Episode 188: digital therapy, DKA with SGLT2s, esketamine for resistant depression, and what is a normal TSH

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!

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 linksBMJ 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/31574019https://pubmed.ncbi.nlm.nih.gov/39964684/ https://pubmed.ncbi.nlm.nih.gov/40023176/ttps://pubmed.ncbi.nlm.nih.gov/39536238/https://pubmed.ncbi.nlm.nih.gov/40163873/

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