Episode Chapters
- Suicide Assessment5:52Loss of Autonomy11:35Paper Chase 1 - Consider the Prostate, Again7:47Resistant Hypertension14:59Paper Chase 2 - How Much Kidney Disease Is There?5:42Osteoporosis, Part 1Free Chapter17:55Adult Vaccination24:40Paper Chase 3 - Hormonal Contraception and Depression5:03Hemorrhoids24:53Paper Chase 4 - ICD Implantation3:51Cross Reactivity of PCN + Cephalosporins12:07Osteoporosis, Part 224:04ALARA15:57Paper Chase 5 - Does Marijuana Cause Diabetes?4:15The Summary15:29
Heidi and Rob discuss the assessment of suicide.
Bones Lose Their Autonomy Full episode audio for MD edition 193:25 min - 91 MB - M4AHippo Primary Care RAP January 2017 Summary 329 KB - PDF
Eric S. - January 22, 2017 5:21 PM
Hi,
Regarding osteoporosis, I heard that we should not screen anyone > 75 y.o. if they never have been treated and have no risk factors - is it accurate?
Thank you!
Heidi J., MD - January 27, 2017 12:37 PM
Hi Eric!
We passed along your question to Dr. Ouellette - here is her response:
"Age, sex and previous history of fracture are the single most important risks for fracture.
CAROC (the Canadian Osteoporosis Guidelines) has no “end date” for screening, since age becomes an increasingly important driver to fracture risk.
I do not believe that FRAX has an “end date” either."
Hope this helps - thanks for listening!
Heidi
Eric S. - January 31, 2017 12:06 PM
Thank you, I finally found where I took this notion. It is more specifically regarding whether we should do a second DEXA scan for patient(e)s after 75yo, if one was done < 4 years... https://www.ncbi.nlm.nih.gov/pubmed/24065012 "In untreated men and women of mean age 75 years, a second BMD measure after 4 years did not meaningfully improve the prediction of hip or major osteoporotic fracture. Repeating a BMD measure within 4 years to improve fracture risk stratification may not be necessary in adults this age untreated for osteoporosis."
Thanks for keeping me up to date!
Danielle K. - February 6, 2017 11:36 AM
had a patient come in today after a 72 hours hold and kept this in mind! documented about safety plan and resources she had available to her! Thankful I listened to this over the weekend for a quick refresher!!!
Heidi J., MD - March 25, 2017 5:30 AM
Glad to hear the segment was helpful, Danielle :)
John K., MD - March 22, 2017 8:11 AM
99% of my 65 plus year old patients refer to both pcv23 and prevnar 13 at the pneumonia vaccine. Out state does not have an online adult vaccine database. Many of my patients are relatively new to the practice as well.
1. any hints on figuring out what patients have actually received?
2. is there a risk if a patient receives prevnar 13 twice?
thanks, JK
Heidi J., MD - March 25, 2017 5:36 AM
Hi John -
I feel your pain! Vaccination records are notoriously difficult to track. In the absence of a database, perhaps your patient's previous providers would have that information?
Regarding receiving Prevnar twice, I wasn't able to find any specific info, but in general getting an additional, unintended dose of any vaccine should only expose you to the baseline risks associated with receiving the vaccine. I'll check with Dr. Smyth, our ID doc, and update you if he has any comments to the contrary.
Thanks and good luck!
Heidi