Frankly Speaking About Family Medicine

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A weekly podcast series, hosted by Frank Domino, MD, covering newsworthy topics and patient-focused best practices in Family Medicine.

Episode Date
Goals of Care Discussions in Patients with Serious Illness: Is It a Downer? - Frankly Speaking EP 81

Discussing goals of care with patients that have a serious, life-limiting illness does not affect the patient’s anxiety or depression—but can increase the quality of the communication. Listen to this podcast episode for tips that are easily adaptable to any outpatient or specialty practice.

Guest: Jill Terrien PhD, ANP-BC

Aug 13, 2018
Breastfeeding Supplemented with Formula; When Is It the Right Thing to Do? - Frankly Speaking EP 80

Breastfeeding exclusively in the first six months of life is widely recommended. However, in this study of newborns who were losing weight because their mother’s milk had not yet come in, post-breastfeeding supplementation improved weight and did not alter breastfeeding rates at one month. 

Guest: Susan Feeney, DNP, FNP-BC 

Aug 06, 2018
Mangia: What Is the Truth about the Mediterranean Diet and CVD Health? - Frankly Speaking EP 79

In 2013, a groundbreaking clinical trial from Spain touted the benefits of the Mediterranean Diet to reduce CVD risk. A recent review of the study found some irregularities in the randomization procedure that cast concern on the validity of the findings. After reanalysis of the data, however, the results were essentially the same.

Guest: Susan Feeney, DNP, FNP-BC

Jul 30, 2018
Binge Drinking in Adolescents: A Sober Subject That Begs for Attention - Frankly Speaking EP 78

For adolescents who binge drink, when they begin and how often they do it affects academic performance. This episode discusses the findings of a longitudinal analysis of secondary school students in Canada: The COMPASS study.

Guest: Jill Terrien PhD, ANP-BC

Jul 23, 2018
Treatment of Post-Op Pain Following Spine and Joint Surgery - Frankly Speaking EP 77

This study looked at how pain was treated following spine and joint surgery and found the majority of patients were not encouraged to use non-opioid analgesia and that most had a supply of unused opioids at home.

Guest: Jill Terrien PhD, ANP-BC

Jul 16, 2018
Assessing Blood Pressure: How Accurate Are the Blood Pressure Measurements You Use to Care for Your Patients? - Frankly Speaking EP 76

Hypertension affects an estimated 80 million Americans. We diagnose, determine the need for medication therapy, and monitor treatment efficacy based on a simple office blood pressure measurement – but how accurate is that measurement, and what is the most valid method to obtain it?

Guest: Susan Feeney, DNP, FNP-BC

Jul 09, 2018
Moving Fast, Moving Slow - Frankly Speaking EP 75

Fibromyalgia can be difficult to treat and often requires a multifaceted approach combining exercise, medications, cognitive behavioral therapy, and health education. For many patients, pain hinders participation in a vigorous exercise regimen. Listen to this review of a randomized trial comparing aerobic exercise to tai chi in a patient population with fibromyalgia.

Guest: Alan Ehrlich, MD 

Jul 02, 2018
Uncomplicated UTI in Women: What a Pain! - Frankly Speaking EP 74

For women experiencing an uncomplicated UTI, nitrofurantoin and fosfomycin are two first-line options for treatment. Is one more effective than the other? Listen to this episode to learn about the results from a multinational, open-label, randomized clinical trial.

Guest: Jill Terrien PhD, ANP-BC

Jun 25, 2018
Put That Finger Down! The End of the Screening Rectal Exam - Frankly Speaking EP 73

Listen to this week’s podcast episode to learn about a meta-analysis showing no benefit to rectal examinations in men.

Guest: Susan Feeney, DNP, FNP-BC 

Jun 18, 2018
Don’t Make Me Exercise – Give Me Some Tea & a Pill! - Frankly Speaking EP 72

A recent AHA presentation offered data that showed an overwhelming amount of patients would prefer to take a pill or drink tea rather than exercise to lower their BP. This begs the questions: How much does drinking tea lower BP? Does exercise help those with primary HTN or resistant HTN who are already on medication? Finally, how do we get our patients to exercise? 

Guest: Robert A. Baldor, MD, FAAFP

Jun 11, 2018
Mom, Do I Have to Practice the Piano Again? The Benefit of Music Instruction on Executive Function - Frankly Speaking EP 71

Listen to this week's episode to learn about a randomized trial of children in music vs. visual arts instruction. Music instruction led to improvements in verbal intelligence, executive functions, and academic performance.

Guest: Susan Feeney, DNP, FNP-BC

Jun 04, 2018
Hot Flashes, Night Sweats, and Insomnia: Will I Ever Sleep Through the Night Again? - Frankly Speaking EP 70

This episode will review The Menopause Strategies: Finding Lasting Answers for Symptoms and Health (MsFLASH) series of 4 randomized controlled trials, pooling individual data that will provide guidance for discussing pharmacologic and non-pharmacologic options for your peri- and postmenopausal patients.

Guest: Jill Terrien PhD, ANP-BC


May 28, 2018
Biomarkers for Alzheimer’s Diagnosis? - Frankly Speaking EP 69

The National Institute on Aging-Alzheimer’s Association (NIA-AA) just released an updated Framework of the 2011 Guidelines for Alzheimer’s Disease Research, focusing on the use of biomarkers rather than clinical criteria to make the diagnosis. Listen to this week’s episode to learn more.

Guest: Robert A. Baldor, MD, FAAFP

May 21, 2018
My Joints Are Killing Me! Opioids vs. NSAIDs for Chronic Pain - Frankly Speaking EP 68

Chronic pain is a difficult but common problem in primary care. Patients are often desperate for any form of relief, and as a result, many are eventually started on opioid analgesics. This can be associated with many adverse effects. But is it worth it? A recent randomized trial compared opioid to non-opioid management of patients with chronic low back pain or chronic hip pain or knee pain due to osteoarthritis.

Guest: Alan Ehrlich, MD

May 14, 2018
Antibiotics and Sinusitis – How Long is Too Long? - Frankly Speaking EP 67

A recent research study published in JAMA Internal Medicine examined the use of antibiotics to treat acute sinusitis based upon the Infectious Diseases Society of America (IDSA) guideline recommending 5-7 days when antibiotics are indicated and found that most courses of antibiotics are too long. Listen to this week’s episode to learn more.

Guest: Robert A. Baldor, MD, FAAFP

May 07, 2018
Best Evidence Goals for Type 2 Diabetes - Frankly Speaking EP 66

The American College of Physicians supported an evidence-based review of the topic guidelines for type 2 diabetes and concluded clinicians should aim for an A1c goal between 7.0-8.0 and recommended even less aggressive care for those over the age 80 years. Listen to this podcast episode to learn more about these new guidelines.

Guest: Alan Ehrlich MD

Apr 30, 2018
Is Screen Time Taking Your Child’s Sleep Time? - Frankly Speaking EP 65

Listen to this podcast episode for a brief summary of the literature on electronic media and its relation to sleep—specifically delayed bedtimes and decreased sleep duration. Screen-based media consumption is eating up our sleep health!

Guest: Jill Terrien PhD, ANP-BC

Apr 23, 2018
Diet! Diet! Who’s Got the Best Diet? - Frankly Speaking EP 64

71% of adults in the United States are overweight or obese. To tackle this problem, primary care providers must stay up to date on the best evidence for addressing overweight and obese status in their patients. The DIETFITS Randomized Clinical Trial offers direction for nutritional advice in this important and serious public health concern.

Guest: Kenneth Peterson, PhD, FNP-BC

Apr 16, 2018
Changing Immunization Practices: 2-Dose Vaccines - Frankly Speaking EP 63

Immunization practices are constantly in flux as new vaccines are approved and guidelines are updated. Recently, the FDA approved a 2-dose hepatitis B virus (HBV) vaccine and a new 2-dose herpes zoster (HZ) vaccine. Additionally, the CDC now recommends a 2-dose human papillomavirus (HPV) vaccine schedule, a change from the previous recommendation for a 3-dose schedule. This session will discuss the changing landscape of immunization practices and recent changes to recommendations.

Guest: Robert A. Baldor, MD, FAAFP

Apr 09, 2018
I’ve Got Rhythm: Catheter Ablation Therapy for Patients with Atrial Fibrillation and Heart Failure - Frankly Speaking EP 62

Management of patients with atrial fibrillation has long centered on the relative merits of rate control versus rhythm control. The CASTLE-AF trial evaluated catheter ablation as a treatment for patients with both heart failure with reduced ejection fraction and atrial fibrillation. Listen to this week’s podcast episode to learn about the results of this new trial and how the catheter ablation impacted clinical outcomes. 

Guest: Alan Ehrlich MD

Apr 02, 2018
How to Best Treat Cognitive Impairment – 2018 AAN Recommendations - Frankly Speaking EP 61

In this week’s episode, we’ll be continuing the discussion on the AAN’s updated practice guideline on mild cognitive impairment. Last week’s podcast episode provided overview of the updated practice guideline, and this week’s episode focuses on treatment recommendations.

Guest: Robert A. Baldor, MD, FAAFP

Mar 26, 2018
Screening for Dementia; Better Than MMSE (Mini Mental Status Exam) - Frankly Speaking EP 60

The American Academy of Neurology recently published the first updated practice guideline on mild cognitive impairment since 2001. Listen to this week’s episode for an overview of the updated practice guideline, which includes a systematic review of prevalence, prognosis, screening, and treatment research with clear recommendations for practicing clinicians.

Guest: Robert A. Baldor, MD, FAAFP

Mar 19, 2018
GET UP: A Small Bit of Movement Makes a Big Impact - Frankly Speaking EP 59

This observational study found adding very little activity, akin to going for a 30-minute walk or converting to a standing desk for half your workday, lowered all-cause and cardiovascular mortality.

Guest: Alan Ehrlich, MD

Mar 12, 2018
Do We Still Use Warfarin? - Frankly Speaking EP 58

Direct acting oral anticoagulants are increasingly used for stroke prevention for individuals with atrial fibrillation. Whether these agents are as safe and effective as warfarin has been a concern for many clinicians, but recent comparative effectiveness analyses are providing answers. In this week’s podcast episode, we will review these recent studies and draw some conclusions about which agents are best.

Guest: Robert A. Baldor, MD, FAAFP

Mar 05, 2018
Helping Depressed Patients Change: Behavioral Activation - Frankly Speaking EP 57

Listen to this week’s episode to learn about the basic concepts of behavioral activation (BA), what research has demonstrated about its use in depression, and how to apply BA in everyday care. 

Guest: Susan Feeney, DNP, FNP-BC

Feb 26, 2018
The Flu is Bad for Your Heart - Frankly Speaking EP 56

Patients with chronic diseases, including coronary artery disease, are advised to get yearly flu shots because they are at higher risk for having a more severe illness. Canadian researchers have found that in the week following being diagnosed with the flu, adults over 65 years old have a significantly increased risk of myocardial infection.

Feb 19, 2018
Too Little, Too Much: How Much Sleep is Just Right? - Frankly Speaking EP 55

In this session we discuss the impact of length of sleep on obesity and DM II.

Feb 12, 2018
Your Morning “Cup of Joe” Could Be Doing More Than Starting Your Day - Frankly Speaking EP 54

This session will review the existing evidence between coffee consumption and multiple health outcomes. 

Feb 05, 2018
An Oral Fecal Transplant for Lunch?- Frankly Speaking EP 53

Treating recurrent C. difficile colitis can be difficult, but recent trials have demonstrated the benefit of treating with fecal transplantation. Questions exist, however, about around the best mode of administration. Listen to this week’s episode to learn about a recent RCT that compares oral and colonoscopic delivery methods and provides an answer.


Learning Objectives: 

  1. Appreciate the current guidelines for treating recurrent difficile colitis
  2. Understand the pharmacology of fecal transplantation
  3. Learn about the latest research on how best to administer such treatment
Jan 29, 2018
The New Hypertension Guidelines - Frankly Speaking EP 52

New hypertension guidelines from the American College of Cardiology have introduced a new blood pressure classification system and lowered the threshold for initiating pharmacotherapy in certain patient populations.

Learning Objectives:

  1. Understand the new classification categories of hypertension
  2. Understand the new thresholds for starting treatment
  3. Understand the limitations of the new recommendations to specific patient populations
Jan 22, 2018
Preventing Opioid Addiction: Treating Acute Pain Safely - Frankly Speaking EP 51

For severe, acute pain, 1000 mg of acetaminophen PLUS 400 mg of ibuprofen is as effective as acetaminophen/oxycodone, acetaminophen/hydrocodone, or acetaminophen/codeine. Listen to this week’s episode to learn more about treating acute pain safely. 


Learning Objectives: 

  1. Review the current trial comparing Acetaminophen plus Ibuprofen to other acetaminophen/opioid combinations on pain outcomes
  2. Summarize the other data supporting this combination in children and adults
  3. Understand the path that can lead from acute pain to dependence.
Jan 15, 2018
Herpes Zoster Vaccination: New Recommendations for Shingles Prevention - Frankly Speaking EP 50

This session will review the recommendations put forth by the CDC’s Advisory Committee on Immunization Practices for the use of a new shingles vaccine. Dosing, use, and efficacy will be discussed.


Learning Objectives:

  1. Review the new vaccine recommendations for the prevention of shingles.
  2. Discuss the use of the current vaccine and new vaccine with dosage and schedule.
  3. Provide a resource for the treatment of post herpetic neuralgia.
Jan 08, 2018
Diabetes Remission with Weight Loss - Frankly Speaking EP 49

Diabetes remission is defined as a return to normal blood sugar control without the use of medications. Listen to this episode to learn about a trial in which the use of a very low calorie diet in a primary care setting resulted in significant weight loss and remission of diabetes.


Learning Objectives:

  1. Understand what is meant by diabetes remission
  2. Understand what treatments can lead to diabetes remission


Jan 02, 2018
What Does the Evidence Tell Us About Diagnosing and Treating Sinusitis? - Frankly Speaking EP 48

Listen to this episode to learn about the evidence-based guidelines for the diagnosis and management of acute sinusitis.

Learning Objectives:

  1. Discuss the most recent EBP Guidelines on diagnosis and management of acute sinusitis
  2. Discuss application of best practices for appropriate management of acute sinusitis and strategies for good antibiotic stewardship.

Guest: Susan Feeney, DNP, FNP-BC

Dec 26, 2017
Treatment Options in Opioid Dependence - Frankly Speaking EP 47

Medication-based maintenance therapy is recommended for patients with opioid dependence. Listen to this week’s episode to learn how once monthly naltrexone injections are as effective as daily treatment with buprenorphine/naloxone.


Learning Objectives: 

  1. Understand data comparing long-acting naltrexone to daily buprenorphine/naloxone
  2. Understand importance of medication-based maintenance therapy
Dec 18, 2017
New Treatment for Asthma - Frankly Speaking EP 46

We will discuss the use of azithromycin as a therapeutic option for patients with persistent symptomatic asthma despite controller maintenance therapy with inhaled corticosteroids and a long-acting bronchodilator.

Learning Objectives:

  1. Understand the effect of chronic azithromycin for reducing asthma exacerbation
  2. Understand the role azithromycin can play in asthma step-wise therapy
Dec 11, 2017
Endurance Sports: In it for the long haul - Frankly Speaking EP 45

What do you say when your 50-year-old patient that has been relatively sedentary in the last 3 decades wants to do a triathlon? In this episode, we will review a U.S. case series of participants in triathlon races from 1985-2016, and discuss risk, reward, and reality.

Learning Objectives: 

  1. Review data collected over 30 years on triathlon events and the risks to participants.
  2. Discuss recommendations for patients embarking on extreme physical activity.
  3. Review strategies to promote well-being and lower risk when considering endurance sports.
Dec 04, 2017
Blood Pressure Determination on Obese Arms - Frankly Speaking EP 44

If you become frustrated trying to get a thigh cuff onto the arm of an obese patient, we may have the answer.

Learning Objectives: 

  1. Review the comparison of standard BP determination with using the forearm and radial pulse with a large cuff
  2. Appreciate the benefits of systolic hypertension control
  3. Review the causes of secondary hypertension in obese patients 
Nov 27, 2017
Tattooing and Body Modification: From Risky to Mainstream – What are the Implications for Patient Care? - Frankly Speaking EP 43

In this episode, we discuss the first evidence-based guidelines by the American Academy of Pediatrics on body modification, piercing, and scarification, including complications and assessment of risk. 

Learning Objectives: 

  1. Discuss the AAP’s EBP Guidelines on body modification, piercing and scarification in children, adolescents and young adults
  2. Discuss best practices for counseling adolescents and strategies for reducing associated risks regarding these practices.



Nov 20, 2017
‘Tis the Season … for Depression; Get Your Patients Moving. - Frankly Speaking EP 42

How much exercise makes a difference in the primary prevention of depression and anxiety? Find out in this podcast which will provide insights from Norway’s HUNT cohort study that followed a healthy cohort of 33,908 individuals for 11 years.

Learning Objectives: 

  1. Review the relation of exercise and the development of depression and anxiety in a healthy population.
  2. Discuss strategies and options to alleviate stress and promote wellness.


Nov 13, 2017
Is Oxygen Helpful for Patients with Acute Stroke? - Frankly Speaking EP 41

Learning Objectives: 

  1. Understand the results of the Stroke Oxygen Study
  2. Understand which patients will benefit from supplemental oxygen
Nov 06, 2017
The Sun is Setting for Sulfonylureas - Frankly Speaking EP 40

Learning Objectives: 

  1. Review the data on the risks of SU use
  2. Consider other second line approaches to Type 2 DM
  3. Review Primary Treatment Goals for T2DM
Oct 30, 2017
Rare Risks with Pediatric Cough & Cold Medications - Frankly Speaking EP 39

Learning Objectives:

  1. Discuss the AAP position and why
  2. Review findings of adverse events and where the danger lies
  3. Offer advice on what to use and how to dose.
Oct 23, 2017
Treating Major Depressive Disorder: Considerations in Applying the Evidence - Frankly Speaking EP 38

Learning Objectives: 

  1. Identify the concerns surrounding depression screening and treatment.
  2. Discuss the numerous factors primary care providers need to take into consideration to improve management of depression in their patients.
Oct 16, 2017
PPIs: Too Much of a Good Thing? When and How to Discontinue Them - Frankly Speaking EP 37

Learning Objectives: 

  1. Discuss EBP Guidelines on management of Acid related GI condition and PPI prescribing
  2. Discuss best practice for appropriate PPI use in primary care and strategies for discontinuation. 
Oct 09, 2017
The Flu Stops with You – 2017/2018 Influenza Vaccination Recommendations - Frankly Speaking EP 36

Learning Objectives:

  1. Discuss the 2017-2018 American College of Advisory Committee on Immunization Practices (ACIP) 2017-2018 Seasonal Influenza Vaccine.
  2. Review age recommendations, high-risk populations and contraindications for seasonal influenza vaccination.
  3. Discuss best practices and dispel myths your patients may believe that prevent influenza vaccination.
Oct 02, 2017
Tonsillectomy Improves Sleep Disordered Breathing In Children - Frankly Speaking EP 35

Learning Objectives: 

  1. Understand the scope of the problems associated with sleep disordered breathing in children
  2. Review outcomes from this systematic review and meta analysis
  3. Appreciate the possible indications for surgery in children with sleep disordered breathing
Sep 25, 2017
Putting E-cigarettes to Good Use: Evidence on Smoking Cessation Impact and Population Health - Frankly Speaking EP 34

Learning Objectives:

  1. Clarify the concerns surrounding e-cigarette use.
  2. Discuss the potential for incorporating e-cigarette use as a smoking cessation strategy for patients.
Sep 18, 2017
Treating an Abscess: When are Antibiotics Needed? - Frankly Speaking EP 33

Learning Objectives: 

  1. Know which patients are most likely to benefit from antibiotics following incision and drainage of and abscess
  2. Know which antibiotics are preferred to use for patients following incision and drainage 
Sep 11, 2017
Infant Sleep Safety: AAP Recommendations Explained - Frankly Speaking EP 32

Learning Objectives:

  1. Discuss the most recent evidence based practice guidelines on safe infant sleep environment
  2. Discuss barriers to implementing the EBP safe sleep environment guidelines
  3. Discuss strategies to improve compliance with EBP safe sleep environment guidelines
Sep 04, 2017
Late Breaking News: Let's Talk About Alcohol Consumption and Health Outcomes - Frankly Speaking EP 31

Learning Objectives:

  1. Discuss the results of a longitudinal cohort study re: alcohol consumption and cognitive decline.
  2. Review U.S. Guidelines for alcohol consumption.
  3. Discuss best practice recommendations for primary care patient discussions on the use of alcohol.
Aug 28, 2017
Help Me with My Headache—Please! - Frankly Speaking EP 30

Learning Objectives: 

  1. Review best practices in the identification of migraine headache.
  2. Discuss recent updates for the prevention and treatment of migraines.

  3. Review the use of technology in the care of headache patients.


Aug 21, 2017
Practical Approaches to the New Guidelines on Breast Cancer Screening - Frankly Speaking EP 29

Learning Objectives:

  1. Review and compare current EB guidelines from the ACS, ACOG and USPSTF
  2. Discuss breast cancer risk and its impact on screening recommendations
  3. Discuss strategies to apply guidelines in practice
Aug 14, 2017
E-Cigarettes – Risks of Teen Vaping - Frankly Speaking EP 28

Learning Objectives:

  1. Discuss the history of e-Cigarettes and how they function
  2. Discuss the findings of the recent meta-analysis/systematic review regarding US teen use and the association with future tobacco smoking behavior
  3. Discuss the potential public health concerns, implication for health policy and best practice for family and pediatric providers
Aug 07, 2017
The American Heart Association Update on the Role of Fat in Your Diet - Frankly Speaking EP 27

Learning Objectives:

  1. Discuss the AHA position statement on fats in the diet
  2. Review the types of fat and what is known about their relationship to heart disease

  3. Recommend a dietary approach that is based upon best evidence
Jul 31, 2017
The Opioid Epidemic: Is Your Practice Changing? - Frankly Speaking EP 26

Learning Objectives:

  1. Discuss the findings of Martins et al survey results in the context of primary care practice
  2. Identify validated tools useful in your practice to identify opioid misuse
  3. Discuss methods to promote effective pain management including utilizing safe prescribing strategies
Jul 24, 2017
Artificial Sweeteners: Does Diet Soda Do More Harm Than Good? - Frankly Speaking EP 25

Learning Objectives:

  1. Review how the correlation of artificial sweeteners and CNS outcomes were related
  2. Summarize how artificial sweeteners may increase risk for obesity and Type 2 Diabetes
  3. Remind listeners that use of sucrose in appropriate dosages is safer than artificial sweeteners
Jul 17, 2017
Whole Milk Does Not Increase Adverse Cardiovascular Outcomes - Frankly Speaking EP 24

This podcast reviews the results of a meta-analysis that found no negative relationship between whole milk consumption and cardiovascular disease or with mortality.

Learning Objectives

  1. Understand the rationale that led to decreased milk intake in the 80's and 90's
  2. Appreciate how a meta analysis can shed light on the role whole milk might play on heart disease
  3. Be reminded that using "logic" without scientific rigor can lead to false conclusions
Jul 10, 2017
Here’s to Your Health: What Meat Shall You Eat? - Frankly Speaking EP 23

Teaching patients lifestyle management strategies to improve health is no easy task. First steps involve increasing provider knowledge of the impact foods have on health. This episode discusses the latest evidence on different types of meat intake and meat associated compounds on health.  

Learning Objectives:

  1. Review the current evidence on meat intake and mortality
  2. Discuss the “real” world impact for patients in primary care
Jul 03, 2017
Fruit Juice and Kids: How Sweet it is - Frankly Speaking EP 22

Kids love fruit juice. But how much is OK? What are the facts on fruit juice consumption in kids and what should you advise the families you care for? In this episode, we will discuss the latest recommendations from the American Academy of Pediatrics and how they may impact your practice.

Learning Objectives:

  1. Identify the AAP recommendations for fruit juice consumption across childhood from infancy through adolescence
  2. Discuss health risks associated with increased fruit juice consumption
  3. Discuss strategies to promote healthy consumption of beverages in children and families
Jun 26, 2017
New Simpler HPV Vaccine Schedule - Frankly Speaking EP 21

HPV immunization has been recommended for pre-teens and teens for over a decade, however vaccination rates remain low. In October 2016 the CDC changed their recommendations to 2 doses of HPV vaccine in teens before their 15th birthday (from 3 doses), does this make it easier for completion? 

Learning Objectives:

  1. Review the current recommendations for Human Papilloma Vaccination (HPV) in the young adolescent population including immunogenicity.
  2. Discuss the prevalence of HPV and associated diseases and cancer
  3. Review strategies to increase vaccination rates
Jun 19, 2017
Are Short-term Corticosteroids Dangerous? - Frankly Speaking EP 20

Corticosteroids are often prescribed for short-term use for conditions such as asthma exacerbation, contact dermatitis, gout, and Bell’s palsy. Adverse effects from chronic use of corticosteroids is well known, but many clinicians believe that the risk of significant adverse effects from short-term use is minimal. A recent retrospective cohort study was done reviewing the records of 1.5 million adults to assess the adverse effects of treatment with corticosteroids for less than 30 days.

Learning Objectives: 

  1. Review the conditions for which corticosteroids may be used for short-term treatment
  2. Understand the potential risks associated with short-term treatment
  3. Understand the magnitude of the potential risks relative to possible benefits
Jun 12, 2017
Alternate-day Fasting for Weight Loss - Frankly Speaking EP 19

Is Alternate day fasting the future of weight loss?  Maybe not...

Learning Objectives

  1. Understand how Alternate day fasting is practiced
  2. Appreciate why Alternate day fasting might make physiologic sense
  3. Review the recent literature on its strengths and weaknesses
Jun 05, 2017
Do Corticosteroids Decrease the Pain of Acute Pharyngitis? - Frankly Speaking EP 18

When patients present with symptoms of a sore throat, an option for managing the pain  that is sometimes used is corticosteroids. A randomized trial of a 1-time dose of 10 mg in patients with moderate to severe pharyngitis who were deemed to not need antibiotics found higher rates of symptom resolution at 48 hours.

Learning Objectives:

  1. Understand potential benefits of corticosteroids for treatment of pain of acute pharyngitis
  2. Understand limitations of evidence for benefit
  3. Understand other options for symptom relief
May 29, 2017
Contraception: The Pill Needs to Share - Frankly Speaking EP17

Sensitive and important conversations with your adolescent population include contraceptive options.  How do long acting reversible contraceptive methods (LARC’s) fit into your conversation?  Let’s discuss a recent review and update your talk!

Learning Objectives:

  1. Discuss the use of long acting reversible contraceptive methods (LARC’s).
  2. Describe the efficacy or LARC’s compared to other birth control methods.
  3. Describe communication strategies useful in discussing contraception with adolescents. 
May 22, 2017
Safe and Effective Narcotic Use in Chronic Pain - Frankly Speaking EP 16

Based upon CDC data of death, narcotic prescription length of less than 5 days provided the best outcomes and the lowest risk of continued narcotic use.

Learning Objectives:

  1. Understand the scope of the death attributable to narcotics
  2. Learn how to prevent a patient from becoming dependent upon opioids
  3. Consider methods to wean off opioids and use other proven agents for chronic non-cancerous pain
May 15, 2017
Oxygen for patients with STEMI: Who benefits? - Frankly Speaking EP 15

Oxygen is frequently  given to patients routinely during the initial treatment of a myocardial infarction, but there is a lack of data to support or refute this. A recent systematic review found no benefit in patients who did not have baseline hypoxia. Oxygen therapy continues to be indicated for those with hypoxia and needs to be used with caution in COPD patients with carbon dioxide retention.

Learning Objectives

  1. Understand the role of oxygen in the management of acute myocardial infarction
  2. Understand the potential for harm of unnecessary oxygen therapy
May 08, 2017
Back Pain is Here to Stay! - Frankly Speaking EP 14

What are your evidence-based strategies for managing acute, subacute and chronic low back pain?  A review of the current American College of Physicians Clinical Practice Guideline can renew your toolkit as you help your patients with back pain maintain a healthy and active lifestyle.

Learning Objectives

  1. Review the latest guidelines on acute, subacute and chronic low back pain (ACP 2/2017)
  2. Discuss non-pharmacologic and pharmacologic therapies available to the primary care provider

May 01, 2017
When Can We Start Preventing Recurrence of Acute Gout? - Frankly Speaking EP13

Most patients who suffer an acute gout attack should be started on urate lowering therapy. It is known that starting urate lowering therapy can itself precipitate a gout attack and concern for not worsening the acute symptoms has been the reason some guidelines recommend waiting until after the acute episode has subsided to start urate lowering therapy. A look at recent data indicates waiting for the acute attack to subside may not be necessary

Learning Objectives:

  1. Understand the principles of urate lowering therapy for preventing gout attacks
  2. Be familiar with the risks and benefits or starting urate lowering therapy during an acute gout attack
Apr 24, 2017
Constipation: Going With the Flow - Frankly Speaking EP12

In this week's podcast episode, we will review recent literature on ineffectiveness of laxatives and learn about indications for newer agents. 

Apr 17, 2017
Physical Activity Following a Concussion - Frankly Speaking EP11

In this podcast episode, we will discuss current guidelines for a concussion evaluation or work-up as well as return to activity following a concussion. We will also put into context this paper and consider what impact this should have on your practice.

Apr 10, 2017
Treating Systolic Hypertension in the Elderly - Frankly Speaking EP10

In this podcast episode, we will talk about how systolic hypertension effects outcomes, put into context a recent JACC systematic review paper on the topic and JNC 8 and discuss NNT and NNH.

Apr 03, 2017
Obstructive Sleep Apnea: Recommendations for Screening Adults - Frankly Speaking EP9

In this week's podcast episode, we will identify the known health risks of OSA and outcomes of OSA treatment, discuss the new USPSTF screening recommendations on OSA and consider application of the new recommendations, known risks and outcomes of practice.

Mar 27, 2017
Non-Fasting Lipids for Cardiovascular Risk Evaluation - Frankly Speaking EP8

In this podcast episode, we will consider the rationale for using non-fasting labs to screen for ASCVD as well as review the controversies around their use and talk about the differential diagnosis of hypertriglyceridemia.

Mar 20, 2017
Helping Kidney Stones Pass: Use of Alpha Antagonists – Frankly Speaking EP7

In this podcast episode, we will talk about the benefits of alpha antagonists on passing larger kidney stones as well as discuss the need for stone collection and analysis to prevent future stones. We will also learn how to effectively counsel patients about alpha antagonist use including risks and benefits.

Mar 13, 2017
Breast Cancer and the Harms of Overdiagnosis - Frankly Speaking EP6

In this podcast episode, we consider the premise of overdiagnosis and how it applies to women being screened for breast cancer and highlight ways to mitigate the risks of overdiagnosis of breast cancer.

Mar 06, 2017
Weekend Warrior: Exercising on the Weekends can be enough - Frankly Speaking EP5


  1. Appreciate the data on different exercise timelines
  2. Learn new options when counseling patients for exercise
  3. Understand the need to include exercise counseling for most adults
Feb 27, 2017
Easy Management of Statin Induced Myalgias - Frankly Speaking EP4

Have a patient with Statin Induced Myalgias? This episode will give you the best evidence on a simple and cost effective solution, and dispel common myths about this problem.

Feb 17, 2017
Introduction of Food to Infants: Preventing Peanut Allergies - Frankly Speaking EP3

Can peanut allergy be prevented in children? This podcast will review the newest AAP recommendations on feeding in the first year of life, with a special emphasis on preventing atopic disorders. After listening to the podcast, listeners will be able to summarize essential points of current AAP EBP guidelines for introduction of complementary foods to infants and current EBP recommendations for introducing potentially allergenic foods, specifically peanut products, to low risk and high risk infants. 

Jan 25, 2017
Getting the Complicated Asthmatic Under Control - Frankly Speaking EP2

This episode will build on the previous podcast with a focus on how to apply the management guidelines in Asthma with a focus on critical features to know for board preparation.

Jan 24, 2017
Asthma: Critical Risk Stratification to Decide Care - Frankly Speaking EP1

This episode will review the basics of asthma diagnosis and management, covering the critical content for both patient management and board preparation.

Jan 10, 2017