The Curbsiders Internal Medicine Podcast #328 Updates in Hospital Medicine, Primary Care, Breast Health, Sexual Health, Addiction Medicine, Meded and more! Highlights from #SGIM22
Apr 15, 2022
01:20:22
High-Yield Ambulatory Teaching Models
- Use the One Minute Preceptor or SNAPS to structure quick ambulatory teaching moments.
- Try precepting in the presence of the patient (PIPP) to increase face-to-face time and perceived efficiency.
Monitor Silicone Implants And Counsel On ALCL Risk
- For patients with silicone breast implants recommend regular imaging surveillance because silent ruptures can occur.
- Explain breast implant associated ALCL risk is linked to textured implants and is small; removal is optional based on patient preference.
Use Doxycycline For Most Chlamydia Infections
- Treat chlamydia with doxycycline 100 mg twice daily for seven days as first-line except in pregnancy.
- Use azithromycin when adherence or immediate observed therapy is essential.
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Introduction
00:00 • 2min
Y Y Usis Just Staring in Each Other's Eyes
01:35 • 2min
Teaching Models in the Ambulatory Care Setting
03:10 • 2min
Is It a Bedside Rounding Model or a P Ip Model?
05:29 • 2min
Shemer Sigamer and Cari M Shrea
07:00 • 2min
What's Your Notion of Purpose?
08:37 • 2min
What Is Something That Brings You Joy Outside of Work?
10:42 • 2min
How Does Knowledge Retention Vary Between Listening and Commuting?
12:59 • 2min
What Have You Learned So Far at the Conference?
14:43 • 3min
Cancer Survivor's Symptoms
17:57 • 2min
Breast Cancer Oncology and Survivorship Care Plans
20:19 • 2min
Cancer Survivor - Is There an Impact on Your Sexual Function?
22:23 • 2min
The Benefits of Physical Activity in a Breast Cancer Survivor Population
24:35 • 2min
Climate and Health for the Physicians
26:18 • 2min
Climate Change and Primary Care Doctors
28:19 • 2min
The 15 Steps of Clima Communication Podcast
29:51 • 2min
Green Chef - The Number One Milk Kit for Eating
31:28 • 2min
What's the Point of a P T Consultation?
33:00 • 2min
Aspiration, Pneumonia or Slash Neumanitis?
34:45 • 2min
The Bias in Note Writing
36:31 • 2min
Plant Baste Beats Are Amazing for You
38:37 • 2min
Is This a Healthy Alternative for Your Body?
41:05 • 2min
Breast Augmentation
42:39 • 2min
Breast Implants
44:10 • 1min
Is There a Breast Implant Associated Lim Poma?
45:40 • 2min
Breast Reduction
47:14 • 2min
Doty Cyclone
49:14 • 2min
Metronitus All, You Cannot Drink Alcohol When You Take It, Right?
50:55 • 2min
Women's Health, I'm Afraid.
52:45 • 2min
Getting Involved in Interest Groups for Faculty Development
54:22 • 2min
Is There a Benefit to the Beast Mode?
56:00 • 2min
Burnout Is the Best Medicine
58:07 • 2min
Master Works Dot Art Slash Curb Siders
59:44 • 5min
New Innovative Web Sides for Medical Education
01:05:00 • 2min
Clinical Up Dates and Primary Care
01:06:36 • 2min
Type 2 Diabetes - Is There a Barrier to Insurance?
01:08:10 • 2min
Rotator Cuff Injuries - Is a Seroid Injection a Better Treatment?
01:09:57 • 3min
Do You Have a Recurrence of Depression?
01:12:30 • 2min
What Can We Do for Methem Feteminus?
01:14:16 • 3min
The Curb Siders - Episode 22
01:17:23 • 2min
The Podcasts Podcast
01:19:02 • 2min
Fill up with delicious practice-changing knowledge food from #SGIM22 as The Curbsiders team discusses breast cancer survivorship, sexual dysfunction, How climate change will affect health, Are PT consults necessary in the hospital?, Do we need antibiotics for aspiration events?, bias in note writing, Are plant-based meats a healthy?, complications after breast implantation, how to get breast reduction approved, doxycycline for chlamydia, the metronidazole and alcohol myth, pearls for clinician-educators, telehealth, TEACHIM.org, CGMs help lower a1c, PT for rotator cuff disease, Is it safe to taper antidepressants? and how to treat methamphetamine use disorder!
Note: There is no CME for this episode, but claim CME for prior episodes at curbsiders.vcuhealth.org!
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Credits
- Written and Hosted by: Nora Taranto MD, Beth Garbitelli (about to be an MD!), Era Kryzhanovskaya MD, Justin Berk MD, MPH, MBA, Shreya Trivedi MD, Chris Chiu MD, Paul Williams MD, Matthew Watto MD
- Show Notes and Cover Art: Matthew Watto MD, FACP
- Showrunner: Matthew Watto MD, FACP
- Technical Production: Pod Paste
Show Segments
- Intro
- A few ambulatory teaching models include the One Minute Preceptor, SNAPS (summarize, narrow, analyze, probe, plan, and select), PIPP (precepting in the presence of the patient) [see Community Preceptor Toolbox]
- Ikigai is a Japanese term indicating a motivational force or reason for living. It is associated with decreased mortality [Tanno, 2009]. Explore your ikigai here (PositivePsychology.com).
- Listening to podcasts while driving does not affect knowledge retention (Gottleib et al. 2021)
- Treatment of Hot flashes: Avoid paroxetine, fluoxetine, and sertraline in breast cancers survivors taking tamoxifen. Instead use venlafaxine (or another SNRI), citalopram, or escitalopram. Gabapentin given at bedtime is also an option. (Clinical Update 2019: Tamoxifen and Antidepressants)
- Distress in patients with cancer can be measured using the NCCN screening tool [NCCN Distress Thermometer]
- Don’t forget to ask for a Cancer Survivorship Plan from oncology [CDC Cancer Survivorship Care Plans]
- Ask about sexual dysfunction in cancer survivors.
- How will climate change impact our patient’s health? NIH framework; CH2OPD2 environmental screening tool [CH2OPD2 ]; and the 15 steps of climate communication.
- Use the AM-PAC score cutoff of >18 to avoid a PT consult in hospitalized patients (Martinez 2021).
- Early antibiotics after an aspiration event do not improve outcomes (Aga 2021).
- Biased language is more common in notes about Black patients (Beach 2021). Be thoughtful about what you write and role model good behavior.
- While plant-based meats are more eco-friendly than animal-sourced meats, they are heavily processed foods (van Vliet 2021) and may have high sodium.
- Silicone breast implant rupture can be insidious. Guidelines recommend screening with MRI after 6 years, then every 2-3 years (FDA 2020, More FDA info) (Note: FDA’s most recent guidance also recommends ultrasound as an alternative screening method, so always check with the patient's insurance about which modality will be covered)
- Document a trial of NSAIDs, physical therapy, attempted weight loss, and supportive bra usage before breast reduction surgery for macromastia.
- Doxycycline is now first line for chlamydia rather than azithromycin [STI Treatment Guidelines Update], BUT the most effective treatment is the one your patient will take!
- Metronidazole does not cause a disulfiram-like reaction and is no longer recommended by the guidelines [STI Treatment Guidelines Update]
- More clinician-educator pearls from Era: Don’t be afraid to brand yourself! Network with like-minded individuals (e.g. interest groups).
- BST mode: bite-sized teaching pearls can help reduce extrinsic load and improve retention [Manning, 2021]
- A guided discussion based on Scrubs episodes can improve resident wellness [Holtzclaw 2021]
- Chris recaps some posters (click links to see them on Twitter!): Telehealth disparities and tech equity (poster 1, poster 2); TeachIM.org (poster)
- Continuous glucose monitors can help lower a1c in patients on basal insulin [Martens 2021]
- A single session of PT improved shoulder pain. The benefits of steroid injections were limited to 8 weeks in the GRASP trial [Hopewell 2021]
- There is a high risk of recurrence after tapering antidepressants [Lewis 2021]
- Methamphetamine use disorder can be treated with IM naltrexone every 3 weeks, plus oral bupropion 450 mg daily [Trivedi 2021]. Limitations include cost and co-use of opioids.
- Outro
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