Mayo Talks

Special Back to School Sports Medicine for the Primary Care Provider Series – Episode 1: According to the CDC, sports concussions have reach epidemic levels. Dr. Cara Prideaux discusses risks for concussions, evaluation signs and symptoms, and when referral and imaging is recommended. What should be happening on the sidelines when one of your patients has an event? What are the recommendations for recovery and returning your patients to school and sports? Dr. Prideaux details the dangers of returning too early and what to do when patients are making a delayed transition back to normality. For a deeper dive: American Medical Society for Sports Medicine Position Statement on Concussion in Sport Harmon KG, Clugston JR, Dec K, et al American Medical Society for Sports Medicine position statement on concussion in sport British Journal of Sports Medicine 2019;53:213-225. http://dx.doi.org/10.1136/bjsports-2018-100338

Who decides when the plane needs to land due to a medical emergency and what’s involved in those decisions? What’s the protocol for CPR onboard and what tools are available to help with resuscitation? What happens when a passenger dies on a flight? Drs. Haddon and Harris step through the intricacies of responding to inflight emergencies and the ethics involved.

Are you required to respond? If you do, what are your responsibilities? What are your liability risks and protections? Dr. Harris steps through some recommendations for responding to in-flight emergencies. Dr. Haddon runs through what you should ask as part of the physical exam while in-flight and why these questions are important.

What causes Irritable Bowel Syndrome (IBS)? What diets are recommended? What is gut-brain access and what does it have to do with IBS? Dr. Hansel covers treatment recommendations for IBS-diarrhea predominant, IBS-constipation predominant, and IBS-mixed type, including the role of bile acid malabsorption. For a deeper dive: Bile Acid Malabsorption Testing: https://news.mayocliniclabs.com/2018/03/09/michael-camilleri-m-d-leslie-donato-ph-d-discuss-testing-bile-acid-malabsorption-clinical-practice/

Who can be treated outpatient and who really needs to be evaluated in the ED? When does the risk of treatment outweigh the benefits? What tools can you use to help make these decisions? Dr. Matthew Bartlett discusses when to treat, options for treatment – including direct oral anticoagulants, follow up care, and preventative measures for patients with thrombotic disease.

What are microaggressions? How do you recognize them? How do you address them? Efficient teams and effective health care require diverse and inclusive environments. Drs. Njathi-Ori, O’Brien, and Warner present on microaggressions in medicine, the evidence in gender gap research, and give you tools to address microaggressions when they happen in your environment.

What are the updated guidelines for managing hyperlipidemia and how do the risk modifiers change how patients should be treated? What do you do when a patient starts a statin and there is no change in cholesterol levels? What do you do when increasing the dose or switching to a stronger drug continues to have little to no impact? Dr. Kopecky discusses the updated guidelines, challenges with statin therapy, and additional tactics to consider in treating hyperlipidemia. For a deeper dive check out these resources: 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines http://www.onlinejacc.org/content/early/2018/11/02/j.jacc.2018.11.003 Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia https://www.nejm.org/doi/full/10.1056/NEJMoa1812792

The World Health Organization has listed vaccine hesitancy as a Top 10 Global Health Threat. How do you discuss vaccine myths with vaccine hesitant patients? What are the true risks associated with vaccines? How do you navigate conversation with a patient who refuses a flu vaccine because they had one in the past and still got the flu? Dr. Gregory Poland discusses vaccine hesitancy, immunization in pregnancy, late-season flu vaccines, antigenic burden and the evidence behind single session multiple vaccine administration, and the ethics of health care provider immunizations. For a deeper dive check out these articles: 1. Poland GA, Jacobson RM. The age-old struggle against the antivaccinationists. N Engl J Med. 2011 Jan 13;364(2):97-9. doi: 10.1056/NEJMp1010594. https://www.nejm.org/doi/10.1056/NEJMp1010594 2. Poland GA. Influenza vaccine failure: failure to protect or failure to understand? Expert Rev Vaccines. 2018 Jun;17(6):495-502. https://doi.org/10.1080/14760584.2018.1484284 3. Poland CM, Poland GA

Who is a good candidate for multitarget stool DNA testing and what do you do when it’s positive but the colonoscopy is discordant? Do you have a surveillance plan for your patients with ulcerative colitis and irritable bowel disease? What are the current screening recommendations for the general public versus patients with a family history? Dr. John Kisiel discusses these recommendations and the evidence behind them. He shares tips on managing patients on anticoagulant therapy going for polypectomy and when to stop screening in the elderly.

What’s the difference between e-cigarettes, vaping, and the newly FDA authorized “heat-not-burn” or IQOS devices? Do they really help our patients stop smoking and what data is available on the safety of these products? Listen now to hear Dr. Taylor Hays discuss these points and more. For a deeper dive check out these resources: The FDA Authorization of IQOS: https://bit.ly/2XV2cLw A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy: https://www.nejm.org/doi/full/10.1056/NEJMoa1808779

How can we help women at high risk of breast cancer manage their risk? How do you rank these risks and approach their management? Dr. Pruthi discusses what you can do and tools that you can use to help calculate risk and what to do with the information you have. Breast cancer risk assessment tool: Gail model https://bcrisktool.cancer.gov/ IBIS breast cancer risk evaluation tool http://www.ems-trials.org/riskevaluator/

Female veterans can face significant barriers to receiving proper care. As the number of female service members increases, what can we do to help address these barriers and facilitate access to the care they need? What resources exist and how do we identify this population if they do not readily self-identify as veterans? Check out these resources for more information: MACVSO.org NACVSO.org VA Women’s Health Research Network: https://www.hsrd.research.va.gov/for_researchers/womens_health/ https://www.rand.org/topics/military-health-and-health-care.html

How do you detect Lyme’s disease without the rash? What are the implications for our patients if we miss it? If you practice in an endemic area what are the guidelines for treatment when your patient has been bitten by a tick? Dr. Bobbi Pritt discusses Lyme disease detection, prophylaxis, and some of the long-term consequences of Lyme disease. Listen now to learn the ABCs of tick bite prevention. CDC Guidelines for Tick Bite Prophylaxis: https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophylaxis.html To see more from Dr. Pritt and dive deeper into the world of “Creepy, Dreadful, Wonderful Parasites,” view her blog at https://parasitewonders.blogspot.com/ You can also follow Dr. Pritt on Twitter at @parasitegal

Does perception of care equal quality of care? Healthcare is increasingly consumer-centric and patient experience data can inform us about how we compare within our own institution and across healthcare. But the data can also be influenced by the nature of your practice and implicit bias present in our patients. What are some of the unintended implications of patient experience data? How can we responsibly interpret and utilize it? What scores should we be striving for? What is the sweet spot? For a deeper dive into Dr. Poole’s research follow the link to his article in the New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMp1813418 A brief webcomic by Whit Taylor and Chris Kindred on the Tuskegee Experiment: https://thenib.com/tuskegee-experiment?utm_campaign=web-share-links&utm_medium=social&utm_source=link

How close are we to having an immunization for HIV? What’s on the horizon? When should your patients be referred to an HIV center or clinic for care? How do you connect a patient that wants local care when a center isn’t close by? Dr. Rizza discusses the management of HIV, pharmacotherapy, and goals of treatment in the second episode of this two-part HIV mini-series.

Can you predict who has HIV and who doesn’t? Do you order universal HIV screening? What screening tests should be ordered and what happens when the results are positive or equivocal? When is a false negative possible? What is the effective window for post-exposure prophylaxis? Dr. Stacey Rizza discusses HIV and progression to AIDS, medical exposures, and screening in the first episode of this two-part HIV mini-series. Dive deeper into universal screening: https://doi.org/10.1016/j.mayocp.2012.06.021

Why are prescription drug costs so high in the United States? What role does the rebate system potentially play in drug availability? What is value-based pricing? Vincent Rajkumar, M.D. discuss research in this area and provides resources for health care providers to have discussions with patients about drug affordability. Check out his articles here: https://doi.org/10.1016/j.mayocp.2012.07.007 and https://doi.org/10.1016/j.mayocp.2015.01.014

When should patients be referred to a physiatrist versus a physical therapist? What services can you expect when referring your patient to physical medicine and rehabilitation? Can they help your patients avoid surgery? What resources do they utilize to decrease pain and increase function? Listen as Dr. Jeff Brault discusses his five-finger approach to treatment of chronic and degenerative disease.

The healthcare system is not immune to bias, harassment, and discrimination. How do we create a climate of mutual respect? How do we empower bystanders to step up? How do we create systems and procedures to ensure consistent messaging and action when these things occur? Listen in as Dr. Sharonne Hayes discusses the Time’s Up Healthcare movement and what you can do to get involved. https://www.timesuphealthcare.org

When does forgetfulness become a red flag for dementia? What’s normal aging and what’s underlying disease process? When is a mental status exam not enough and what should you do next? Dr. Richard Caselli discusses dementia diagnosis, risk factors, treatment, and research.