AI-powered
podcast player
Listen to all your favourite podcasts with AI-powered features
The Curbsiders Internal Medicine Podcast
#394 Recap, Top Pearls from ACP #IM2023
May 8, 2023
01:40:21
Episode guests
AI Summary
AI Chapters
Episode notes
Podcast summary created with Snipd AI
Quick takeaways
- Phenobarbital may be an effective alternative to benzodiazepines for alcohol withdrawal syndrome.
- Addressing healthcare needs of incarcerated individuals can impact the community and improve access to care.
- The management of aortic stenosis involves considering the durability of different valve interventions.
- Cognitive Behavioral Therapy for Insomnia (CBTI) is recommended as the first-line treatment.
- Healthcare providers should be educated on firearm safety and discussions with patients.
- Individualized care and considering coexisting conditions is important in managing sleep apnea.
Deep dives
Alcohol Withdrawal Treatment: Phenobarbital as an Alternative to Benzodiazepines
The use of phenobarbital as an alternative treatment for alcohol withdrawal syndrome in the inpatient setting was discussed. While benzodiazepines have traditionally been used, there is growing interest in the use of phenobarbital due to potential benefits such as decreased benzodiazepine use and improved outcomes. However, further research is needed to compare phenobarbital to long-acting benzodiazepines in the treatment of alcohol withdrawal syndrome.
Community Health and Incarceration
The importance of addressing the healthcare needs of individuals involved in the justice system was highlighted. Mass incarceration was described as a public health issue, and it was emphasized that the health of incarcerated individuals can impact the community at large. Efforts were discussed to improve access to healthcare for those in the justice system, including the implementation of Medicaid coverage while incarcerated and the importance of continuity of care post-release.
Management Strategies for Aortic Stenosis
The management of aortic stenosis was discussed, particularly in relation to the choice of valve intervention. Different options, such as surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI), were explored, with considerations given to the durability of the valve and the need for potential re-interventions or valve replacements in the future. The use of cardiac CT and valve calcium scoring to estimate valve calcium burden and guide treatment decisions was also highlighted.
Insomnia Treatment: Cognitive Behavioral Therapy for Insomnia (CBTI)
Cognitive Behavioral Therapy for Insomnia (CBTI) was discussed as the first-line treatment for insomnia. The efficacy of CBTI in improving sleep quality and addressing underlying causes of insomnia was emphasized. Online resources and mobile apps for CBTI were also mentioned as useful tools for patients seeking non-pharmacological treatment for insomnia.
Firearm Safety Education and Advocacy
The importance of healthcare providers being educated on firearm safety and discussions around firearms with patients was emphasized. Resources, including online education hubs and legislative toolkits, were recommended as tools to support healthcare providers in addressing firearm safety and advocating for policies to reduce firearm-related injuries and deaths.
Management of Sleep Apnea
The management of sleep apnea, including approaches to diagnosis and treatment, was discussed. Home sleep tests were highlighted as a valuable option for diagnosing sleep apnea, though it was emphasized that the choice between home sleep testing and in-lab testing should be individualized. Different treatment modalities were explored, such as continuous positive airway pressure (CPAP) therapy, oral appliances, and various surgical options. The importance of individualized care and considering coexisting conditions, such as central sleep apnea, was emphasized.
Alcohol Withdrawal Treatment: Phenobarbital as an Alternative to Benzodiazepines
The use of phenobarbital as an alternative treatment for alcohol withdrawal syndrome in the inpatient setting was discussed. While benzodiazepines have traditionally been used, there is growing interest in the use of phenobarbital due to potential benefits such as decreased benzodiazepine use and improved outcomes. However, further research is needed to compare phenobarbital to long-acting benzodiazepines in the treatment of alcohol withdrawal syndrome.
Community Health and Incarceration
The importance of addressing the healthcare needs of individuals involved in the justice system was highlighted. Mass incarceration was described as a public health issue, and it was emphasized that the health of incarcerated individuals can impact the community at large. Efforts were discussed to improve access to healthcare for those in the justice system, including the implementation of Medicaid coverage while incarcerated and the importance of continuity of care post-release.
Management Strategies for Aortic Stenosis
The management of aortic stenosis was discussed, particularly in relation to the choice of valve intervention. Different options, such as surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI), were explored, with considerations given to the durability of the valve and the need for potential re-interventions or valve replacements in the future. The use of cardiac CT and valve calcium scoring to estimate valve calcium burden and guide treatment decisions was also highlighted.
Insomnia Treatment: Cognitive Behavioral Therapy for Insomnia (CBTI)
Cognitive Behavioral Therapy for Insomnia (CBTI) was discussed as the first-line treatment for insomnia. The efficacy of CBTI in improving sleep quality and addressing underlying causes of insomnia was emphasized. Online resources and mobile apps for CBTI were also mentioned as useful tools for patients seeking non-pharmacological treatment for insomnia.
Firearm Safety Education and Advocacy
The importance of healthcare providers being educated on firearm safety and discussions around firearms with patients was emphasized. Resources, including online education hubs and legislative toolkits, were recommended as tools to support healthcare providers in addressing firearm safety and advocating for policies to reduce firearm-related injuries and deaths.
Management of Sleep Apnea
The management of sleep apnea, including approaches to diagnosis and treatment, was discussed. Home sleep tests were highlighted as a valuable option for diagnosing sleep apnea, though it was emphasized that the choice between home sleep testing and in-lab testing should be individualized. Different treatment modalities were explored, such as continuous positive airway pressure (CPAP) therapy, oral appliances, and various surgical options. The importance of individualized care and considering coexisting conditions, such as central sleep apnea, was emphasized.
Functional Dyspepsia: Clear Communication with Patients
Dr. Mike discussed how to frame the conversation with patients who have functional dyspepsia, a condition with no abnormal findings. By reassuring patients that a diagnosis has been made and tests are being done to rule out any serious conditions, they feel validated and understand the process better, leading to a better patient-physician relationship.
Hepatic Encephalopathy: Importance of Bristol Stool Scale
In patients with hepatic encephalopathy, incorporating the Bristol Stool Scale into patient counseling has shown positive outcomes. Patients who have two to three bowel movements with Bristol stool scale types three or four, indicating softer stools, have lower hospital admissions, better stability on hepatic encephalopathy therapy, and improved outcomes compared to those with firm, pebble-like stools.
Dyspepsia and the Thoughtful Use of PPIs
In the discussion about dyspepsia, Dr. Hilena Pashayeva highlighted the importance of clear communication with patients and the selection of appropriate treatment. She emphasized using acid-suppressing medications, such as proton pump inhibitors, for functional dyspepsia (non-ulcer dyspepsia). Additionally, she mentioned that patients should be made aware that these medications are being used specifically for functional dyspepsia rather than anxiety or depression.
Systolic and Diastolic Hypertension: Importance of Assessing Both
Dr. Mark Smith discussed the significance of assessing both systolic and diastolic blood pressure in patients with hypertension. While systolic blood pressure is often considered more important in older adults, diastolic blood pressure should not be neglected, as it is also a key predictor of cardiovascular outcomes. By considering both values, healthcare professionals can effectively manage hypertension and reduce cardiovascular risks.
Don’t miss this rapid fire recap of our top pearls from ACP #IM2023 in San Diego including hypertension, hypogonadism, frailty, afib, sleep medicine, in-flight emergencies, nephroprotective meds, order of antibiotics for pneumonia in the hospital, genitourinary syndrome of menopause, pickle juice for leg cramps, bristol stool scale and hepatic encephalopathy, coronary calcium, tirzepatide, cystatin c, functional dyspepsia, hair and nails, and more! Paul and Watto are joined by Drs. Justin Berk (@justinberk) and Chris Chiu (@cjchiu) of The Cribsiders Podcast.
No CME for this episode due to rapid turnaround, but claim CME for most episodes at curbsiders.vcuhealth.org!
Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME
Show Segments
No CME for this episode due to rapid turnaround, but claim CME for most episodes at curbsiders.vcuhealth.org!
Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME
Show Segments
- Intro
- Recap, Top Pearls Part 1
- Recap, Top Pearls Part 2
- Outro
Credits
- Written, Produced, and Hosted by: Justin Berk MD, MBA, MPH; Chris Chiu MD, FACP, FAAP; Matthew Watto MD, FACP; Paul Williams MD, FACP
- Show Notes: Matthew Watto MD, FACP
- Cover Art: Matthew Watto MD, FACP
- Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
- Technical Production: PodPaste
Sponsor: Grammarly
Go to grammarly.com/tone to download and learn more about Grammarly Premium’s advanced tone suggestions.
Sponsor: Indeed
Start hiring now with a $75 sponsored job credit to upgrade your job post at Indeed.com/INTERNALMEDICINE. Offer good for a limited time.
Full transcript available HERE
Get the Snipd
podcast app
Unlock the knowledge in podcasts with the podcast player of the future.
AI-powered
Discover
highlights
Listen to the best highlights from the podcasts you love and dive into the full episode
Save any
moment
Hear something you like? Tap your headphones to save it with AI-generated key takeaways
Share
& Export
Send highlights to Twitter, WhatsApp or export them to Notion, Readwise & more
AI-powered
podcast player
Listen to all your favourite podcasts with AI-powered features
Discover
highlights
Listen to the best highlights from the podcasts you love and dive into the full episode