Frankly Speaking About Family Medicine

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-254   Overview: Older adults who suffer from loneliness may be at risk of overusing medications prescribed for pain, insomnia, depression, or anxiety. Replacing these medications with social interventions may improve outcomes and help patients avoid adverse consequences. Join us as we discuss the importance of reviewing medications and assessing for loneliness in older adults to prevent adverse events and outcomes.   Episode resource links: Kotwal, A. A., Steinman, M. A., Cenzer, I., & Smith, A. K. (2021). Use of High-risk Medications Among Lonely Older Adults: Results From a Nationally Representative Sample. JAMA internal medicine, e213775. Advance online publication. https://doi.org/10.1001/jamainternmed.2021.3775 https://pubmed.ncbi.nlm.nih.gov/34309620/ Education for Patients: Tips on Staying Connected—National Institutes on Aging https://

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-253   Overview: ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are both recommended as first-line treatments for hypertension. ACE inhibitors have known side effects, such as cough, that are frustrating for many patients, while ARBs appear to have less annoying side effects. This podcast will review a recently published retrospective, comparative cohort study comparing the effectiveness and safety of ACE inhibitors vs ARBs in the first-line treatment of hypertension.   Episode resource links: Hypertension. 2021;78:591–603. DOI: 10.1161/HYPERTENSIONAHA.120.16667   ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Cli

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-252   Overview: For patients who would like to prevent pregnancy, many options—both hormonal and nonhormonal—exist. Despite the availability of multiple options, many patients do not use them because of either a lack of knowledge or a lack of access, the latter being especially true in uninsured and non−English-speaking communities. Research has shown over the years that while unintended pregnancies have decreased in the United States, more can be done, and primary care providers can play an important role in helping to further decrease and eliminate barriers to contraception.   Episode resource links: Lesnewski, R. (2021). Initiating Hormonal Contraception. American Family Physician, 103(5), 291-300. Guest: Mariyan L. Montaque, DNP, FNP-BC   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-251   Overview: Primary care providers should be up to date on the changes to the guidelines for cervical cancer screening to be able to guide patients in shared decision-making about health maintenance. Join us to review the recent changes to cervical cancer screening guidelines as recommended by the American Cancer Society.   Episode resource links: Cervical Cancer Screening: Updated Guidelines from the American Cancer Society. Am Fam Physician. 2021 Sep; 104(2):314-315. American College of Obstetricians and Gynecologists. Updated cervical cancer screening guidelines. Practice advisory. April 2021. Accessed September 30, 2021. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/04/updated-cervical-cancer-screening-guidelines Fontham, ETH, Wolf, AMD, Church, TR, et al. Cervical Cancer Screening for Individuals at Aver

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-250   Overview: While the data conflict on how much sodium intake is optimal for preventing cardiovascular disease, it is clear that daily salt intake for most Americans exceeds what is recommended. However, restricting salt intake on an individual or on a public health level has been controversial. An interesting alternative is the use of salt substitutes, which can help to decrease sodium intake while increasing potassium intake, and both have been associated with lowering blood pressure. Join us to hear a discussion on the results of the recently published studies on salt and cardiovascular disease, along with an overview of the Salt Substitute and Stroke Study (SSaSS).   Episode resource links: Neal B, Wu Y, Feng X, et al. Effect of salt substitution on cardiovascular events and death. N Engl J Med. DOI: 10.1056/NEJMoa2105675 O’Donnell M, Ment

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-249   Overview: For non-valvular atrial fibrillation, physicians, patients, and guideline organizations all prefer direct oral anticoagulants (DOACs) over vitamin K antagonists, such as warfarin, for thromboembolic prophylaxis. For those with valvular atrial fibrillation, the data for safety and efficacy have been limited because randomized trials comparing DOACs to warfarin often exclude patients with valvular atrial fibrillation. Join us to explore new data that shed light on the use of DOACs in valvular atrial fibrillation.   Episode resource links: Dawwas GK, Dietrich E, Cuker A, Barnes GD, Leonard CE, Lewis JD. Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Valvular Atrial Fibrillation : A Population-Based Cohort Study. Ann Intern Med. 2021;174(7):910-919. Guest: Alan Ehrlich MD, FAAFP   Music Cr

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-248   Overview: Join us to hear a discussion on the important changes the AHA/ACC and USPSTF have made to their positions on the use of aspirin for primary prevention of cardiovascular disease. The organizations note that while aspirin for primary prevention lowers the risk of a myocardial infarction, its harmful effects may outweigh its benefits. Learn the aspirin recommendations for your patients in their 40s, 50s, and 60s who are at higher risk for a cardiovascular event.   Episode resource links: New: https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication Old: https://www.aafp.org/afp/2016/1015/od1.html https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/aspirin-to-prevent-cardiovascular-disease-and-cancer Guest: Ji

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-247   Overview: When it comes to chronic migraines, your first-line prevention is probably medication, but according to a new study, it may not have to be. Certain foods may play a role in increasing and decreasing migraine recurrence. Join us to review a recent randomized controlled trial aimed at preventing migraines in those with chronic migraines.   Episode resource links: BMJ 2021; 374 :n1448 doi:10.1136/bmj.n1448; doi: https://doi.org/10.1136/bmj.n1448 The association of dietary patterns with migraine attack frequency in migrainous women. Nutritional Neuroscience 23:9, pages 724-730 Guest: Alan Ehrlich MD, FAAFP   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-246   Overview: Low back pain often leads to disability and loss of income and is a significant burden on patients and the healthcare system. While muscle relaxants are the third most common prescribed drugs in the treatment of low back pain, recent data demonstrating its use and efficacy are limited. This session discusses a recent systematic review of the safety, efficacy, and accepted use of muscle relaxants in the treatment of low back pain. Don’t miss this opportunity to learn how to provide low back pain treatments that have clear benefits for your patients.   Episode resource links: Cashin A G, Folly T, Bagg M K, Wewege M A, Jones M D, Ferraro M C et al. Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis BMJ 2021; 374 :n1446 doi:10.1136/bmj.n1446 https://pub

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-245   Overview: When your patient has an elevated screening PSA level, your first inclination may be to refer for a biopsy, but have you considered obtaining a pre-biopsy MRI? In this podcast, we will review the appropriate management for an elevated screening PSA. You’ll want to hear about the new benefit of obtaining a pre-biopsy MRI to guide diagnostic procedures.   Episode resource links: NEJM July 9, 2021; DOI: 10.1056/NEJMoa2100852\ Urology 2016 Apr;90:32-7. doi: 10.1016/j.urology.2015.11.046 Guest: Frank J. Domino, MD   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-244   Overview: Suicide and attempted suicide are significant health issues affecting the United States and the world. Are you aware of the tools available to you that can support suicide prevention strategies and save lives? Don’t miss this session to learn about how the use of an electronic health record in a large health system may help predict suicide attempts.   Episode resource links: Walsh CG, Johnson KB, Ripperger M, Sperry S, Harris J, Clark N, Fielstein E, Novak L, Robinson K, Stead WW. Prospective Validation of an Electronic Health Record-Based, Real-Time Suicide Risk Model. JAMA Netw Open. 2021 Mar 1;4(3):e211428. doi: 10.1001/jamanetworkopen.2021.1428. PMID: 33710291; PMCID: PMC7955273 doi: 10.1001/jamanetworkopen.2021.1428 Liang, Angela, and Paul Nestadt S . "Suicide Risk in the COVID-19 Pandemic." Johns Hopkins Psychiatry Guide,

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-243   Overview: Evidence strongly supports a correlation between hearing impairment in older adults and decline in physical functioning. A recent population cohort study of older adults revealed that hearing impairment was associated with poorer physical function, reduced walking endurance, and accelerated decline. Join us while we discuss this evidence and how to apply it to your practice. You’ll walk away with strategies to promote hearing assessment and to help optimize physical functioning in your older adult patients.   Episode resource links: Brenowitz WD, Wallhagen MI. Does Hearing Impairment Affect Physical Function?: Current Evidence, Potential Mechanisms, and Future Research Directions for Healthy Aging. JAMA Netw Open. 2021 Jun 1;4(6):e2114782. doi: 10.1001/jamanetworkopen.2021.14782. PMID: 34170308. Martinez-Amezcua P, Powell D, Ku

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-242   Overview: Gluten exposure is known to cause a number of problems in both those with celiac disease and those with non-celiac gluten sensitivity. One aspect that has not received much attention from the research community is the neurocognitive impairment that can occur following gluten exposure in these individuals. Join us for this podcast to dive into a recent article that describes these effects.   Episode resource links: Edwards George JB, Aideyan B, Yates K, et al. Gluten-induced Neurocognitive Impairment: Results of a Nationwide Study [published online ahead of print, 2021 May 28]. J Clin Gastroenterol. 2021 Guest: Alan Ehrlich MD, FAAFP   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-240   Overview: Have you considered continuous glucose monitoring (CGM) for your patients with suboptimally controlled type 2 diabetes mellitus (T2DM) on at least 3 injections of insulin per day? This session will give you the information you need to confidently initiate CGM in appropriate patients. You’ll walk away with a clear understanding of the different CGM options and the benefits and challenges of CGM.   Episode resource links: Ida S, Kaneko R, Murata K. Utility of Real-Time and Retrospective Continuous Glucose Monitoring in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials. J Diabetes Res. 2019 Jan 15;2019:4684815. doi: 10.1155/2019/4684815. PMID: 30775385; PMCID: PMC6350576. Maiorino et al. Diabetes Care. 2020;43:1146–1156 Guest: Jillian Joseph, MPAS, PA-C   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-239   Overview: Join us to discuss the CDC’s new guidelines for the management of sexually transmitted infections due to Neisseria gonorrhoeae. You’ll walk away with recommendations for how to address urogenital, rectal, and pharyngeal infections. You’ll also discover alternative regimens for patients allergic to first-line therapy and understand how to manage coinfection with chlamydia.   Episode resource links: St. Cyr S, Barbee L, Workowski KA, et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–191 Guest: Alan Ehrlich MD, FAAFP   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-238   Overview: Join us to discuss important changes in the 2021 USPSTF recommendation on lung cancer screening. Given lung cancer’s high prevalence and poor prognosis in later stages, it is important for primary care clinicians to know which patients to screen and what method to use. You’ll also learn the appropriate time to stop screening.   Episode resource links: Screening for Lung Cancer US Preventive Services Task Force Recommendation Statement JAMA. 2021;325(10):962-970. doi:10.1001/jama.2021.1117 Guest: Robert A. Baldor MD, FAAFP   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-237   Overview: Solid evidence shows that adverse pregnancy outcomes (APOs) correlate with an increased risk of cardiovascular disease (CVD) in women. Evidence is also becoming clearer that lactation and breastfeeding may have CV protective benefits as well. Social determinants of health play a significant role in these diseases; facts support that Black, Hispanic and Asian American women suffer from worse pregnancy outcomes than White American women. Join us while we discuss the recent American Heart Association (AHA) guideline update regarding the association of increased risk of CVD and metabolic disease with APOs and what can be done to reduce these risks.   Episode resource links: Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women. Nisha I. Parikh, MD, MPH, Chair, Jua

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-236   Overview: Continuous glucose monitoring (CGM) for patients with diabetes has been available for several years now, but its utility in managing diabetes care is unclear. Join us to discuss the results of a systematic review examining the benefits of CGM for patients with both type 1 and type 2 diabetes mellitus.   Episode resource links: Effects of continuous glucose monitoring on metrics of glycemic control in diabetes: a systematic review with meta-analysis of randomized controlled trials. Diabetes Care. 2020;43(5):1146-1156. Implementing Continuous Glucose Monitoring in Clinical Practice. www.aafp.org/fpm March/April 2021 Longo R, Sperling S. Personal versus professional continuous glucose monitoring: when to use which on whom. Diabetes Spectr. 2019;32(3):183-193.   Guest: Robert A. Baldor MD, FAAFP   Music Credit: Richa

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-235   Overview: Perennial allergic rhinitis affects both children and adults, and management includes both allergy avoidance as well as medication management. Intranasal steroids are the mainstay of treatment and have traditionally required consistent use, but new data are emerging. Find out the results of a new study evaluating PRN use as an alternative approach.   Episode resource links: Thongngarm T, Wongsa C, Phinyo P, Assanasen P, Tantilipikorn P, Sompornrattanaphan M. As-Needed Versus Regular Use of Fluticasone Furoate Nasal Spray in Patients with Moderate to Severe, Persistent, Perennial Allergic Rhinitis: A Randomized Controlled Trial. J Allergy Clin Immunol Pract. 2021 Mar;9(3):1365-1373 Guest: Alan Ehrlich MD, FAAFP   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-234   Overview: Many providers overtreat outpatient infections for fear of not treating until resolution or causing a complication, but this can lead to antibiotic resistance and adverse events. Join us to discuss the new ACP guidelines on antibiotic use in the outpatient setting and the pediatric treatment recommendations. Walk away with a clear understanding of the guidelines for optimal duration of antibiotic treatment for individuals with an outpatient infection.   Episode resource links: ACP: Ann Intern Med. doi:10.7326/M20-7355; https://www.acpjournals.org/doi/pdf/10.7326/M20-7355 Low risk for PCN allergy: Am J Respir Crit Care Med 2020 Feb 21; [e-pub]. (https://doi.org/10.1164/rccm.202001-0089LE); Mayo Clinic Proceedings 2018, 93 (1): 101-107 Guest: Robert A. Baldor MD, FAAFP   Music Credit: Richard Onorato