Episode 198: Tirzepatide, using Beers, stent for carotid stenosis, and high dose flu vaccine

Join Mark, Kate, Henry and Gary as they discuss 4 new POEMs (Patient Oriented Evidence that Matters, studies with the potential to change practice): a summary of the evidence on tirzepatide (Zepbound) for weight loss, using the Beers list with your patients, high vs standard dose flu vaccine and the risk of hospitalization, and whether stent or endarterectomy are better than maximal medical therapy for patients with asymptomatic carotid stensosis. Here are the links:Essential Evidence Plus: www.essentialevidenceplus.comTirzepatide systematic review: https://pubmed.ncbi.nlm.nih.gov/41015578/ Tirzepatide vs dulaglutide: https://pubmed.ncbi.nlm.nih.gov/41406444/Applying the Beers list: https://pubmed.ncbi.nlm.nih.gov/40697073/ High vs standard dose flu vaccine: https://pubmed.ncbi.nlm.nih.gov/41115437/ Another high dose flu trial: https://pubmed.ncbi.nlm.nih.gov/39230284/ Asymptomatic carotid stenosis treatment: https://pubmed.ncbi.nlm.nih.gov/41269206/

This week, primary care physicians Kate Rowland, Mark Ebell, Gary Ferenchick and Henry Barry tackle 4 new practice changing studies (POEMs): bathing frequency for people with eczema, tirzepatide in obese children and adolescents with T2DM, a new flu vaccine, and whether beta-blockers still matter after MI.

Join primary care physicians Kate, Gary, Henry and Mark as they discuss 4 new POEM (Patient Oriented Evidence that Matters), chosen for their potential to change practice and improve patient outcomes: Mediterranean diet to prevent diabetes, an update to the community-acquired pneumonia guideline, coffee or decaf for afib, and safety of meds for acute agitation in the elderly. North Dakota Academy of Family Physicians Conference in Big Sky: https://www.ndafp.org/cme/big-sky-conference/ Essential Evidence Plus and all the POEMs: www.essentialevidenceplus.comMed diet to prevent diabetes: https://pubmed.ncbi.nlm.nih.gov/40854218/ Safety of meds for agitation in elderly: https://pubmed.ncbi.nlm.nih.gov/40275439/Updated pneumonia guidelines from ATS/IDSA: https://pubmed.ncbi.nlm.nih.gov/40679934/ Coffee or decaf with afib:  https://pubmed.ncbi.nlm.nih.gov/41206802/

Join Kate, Gary and Mark (Henry has the day off) as we discuss 3 useful new studies: colorectal cancer screening reminders, aspirin or clopidogrel for secondary prevention of CV events, and lipid lowering drugs and dementia risk

This week primary care physicians Gary, Henry, Kate and Mark discuss the safety of CBD, a new guideline for managing adults with hypertension, whether COVID-19 vaccines are still effective, and a living guideline from the BMJ to help us choose the best diabetes drugs. Links to stuffEssential Evidence Plus Illinois Academy of Family Physicians meeting Dec 6 in Naperville, IL (Kate, Gary and Mark)   North Dakota Academy of Family Physicians Big Sky Conference Jan 19 in Big Sky, Montana (Gary and Kate) Safety of CBDACC/AHA Hypertension guidelinePREVENT-CVD risk calculatorEfficacy of COVID-19 vaccinesBMJ living guideline for diabetesBMJ MATCH-IT interactive tool for selecting drugs

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!).LinksEssential Evidence Plus: www.essentialevidenceplus.comHTN 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.comDuration 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.comAcetaminophen 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.c5347MMR 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/40355250And 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-recognizedhttps://www.medscape.com/viewarticle/malnutrition-related-diabetes-officially-named-type-5-2025a10008pd

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.