish this (sometimes) daunting task.
An elderly patient with knee pain limps into your clinic asking for a “cortisone shot”. Do you reach for the needle? Paul Simmons and Justin McCarthy dive in to the real evidence behind intra-articular knee injections in this TIDBSI segment.
Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care.
Most cases of AGE in children are self-limited illness that can be managed with supportive care. Antiemetics facilitate oral rehydration. Treat more severe cases with IV fluid rehydration. Do not empirically treat suspected bacterial diarrhea with antibiotics given risk of HUS with certain strains of E Coli (O157:H7).
Are you an expert in continuous glucose monitors and how to use them? Great! Then you can teach us! If not, endocrinologist and friend of the podcast Dr. Beth Lamos is back to walk us through the indications for CGMs and practical ways to use them in our patients.
Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial.
Ever wondered what to do when a patient has flashers or floaters? None other than Dr. Glaucomflecken is here to teach Mike and Neda about how to tell these presentations apart, how to manage them, and when to call your friendly local ophthalmologist.
Risk of Acute Kidney Injury Following Contrast-enhanced CT in Hospitalized Pediatric Patients.
Dr. Mizuho Morrison & Dr.Jenny Beck Esmay both having had covid themselves, briefly discuss the clinical course and what presence of IgM vs. IgG signifies. They discuss what we currently know about antibody testing (national availability, reliability, sensitivity) as well as convalescent plasma transfusion (CPT) and criteria for donation vs. recipient.
Asthma treatment guidelines have been evolving since the last published guidelines in 2007. Take a deep breath with Paul Simmons as he dives into the 2019 recommendations from GINA.
Effect of Sunscreen Application on Plasma Concentration of Sunscreen Active Ingredients.
Are you stumped by prescribing medications to nursing mothers? Do you know about pumping and dumping? Neda sits down with Dr. Elizabeth Lavery to discuss the use of medications in breastfeeding women so we can feel empowered to prescribe in this population.
Few things can ruin our mood more quickly than a request for a prior authorization or a peer-to-peer. In this segment, Neda and Dr. Ashish Patel tackle the beast that is the dreaded prior authorization.
Screening for Hepatitis C Virus Infection in Adolescents and Adults USPSTF recommendation statement.
*Editor's note: As of June 4, 2020, The Lancet article by Mehra MR et al has been retracted. (https://www.thelancet.com/lancet/article/s0140673620313246)
In this Hippo Education short, Dr.Salim Rezaie from REBEL EM and Lit Matters critically appraises two papers published on Friday May 22nd, 2020. He discusses what the evidence shows for both remdesivir & hydroxychloroquine/chloroquine as effective treatment or prophylaxis for COVID-19.
COVID-19 causes STEMI’s, arrhythmias and myocarditis?!? Emergency medicine and cardiology guru Amal Mattu, MD chats with Mizuho Morrison, DO on the cardiovascular effects of COVID-19. They discuss: the known pathophysiology of how viral infections affect the heart; Review the new consensus statement from the Society of Cardiovascular Angiography and interventions (SCAI), American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP) on how to manage STEMIs; and lastly discuss how cardiac arrest management differs in this COVID era.
Children seem to be less affected than adults by the direct effects of COVID-19 infection, but the pandemic has brought forth other health risks to the pediatric population. Sol Behar interviews Oakland, CA based primary care pediatricians Celine Sparrow and Katie D’Harlingue about the indirect impact of COVID-19 on children. Topics covered include home school and academic achievement, mental health issues, and nutrition/food insecurity.
Sol Behar interviews New York City pediatric emergency doctor Dr. Ee Tay, highlighting the features of pediatric COVID disease, including an emerging illness that is being compared to Kawasaki Shock Syndrome called “pediatric inflammatory multisystem disease” (PIMS).
Dr. Matthieu DeClerck talks to Dr. Manie Beheshti on how the healthcare system should approach the “re-opening” of society as we plan the lifting of social restrictions. What safety implementations need to be in place in order to protect our most vulnerable patients. What changes can we anticipate in the healthcare system moving forward.
Do you like POEMs? Kris and Adrian review some of the top 20 Patient Oriented Evidence that Matters from 2019 and give their take on how to best apply these potentially practice changing recommendations.
Isn’t primary care full of diagnoses you’d never heard of before? In the intro to our May 2020 episode, Neda and Aisha go through the basics of proctalgia fugax, a condition that affects 20% of patients (or more!).
To determine whether adding antiviral treatment for patients with an influenza like illness reduces time to recovery.
Hippo Education’s EM/Ortho expert, Dr. Arun Sayal, joins Matt DeClerck and Neda Frayha for a high-yield conversation about knee pain, the knee exam, and knee X-rays.
Have you ever had a patient who is on peritoneal dialysis? What does this even mean? How does it work? Neda and Paul answer these questions and more in this 2 part-segment about peritoneal dialysis
To identify prevalence and risk factors associated with unnecessary bimanual pelvic exams and pap smears in young women less than 21 y/o.
When a listener wrote that many different chronic pain syndromes felt a little confusing to her, we were relieved that it wasn’t just us! Join us as our regular contributor Dr. Molly Heublein breaks down different pain syndromes that we see all the time in primary care.
Have you ever had a patient who is on peritoneal dialysis? What does this even mean? How does it work? Neda and Paul answer these questions and more in this 2 part-segment about peritoneal dialysis.
To investigate the effect of abstinence from alcohol on secondary prevention of atrial fibrillation.
When PC RAP listener David wrote to us that he has seen more of his patients using alcohol in pregnancy, our own Michael Baca-Atlas put on his addiction medicine hat to review research and recommendations regarding alcohol use in pregnancy.
Sol and Matthieu discuss the differential diagnosis, evaluation and management of pediatric lymphadenopathy, including when to pursue imaging and specialist referral.
To examine different OUD treatment pathways and associations with overdose or opioid-related acute care.
The use of scribes in medical practices has been around for decades. They have been utilized in emergency departments, primary care practices, inpatient medical teams, and specialty practices. The use of scribes in the urgent care can be a big improvement to the practice if the implementation is correct. Sam Ashoo discusses with our team his thoughts on this implementation.
We’ve been discussing breast health and breast cancer screening recently on PC RAP, but haven’t touched on the physical exam yet. In this segment, Dr. Rebecca Zendel Berliner walks us through how to perform a complete history and physical exam for a breast complaint.
To assess the risks of fracture associated with differences in concentrations of 25-hydroxyvitamin D in observational studies and the risks of fracture associated with supplementation with vitamin D alone or in combination with calcium.
In this Hippo Education Short, psychiatrist Dr. Melissa Shepard sits down with Primary Care RAP host Dr. Neda Frayha for some real talk on the mental health challenges facing health care workers in the COVID-19 pandemic, and some concrete, tangible tools to help us get through this period. Spoiler alert: it’s more than yoga.
Dr. Matthew DeLaney and Dr. Michael Weinstock sit down to discuss the threat of lawsuits in the midst of the COVID pandemic. The last thing anyone wants to think about is the risk of a lawsuit. Unfortunately, despite the extra challenges posed by our current pandemic, the threat of medicolegal consequences remains. In this segment, we evaluate the unique medicolegal risks that can occur during disaster situations and look at potential sources of medicolegal protection.
Drs. Mike Weinstock and Josh Russell, from Urgent Care RAP, just published a landmark COVID study: CXRs obtained from confirmed and symptomatic COVID-19 patients presenting to the UC were normal in 58.3% of cases, and normal or only mildly abnormal in 89% of patients.
COVID airway management creates a lot of anxiety for those of us non-intensivists. Dr. Mizuho Morrison interviews Dr. Scott Weingart (founder of EMCrit.org and Chief of the Division of Emergency Critical Care at Stony Brook University Hospital, NY) on the basics of COVID airway management.
Patients with COVID-19 present in a variety of ways, and clinicians need to have a low index of suspicion for diagnosis. Management involves emergency referral for patients with a low oxygen saturation. Every patient should be treated as if they could have COVID-19.
We all like to get paid, right? Do you know all the “ins and outs” of reimbursement? If not, you are in luck! Adrian and Kris talk about the five most common questions regarding reimbursement for PAs in 2019. After that, stick around to hear how to help destigmatize therapy for our patients and make it more universally accepted.
Neda and Paul are back at it, answering your questions. Here they cover: TMJ dysfunction, the new Nordic diet, and hypopigmentation
To evaluate beta blockers efficacy in preventing COPD exacerbations.
It’s estimated that at least 1.4 million Americans identify as transgender. In this segment, Neda and endocrinologist Dr. Elizabeth Lamos discuss how we, as primary care clinicians, can best serve our transgender patients at any point before, during, or after their gender transition.
When a patient with poorly controlled diabetes presents with numbness and tingling in their feet, how well do we really know what to do next? To help us understand diabetic neuropathy a bit better, Dr. Harpreet Tsui joins Neda to discuss screening, diagnosis, and treatment pearls.
To assess effect of Dapagliflozin vs placebo in patients with HFrEF.
Sometimes it can seem like every other child we see has a food allergy. How prevalent are food allergies in the general population, and how can we best diagnose and manage them? To shed light on these questions, as well as recent guideline changes in the allergy community and novel therapies on the horizon, PC RAP welcomes back Dr. Torie Grant, a Med/Peds allergist and immunologist at Johns Hopkins. She sits down with Neda to share the full scoop on food allergies.
Tramadol - good or bad? This age-old question has been burning for decades. Today, Paul Simmons and Justin McCarthy will attempt to settle the matter once and for all in our latest Things I Do But Should I conversation.
To evaluate the safety and efficacy of 10 mg prednisolone in treatment of patients with osteoarthritis and signs of inflammation.
Sol interviews Children’s Hospital of Phildelphia NICU doc Joanna Parga-Belinkie to discuss Covid-19 and the some of the peripartum issues that come up during the novel coronavirus pandemic for both pregnant moms and their newborns.
Mizuho sits down with emergency medicine pharmacist/toxicologist Bryan Hayes, PharmD to answer some pertinent questions and myth-bust clarifications about pharmaceutical options in COIVD-19 treatment.
If your car broke down on the side of the road, wouldn’t you ask for help? New PC RAP contributor Dr. Jay-Sheree Allen brings this analogy to how we can help our patients seek the appropriate mental health care they need, focusing on the indications for and benefits of therapy.
To assess the effect of post-discharge scheduling assistance on PCP followup or readmissions.
Pre-charting can be a controversial topic in the medical community. Should we do it? Should we not? Aisha shares her thoughts on the advantages and disadvantages of pre-charting, as well as some tips and tricks she uses in her own practice.
Vaginal bleeding - an Ob/Gyn concern, right? Not so fast. Turns out, we can handle quite a bit of this in primary care. Neda and Dr. Megan Jones dive into diagnosis and management of bleeding in both the pre and post-menopausal woman.
To investigate the safety of a standardized perioperative DOAC management strategy.
Has your clinical practice shifted to telemedicine yet? In the era of COVID-19, clinicians everywhere are being thrown into telemedicine, often without any experience or background knowledge. To help us all get up to speed with this patient care technology, Hippo Education’s Dr. Neda Frayha sits down with Dr. Edward Kaftarian, the Vice Chair of Mental Health at the American Telemedicine Association and CEO of Orbit Health Telepsychiatry. Together they explore the benefits and potential pitfalls of telemedicine, the equipment required, billing and coding considerations, appropriate etiquette, and much more.
Many healthcare workers are worried if we get called in to help with COVID patients because this may be outside our scope of practice. Aaron Bright, MD sits down with Salim Rezaie, MD to simplify critical frontline lessons to keep you and your patients safe if you get called in. Topics include pearls and pitfalls regarding: PPE, management of stable suspected COVID patients, respiratory interventions, diagnostic and radiology patterns, and provider self-care tips.
Our panel of podcast hosts from a variety of practice settings discuss the logistical and psychological impact of the COVID-19 pandemic on healthcare workers and discuss strategies to mitigate the stress associated with the pandemic.
In this Hippo Education Short, Infectious Diseases specialist Dr. Devang Patel and our own Dr. Neda Frayha discuss the latest, clinician-focused updates on the COVID-19 coronavirus outbreak.
Adrian and Kris talk PAs and Medically Assisted Treatment- that’s MAT for our patients struggling with opioid dependency. Tune is to learn more about the PAs role and opportunities in fighting this crisis.
When the PC RAP mailbag is overflowing, Neda and Paul get to work and tackle a few of your questions at once.
When a patient with COPD and CHF presents with shortness of breath, how do we know what’s causing it? The heart? The lungs? Both? Neda discusses the best approach for this diagnostic conundrum with Dr. Sam Ashoo, ED physician and dyspnea expert.
To assess the ability of a smartwatch to identify individuals with new afib.
Hyperprolactinemia is a common endocrine condition that can be treated in the primary care setting if our patients aren’t able to see an endocrinologist. Aisha and Neda run through the complete diagnosis and management of hyperprolactinemia in this segment.
To assess if there is a superior first-line antihypertensive.
It is now recommended that NOACs are chosen over warfarin, in patients with atrial fibrillation, except in patients with moderate to severe mitral valve stenosis or a mechanical heart valve.
To investigate the relationship between metabolic surgery and incident major adverse cardiovascular events in patients with type 2 diabetes and obesity.
When we treat patients, whether in the hospital or outpatient setting, involving their family members can lead to improved outcomes. Tom and Miz discuss the engagement of family members with Dr. Giora Netzer, who literally wrote the book on family centered care.
To assess incidence compare mortality from neurodegenerative disease morbidity and mortality among soccer players.
Sol Behar interviews Portland, OR doctors Holly Tse (urgent care) and Paul Lewis (infectious disease and public health) to chat about the real world experience of responding to the measles outbreak in their community.
While eye complaints are common, true eye related emergencies are fortunately rare. Any patient with sudden painful vision loss, binocular diplopia or possible penetrating globe injury should be seen emergently by an ophthalmologist.
To describe prescribing trends of gabapentinoids in hospitalized patients.
Approximately 8.2% of the population engages in same-sex behaviors. This population is considered in the sexual minority, and has a different set of health needs from the sexual majority. Neda, Tom, and Dr. Helen Hedian dive into the details of these needs so we can better serve our LGB patients.
PA’s in the UK have finally won their fight to gain licensure regulation! This is a big win for the profession across the pond specifically, and a big win or the profession globally. Then Adrian and Kris will help you “swallow” the segment on dysphagia and give you some of the highlights for your clinical PA practice.
Broken hearts? Octopus traps? What’s the deal with Takotsubo cardiomyopathy? Matt DeClerck and Neda Frayha dive into the details of this interesting condition in this introduction segment.
Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial.
We provide supplemental oxygen all the time. But how often do we really understand the physiology behind what we’re doing, or the different modalities we have available to us? Dr. Avir Mitra, Clerkship Director of Emergency Medicine at the Icahn School of Medicine at Mount Sinai Beth Israel in New York, joins Neda for a conversation about O2 supplementation, mechanical airway support, and the tools we have to oxygenate and ventilate our patients.
How Much Time are Physicians and Nurses Spending Together at the Patient Bedside.
We have been waiting and waiting and waiting for the new community acquired guidelines. And here they are! Infectious Diseases expert Dr. Devang Patel joins Matt DeLaney and Neda Frayha for a conversation on CAP in general and the new guidelines in specific.
N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel.
Management of sprains can be divided into the acute and functional phase. In the acute phase early range of motion exercises and techniques to manage pain and swelling are key aspects of treatment. In the functional phase the focus shifts more to emphasize strength, stability, and a return to pre-injury activity.
The clinical and cost-effectiveness of total vs partial knee replacement I patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomized controlled trial.
Dysphagia? Sounds like a hard-to-swallow diagnosis. ENT expert, Dr. Elizabeth Guardini, helps us navigate phases of swallowing, diagnostic testing, and deciding when to refer to a specialist.
Randomized Trial of Medical versus Surgical Treatment for Refractory Heartburn.
Talking about sex with our patients can feel uncomfortable, but is an important part of primary care practice. Dr. Helene Hedian walks us through how to have this conversation in a sensitive and inclusive manner.
In this Hippo Education Short, Infectious Diseases specialist Dr. Devang Patel sits down with our own Dr. Neda Frayha to discuss what we know so far about the new 2019-n-CoV coronavirus outbreak and what front-line clinicians can do if we suspect a patient of ours might have this viral illness.
How about a little spaced repetition? Lets break in the New Year with a little friendly competition between Adrian and Kris…challenge bowl style! Listen while they recap some of the important topics over the last few months of Primary Care RAP. Got an itch for more? Then “stay put” around as they discuss intrahepatic cholestasis of pregnancy.
Wet to dry dressings? Nope! Our Urgent Care RAP cousin Matt DeLaney schools Neda and Paul on a better way to do wound care. Such as: Foam dressings address the important elements of wound healing; they absorb exponentially more than gauze, keep wound somewhat moist, and can stay on for 3-7 days. Downsides are that they may not help all wounds (little benefit for arterial ulcers).
To determine patterns of apixaban use and its outcomes in dialysis-dependent patients with ESRD and atrial fibrillation.
Respiratory failure in primary care? Not an oxymoron! Our own Drs. Mizuho Morrison and Tom Robertson interview returning pulmonologist extraordinaire, Dr. Nirav Shah, about how we approach and manage respiratory failure, both before our patients need the ICU and after they come out of intensive care.
Itching is a common complaint in pregnancy. When do we need to worry about cholestasis of pregnancy when a pregnant woman complains of itching? Neda sits down with our newest PC Rap contributor, Dr. Matthew Zeitler, to scratch the surface of the most common pregnancy-specific liver disease.
To compare the efficacy of oral finasteride and topical minoxidil for males with androgenetic alopecia.
PC RAP has covered the start-screening-mammos-at-age-50 perspective in the past. Today, we’ll explore the other side of the coin: why women’s health focused organizations recommend beginning annual screening mammography at age 40. Neda sat down with Dr. Alison Chetlen, breast imaging expert and Associate Professor and Vice Chair of Education in the Department of Radiology at Penn State Health and Hershey Medical Center, for a deeper dive into the evidence we don’t always hear about in primary care.
As marijuana becomes legal in more states, it’s important for us to be able to advise our patients on the risk of inhaled marijuana causing lung disease. Neda discusses the current literature with Dr. Kathryn Robinett, pulmonologist extraordinaire.s
To evaluate the efficacy of a polypill containing atorvastatin amlodipine losartan and hydrochlorothiazide for lowering blood pressure and LDL.
Even in the primary care setting, we all need to be prepared to deal with emergencies, including anaphylaxis. Dr. Jason Liebzeit, EM physician, arms us with the knowledge and power to recognize and treat anaphylaxis in the primary care setting.
The medical assistant workforce is the largest in US ambulatory clinics. As nurses shift to inpatient roles, we use medical assistants more and more in the outpatient setting. Neda and Dr. Michael Baca-Atlas chat about how to best utilize this group of allied health professionals as well as share some ideas for expanding their roles in the clinic.
To determine whether providing essential medicines at no charge to outpatients who reported not being able to afford medicines improves adherence.
Kari Sampsel MD reviews how to recognize and manage sexual assault from a medical perspective and also social support that patients warrant.
Back pain is one of the most common complaints that we see in primary care. Many of our patients have either already seen a chiropractor for their pain, or ask our opinion about seeing one. Neda and Tom Robertson talk with Dr. John Allen about the literature regarding chiropractic care.
To obtain patients’ perspectives of factors associated with the onset and continuation of high hospital use.
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