Episode 192: anticoag duration, old drugs for insomnia, lower dose Ozempic, and aspirin + anticoag or anticoag alone

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.

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.comDigital 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.comIncidental 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/39705187Multicancer 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!