Claim OwnershipPrimary Care Update
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© Mark Ebell
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Four healthily skeptical primary care physicians discuss the latest in primary care medicine. Join Essential Evidence Editor Mark Ebell MD, Rush University's Kate Rowland MD, MSU Professor of Medicine Gary Ferenchick MD, and POEMs co-founder Henry Barry MD, MS for this fast-paced weekly update on evidence-based primary care.
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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.
This week, join Henry, Kate, Gary and Mark as they discuss 4 great studies: home suction devices for infants with bronchiolitis, amitriptyline for adults with irritable bowel, high-dose aspirin for preventing colorectal cancer, and communicating about serious illness and end of life.
This week, Kate, Henry, Mark and Gary discuss antiplatelet medications to prevent dementia, post-stroke blood pressure control, the latest guideline for managing patients with chronic cardiac disease, and probiotics for patients with irritable bowel syndrome.
This week Kate, Mark, Henry and Gary talk about how long it takes for lower extremity cellulitis to improve, how long it takes for CGRP monoclonal antibodies to take effect in adults with chronic migraine, whether CBT is effective for fatigue in patients with long COVID, and outcome data for various lipid lowering therapies. Plus a painful quiz, and Gary learns what an umbrella review is!
This week, join Kate, Mark, Henry and Gary (from his carport) as they discuss third trimester Tdap for prevention of infant pertussis, atogepant for preventing migraines, POCUS for diagnosing small bowel obstruction, and whether any medications work for treating gastroparesis
This week, we give Henry the day off, leaving Kate, Mark and Gary to discuss a new app to reduce unhealthy alcohol use, whether e-cigarettes can help you quit smoking, and whether taking stimulant meds for ADHD increases the risk of substance use down the road. And the quiz, and a book recommendation ("A Voyage for Madmen").
This week Kate, Mark, Gary and Henry discuss magnesium to prevent cerebral palsy, amoxicillin challenge in the primary care clinic for suspectec PCN non-allergy, new ACP guidance on colorectal cancer screening, and surgery for carotid disease.
This week, Kate, Mark, Gary and Henry discuss viral loads and risk of HIV transmission, tetracyclines and dental staining in kids, metformin to prevent long COVID in obese and overweight adults, and the effectiveness of terbinafine pulse therapy for ugly toenails
This week, join Kate, Henry, Gary and Mark as they discuss point of care bilirubin tests for neonatal jaundice, guideline for evaluating children in close contact with abused children, early return to activity after concussion, and terminology preferences by patients being treated for substance use disorder.
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/
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!
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
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