Primary care physicians Gary Ferenchick, Kate Rowland, Henry Barry and Mark Ebell want you to know about 4 new studies: the best choice of pharmacotherapy in hypertensive disorders of pregnancy, benefits and harms of intensive BP lowering, elinzanetant for therapy-induced vasomotor symptoms in women with breast cancer, and 23 year follow up of the European Prostate Cancer Screening Trial. Plus a confusing quiz question (thanks Gary!).
Links
Essential Evidence Plus: www.essentialevidenceplus.com
HTN in pregnancy: https://pubmed.ncbi.nlm.nih.gov/40216176/
Intensive BP lowering: https://pubmed.ncbi.nlm.nih.gov/40902616/
Elinzanetant for vasomotor symptoms in patients taking tamoxifen or anastrozole: https://pubmed.ncbi.nlm.nih.gov/40454634/
23 year follow-up of large European prostate cancer study: https://pubmed.ncbi.nlm.nih.gov/41160819/
This week, Gary, Kate, Mark and Henry discuss the optimal duration of anticoagulation after a provoked DVT, using low doses of mirtazapine or amitriptyline in adults with insomnia, whether a lower dose of semaglutide is still effective for weight loss, and adding aspirin for patients with coronary heart disease, a stent and who are also on a DOAC for another indication.
Links:
NICE Barrett Esophagus guideline: https://pubmed.ncbi.nlm.nih.gov/38553042/
Essential Evidence Plus: www.essentialevidenceplus.com
Duration of anticoagulation: https://pubmed.ncbi.nlm.nih.gov/40888734/
Mirtazapine or amitriptyline for insomnia: ttps://pubmed.ncbi.nlm.nih.gov/39814428/
Lower dose semaglutide for obesity: https://pubmed.ncbi.nlm.nih.gov/40934115/
Adding aspirin: N Engl J Med . 2025 Oct 23;393(16):1578-1588https://pubmed.ncbi.nlm.nih.gov/40888725/
This week, primary care physicians Kate Rowland, Mark Ebell, and Henry Barry want to arm our primary care colleagues with the best evidence on whether acetaminophen causes autism, whether MMR causes autism, and whether leucovorin can treat autism. Gary then turns to a study of the value of continuity in primary care, and its association with better health outcomes.
Links:
Henry's essay on Ignaz Semelweis, handwashing, and postage stamps: https://thestampforum.boards.net/thread/13044/current-issue-volume-jul-2025
Essential Evidence Plus and POEMs: www.essentialevidenceplus.com
Acetaminophen in pregnancy and autism: https://www.ncbi.nlm.nih.gov/pubmed/38592388
Leucovorin to treat autism: https://www.ncbi.nlm.nih.gov/pubmed/15781839, https://www.ncbi.nlm.nih.gov/pubmed/34834493
MMR and autism, Wakefield investigation: https://www.bmj.com/content/342/bmj.c5347
MMR and autism, Madsen's Danish study: https://pubmed.ncbi.nlm.nih.gov/12421889/
Value of primary care continuity: https://www.ncbi.nlm.nih.gov/pubmed/40355250
And do NOT eat roadkill. Definitely.
Today Kate, Gary, Mark and Henry discuss influenza vaccines and dementia incidence, therapies for endometriosis-related pain, colchicine for secondary prevention of heart disease, and green tea and drug absorption.
Links:
IgNobel prizes: IgNobel Prizes were recently awarded: https://improbable.com/ig/winners/
www.ncbi.nlm.nih.gov/pubmed/40601364
https://pubmed.ncbi.nlm.nih.gov/40373315/
Colchicine for secondary prevention of CHD: https://pubmed.ncbi.nlm.nih.gov/40314334/
Green tea and drug absorption: https://pubmed.ncbi.nlm.nih.gov/39748104/
https://www.sciencealert.com/a-distinct-new-form-of-diabetes-is-officially-recognized
This week Gary, Kate, Henry and Mark discuss 4 important new studies that are potential POEMs: A new(ish) rescue therapy for asthma, IV thrombolytics for adults with acute minor stroke, whether exercise reduces cancer mortality, and digitoxin (with a t!) as add-on therapy for adults with heart failure.
Join Kate, Mark, Gary and Henry as they discuss 4 great new POEMs (studies with the potential to change practice): a digital mental health intervention, the risk of DKA in patients using SGLT2 inhibitors, esketamine’s effects on suicidal ideation and unresponsive depression, and whether “one-size-fits-all” thyroid reference ranges misleading.
Links:
Essential Evidence Plus: www.essentialevidenceplus.com
Digital mental health app for depression: https://pubmed.ncbi.nlm.nih.gov/40227715/
RIsk of DKA with SGLT2s: pubmed.ncbi.nlm.nih.gov/40070044/
Esketamine and resistant depression or suicidality: pubmed.ncbi.nlm.nih.gov/39790081/
What is a normal TSH: https://pubmed.ncbi.nlm.nih.gov/40324200/
Joseph O'Connor and the Escape Line Trilogy (2 great novels): https://www.amazon.com/The-Rome-Escape-Line-Trilogy-2-book-series/dp/B0BSNX3C89
This week, we found 4 great new studies for primary care physicians (and their patients): the health benefits of “incidental” activity, real world data and the amyloid cascade theory for Alzheimer’s disease, a new blood test for colorectal cancer screening, and DORAs for sleep.
Check out Essential Evidence Plus: www.essentialevidenceplus.com
Incidental activity: https://pubmed.ncbi.nlm.nih.gov/40228066/
New Alzheimer's definition in the real world: https://pubmed.ncbi.nlm.nih.gov/40359457/
Blood test for colorectal cancer screening: https://pubmed.ncbi.nlm.nih.gov/40455622/
"DORAs" for insomnia: https://pubmed.ncbi.nlm.nih.gov/40555730/
Kate, Mark, Gary and Henry discuss 4 important new studies relevant to primary care clinicians: negative pressure wound therapy for wounds healing by secondary intention, comparative effectiveness of acute migraine treatments, contrast enhanced mammography, US, or MRI for women with dense breasts, and metformin for knee pain in patients without diabetes.
Negative pressure wound therapy: https://pubmed.ncbi.nlm.nih.gov/40250455/
Acute migraine treatments: https://pubmed.ncbi.nlm.nih.gov/40096693/
Best enhanced screening for women with dense breasts: https://pubmed.ncbi.nlm.nih.gov/40412427/
Metformin for knee pain in patients without DM: https://pubmed.ncbi.nlm.nih.gov/40274279/
This week our intrepid primary care docs discuss 4 new POEMs: spironolactone vs amiloride for resistant hypertension, mirtazapine for insomnia in older adults, baloxivir for influenza post exposure prophylaxis, and platelet-rich plasma injections for knee osteoarthritis. We've got opinions!
Show notes:
Spironolactone vs amiloride for resistant hypertension: pubmed.ncbi.nlm.nih.gov/40366680/
Mirtazapine for chronic insomnia: https://pubmed.ncbi.nlm.nih.gov/40135470/
Baloxavir to prevent flu in household contacts: https://pubmed.ncbi.nlm.nih.gov/40267424/
Platelet-rich plasma for knee OA: https://pubmed.ncbi.nlm.nih.gov/39751394/
Join Mark, Kate, Henry and Gary as they discuss 4 new POEMs: a new and very hard to pronounce antibiotic for uncomplicated UTI, the best drugs for relieving pain in adults with fibromyalgia, a clinical trial of a multicancer detection test in asymptomatic persons, and bedtime vs morning administration of antihypertensives.
Gepotidacin for uncomplicated UTI: https://pubmed.ncbi.nlm.nih.gov/38342126/
Drugs for fibromyalgia: https://www.ncbi.nlm.nih.gov/pubmed/39705187
Multicancer detection test trial: https://pubmed.ncbi.nlm.nih.gov/39948555/
TIming of antihypertensives: https://pubmed.ncbi.nlm.nih.gov/40354045/
This week, join Kate, Mark and Henry as they discuss all in one triple inhalers for COPD, the best medication for pain management in children and suzetrigine, a new medicine for acute pain in adults. Gary is off this week, working on his French lessons. And we add intro music! Yay!
Join Mark, Henry, and Gary (we are Kate-less unfortunately this week) for discussion of epidural steroid injections for adults with radicular back pain, post a fib ablation management, and oral semaglutide for high-risk patients with Type 2 DM
This week, Kate, Mark, Gary and Henry discuss 4 great new POEMs: foot care wipes for patients at risk of diabetic foot infection, resuming DOACS following intracerebral hemorrhage in adults with a fib, treating prediabetes with tirzepatide, and more on intermittent fasting.
Show links
BMJ Magic Evidence interactive review of diabetes medications. A great practice and teaching tool: https://matchit.magicevidence.org/230125dist-diabetes/#!/
https://www.ncbi.nlm.nih.gov/pubmed/31574019
https://pubmed.ncbi.nlm.nih.gov/39964684/
https://pubmed.ncbi.nlm.nih.gov/40023176/
This week, Kate, Gary, Mark and Henry chat about the health effects of dance for older adults, POCUS for diagnosing clavicular fractures, treating male partners of women with BV, and prehabilitation before elective surgery .
Links:
Dance for older adults: https://pubmed.ncbi.nlm.nih.gov/39480190/
POCUS for clavicle fractures: https://pubmed.ncbi.nlm.nih.gov/39626455/
Oral + topical treatment of male partners for BV: https://pubmed.ncbi.nlm.nih.gov/40043236/
Prehabilitation before elective surgery: https://pubmed.ncbi.nlm.nih.gov/39843215/
Case series of avian flu patients: https://www.nejm.org/doi/full/10.1056/NEJMoa2414610
This week join our intrepid primary care physicians Kate, Gary, Henry and Mark as they discuss 4 new studies: an experimental treatment for chronic migraines, safety of albuterol in wheezy kids under 2, oral gepotidacin for uncomplicated UTI, and vitamin K2 and Leg Cramps.
Here are the links:
Lukas' Fund supporting the Piedmont Athens and Grady Atlanta NICUs: https://www.lukasfund.org
Essential Evidence Plus: http://www.essentialevidenceplus.com
Vibrating intranasal balloons for migraine: https://pubmed.ncbi.nlm.nih.gov/39787477/ and Ozilia
Safety of albuterol in infants: https://www.ncbi.nlm.nih.gov/pubmed/39266286
Oral gepotidacin for uncomplicated UTI: https://www.ncbi.nlm.nih.gov/pubmed/38342126
Vitamin K2 for nocturnal leg cramps: https://pmc.ncbi.nlm.nih.gov/articles/PMC11581596/
This week Kate, Gary, Mark and Henry discuss discontinuation of benzodiazepines and treatment of insomnia, the value of baseline cognitive testing of college athletes, vonoprazan vs PPI for preventing and treating ulcers, and whether herpes zoster vaccine reduces dementia risk.
Show links:
Essential Evidence Plus: www.essentialevidenceplus.com
Tapering benzos: https://pubmed.ncbi.nlm.nih.gov/39374004/
Baseline neuro eval for athletes: pubmed.ncbi.nlm.nih.gov/39741470/
David Kaufman, “We Need You in the Locker Room” https://thesagergroup.net/books/in-the-locker-room
Vonoprazan vs PPIs for ulcers: https://pubmed.ncbi.nlm.nih.gov/39294424/
Zoster and dementia: https://pubmed.ncbi.nlm.nih.gov/40175543/
This week Gary, Mark, Kate and Henry discuss: adverse effects from inhaled steroids in asthma, Italian dementia guideline, fezolinetant for treatment of vasomotor symptoms, and updated USPSTF recommendations for osteoporosis screening.
Show notes and links:
Asthma and risk of CV events: https://pubmed.ncbi.nlm.nih.gov/39088770/
GINA 2024 guidelines: https://ginasthma.org/2024-report/
Italian dementia guidelines: https://www.ncbi.nlm.nih.gov/pubmed/39544104 with link to full report in Inglese: https://www.iss.it/documents/d/guest/the-full-guideline-english-version
Fezolinetant for vasomotor symptoms: https://pubmed.ncbi.nlm.nih.gov/39557487/
USPSTF osteoporosis screening guideline: https://pubmed.ncbi.nlm.nih.gov/39808425/
Dietary assessment tool: https://epi.grants.cancer.gov/asa24/
Article on interval for next BMD screening based on initial result: https://pubmed.ncbi.nlm.nih.gov/22256806/
Join Kate, Gary, Mark and Henry as they discuss 4 new POEMs relevant to primary care: bright light therapy for non-seasonal depression, fever control in children, abelacimab for atrial fibrillation, antibiotics vs surgery in children with nonperforated appendicitis. Get all of the POEMs (a new one every day) by going to Essential Evidence Plus and subscribing.
Links from today's podcast:
Bright lights for non-seasonal depression: https://pubmed.ncbi.nlm.nih.gov/39356500/
Controlling fever in children: https://pubmed.ncbi.nlm.nih.gov/39318339/
Abelacimab for anticoagulation in atrial fib: https://pubmed.ncbi.nlm.nih.gov/39842011/
Antibiotics vs surgery for appendicitis in kids: https://www.ncbi.nlm.nih.gov/pubmed/39826968
Independent predictors of suicidal ideation: https://pubmed.ncbi.nlm.nih.gov/7966924/
Here is the probability of suicidal ideation by # of risk factors:
0: 0.5%
1: 3.0%
2: 7.4%
3: 23%
4: 46%
This week, Gary, Kate, Henry and Mark discuss 4 new studies relevant to primary care practice: the effectiveness of RSV monoclonals in infants, acupuncture for sciatica associated with disk herniation, zoledronate every 5 years for low risk women, and the effect of arm position on blood pressure readings. Plus a quiz! Please see below for show notes and links:
Learn more about Essential Evidence Plus: www.essentialevidenceplus.com
Real world study of nirsevemab for average risk infants: https://pubmed.ncbi.nlm.nih.gov/39257372/
Acupuncture effective for sciatica: https://pubmed.ncbi.nlm.nih.gov/39401008/
Zoledronate every 5 years for average risk women: https://pubmed.ncbi.nlm.nih.gov/39813642/
Importance of correct arm position for BP: https://pubmed.ncbi.nlm.nih.gov/39373998/
A nice infographic for measuring BP correctly from the AMA and Johns Hopkins: https://targetbp.org/wp-content/uploads/2016/10/MAPHypertension_7StepsInOfficeInfographic_Landscape_English_NoCropsNoBleeds-12.pdf
Join Kate, Mark, Gary and Henry as they discuss 4 new POEMs on treatment of sexual dysfunction, the benefits and harms of GLP-1 agonists, active surveillance vs usual care for ductal carcinoma in situ, and medications to prevent episodic migraine headache.