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The Primary Viewpoints podcast features informative conversations with health care experts, opinion leaders, and practicing physicians, about what impacts primary care medicine today.

In episode 11, incoming American Academy of Family Physicians (AAFP) president Sterling Ransone, Jr, MD, shares the greatest concerns among AAFP members regarding the upcoming influenza season, including a feared drain on clinic and staff resources.

 to subscribe to the Primary Viewpoints podcast. Be sure to leave a rating and review for the show. Thanks for listening!

"Primary Viewpoints," a podcast from Patient Care Online, brings you an exclusive interview with incoming AAFP president Sterling Ransone, MD. 

Primary Viewpoints Episode 11: AAFP President-elect Discusses Greatest Concerns about Upcoming Flu Season

Episode 9, "Long COVID Review Lead Author Highlights Knowns and Unknowns," features an interview with Ani Nalbandian, MD, a cardiology fellow at Columbia University Vagelos School of Medicine and lead author of a recent comprehensive review of the literature accumulating on post-acute COVID-19 syndrome that was published in the March issue of 

. Dr Nalbandian discusses the research, the findings, and the future. 

"Primary Viewpoints," a podcast from Patient Care Online, brings you an exclusive interview with Ani Nalbandian, MD. 



Primary Viewpoints Episode 9: Long COVID: A Review

In episode 6 of Primary Viewpoints, physician mental health expert Michael Myers, MD, discusses the state of physician mental health during the COVID-19 pandemic. 

Primary Viewpoints Episode 6: COVID-19 Impact on Physician Mental Health

In this Special Report on hepatitis C in primary care, the authors have described the various therapeutic options for patients who have HCV infection and what happens when you treat them.

In this podcast, they discuss what happens when you don’t.

Rodger D. MacArthur, MD is Professor of Medicine and Merin Varghese, MD is a Fellow in Infectious Diseases at the Medical College of Georgia at Augusta University.

Severe outcomes may ensue in a high percentage of patients. The authors discuss the consequences in this brief podcast.

Hepatitis C: What If You Do Not Treat?

New guidelines on the stratification of severity and subsequent treatment of 

 this spring. The guidelines recommend graduated therapy based on criteria that indicate mild to moderate, severe, or severe and complicated disease.

Here, Dr Christina Surawicz, lead author on the guidelines, highlights changes in recommended diagnostic and treatment approaches.

Dr Surawicz is Professor of Medicine in the Division of Gastroenterology and section chief of GI at Harborview Medical Center at the University of Washington School of Medicine. She is the lead author on revised guidelines for the diagnosis, treatment, and prevention of 

•Polymerase chain reaction assay for toxin B strains will likely replace EIA tests for diagnosis

•Metronidazole remains the choice for mild to moderate disease but may not be adequate for patients with severe or complicated disease who should have initial therapy with vancomycin and sometimes IV metronidazole.

 infection remains difficult to treat; a pulse vancomycin regimen should be tried. Fecal microbiota transplant shows great promise.  


Surawicz CM, Brandt LJ, Binion DG, et al. Guidelines for diagnosis, treatment, and prevention of 

http://www.nature.com/ajg/journal/v108/n4/full/ajg20134a.html

Digestive Disease Week

Recurrent C difficile requires pulse vancomycin therapy; fecal microbiota transplant shows promise.

Clostridium difficile: New Guidelines Confront Hypervirulent Strain

Late in 2012 the United States Preventive Services Task Force (USPSTF)   opened comment on a recommendation of HIV testing for everyone from age   15 to 64 years. What is different in this draft guideline from the   recommendations made by the task force in 2005 and who does the task   force want to reach most with the new guidance? 

 In this podcast Dr Rodger MacArthur answers these and other questions   and helps place the Task Force guidance into context for primary care   physicians. Dr MacArthur is a Professor in the Department of Medicine,   Division of Infectious Diseases, at Wayne State University in Detroit.   Dr MacArthur specializes in the care of people with HIV/AIDs.

 Data accumulated since the 2005 recommendation was put forth shows that  expanded HIV screening identifies a substantial number of persons with  previously undiagnosed infection. In fact, approximately 20% to 25% of  individuals living with HIV infection are unaware of their positive  status. Routine testing would eliminate the need for physicians to delve  into sexual history with a patient before recommending screening. 

 The draft guidance can be read, 

. 

 Conflict of Interest: Dr MacArthur is a consultant to, and has received  grants administered through his university from Salix Pharmaceuticals,  Inc, the manufacturer of crofelemer (Fulyzaq); Gilead Sciences, the  manufacturer of Atripla; and ViiV Healthcare, the manufacturer of  abacavir (Epivir; Epzicom). He received no compensation from any source  for this interview.

Approximately 25% of those infected with HIV are unaware of their positive status. The USPSTF says universal screening can help reduce disease burden.

USPSTF: Increase HIV Detection through Routine Screening

For patients with HIV infection, what are some of the more common  antiretroviral side effects? What can the primary care physician do to  help manage those side effects? 

 Here to address these questions is Rodger MacArthur, MD, Professor in  the Department of Medicine, Division of Infectious Diseases, at Wayne  State University in Detroit.


 For a detailed review of antiretrovial therapy, Dr MacArthur refers  readers to the so-called DHHS guidelines. The most recently updated "

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents"

Dr MacArthur is a consultant to, and has received grants administered  through his university from Salix Pharmaceuticals, Inc, the  manufacturer of crofelemer (Fulyzaq); Gilead Sciences, the manufacturer  of Atripla; and ViiV Healthcare, the manufacturer of abacavir (Epivir;  Epzicom). He received no compensation from any source for this  interview.

What are some of the more common side effects of antiretroviral therapy, and what can the primary care physician do to help manage these effects? In this podcast, infectious disease expert Rodger MacArthur, MD, offers insights and points readers to updated comprehensive guidelines.

Common Side Effects of Antiretroviral Therapy in HIV Infection

The goals of therapy for patients with inflammatory bowel disorder  include inducing and maintaining a steroid-free remission, preventing and  treating the complications of the disease, minimizing treatment toxicity,  achieving mucosal healing, and enhancing quality of life.

So what role do antibiotics and corticosteroids play in achieving these  goals?

Here to address that question is Raymond Cross, MD, Associate  Professor of Medicine in the Division of Gastroenterology and Hepatology and  Director of the Inflammatory Bowel Disease Program at the University of  Maryland School of Medicine. Dr Cross recently addressed the use of antibiotics  and corticosteroids in optimizing therapy at the 2012 Advances in Inflammatory  Bowel Diseases, Crohn’s & Colitis Foundation’s Clinical & Research  Conference in Florida.

Dr Moss is Assistant Professor of Medicine at  Harvard Medical School and is a gastroenterologist at Beth Israel Deaconess  Medical Center in Boston, Massachusetts. He discussed diagnosis and  management of extraintestinal manifestations of IBD in his presentation at the  2012 Advances in Inflammatory Bowel Diseases, the Crohn’s & Colitis  Foundation’s Clinical & Research Conference, held December 13-15 in  Hollywood, Florida.

AIBD

The goals of therapy for patients with inflammatory bowel disorder include inducing and maintaining a steroid-free remission, preventing and treating the complications of the disease, minimizing treatment toxicity, achieving mucosal healing, and enhancing quality of life.

Clinical Tips for Using Antibiotics and Corticosteroids in IBD

When available, clinical tests and scales can help  clinicians make quick and accurate diagnoses, which, in turn, lead to quicker  treatment and often better prognosis. But sometimes these tests are faulty.

For instance, there is controversy concerning glucose and  lactose hydrogen breath tests, which are used to diagnose small-intestine  bacterial overgrowth and to distinguish patients with irritable bowel syndrome from  healthy individuals. Disparities in the sensitivities and specificities of  these tests have caused some to question their usefulness.

To help shed some light on this topic, we have invited Dr  Satish Rao to discuss the usefulness of breath tests. Dr Rao is Professor of Medicine, Chief of the Section of Gastroenterology and Hepatology, and  founding Director of the Digestive Health Center at Georgia Health Sciences  University. Dr Rao’s and his colleague’s  work was shared as a poster presentation at the American College of  Gastroenterology’s 2012 Annual Scientific Meeting held in Las Vegas.

Breath Tests Prove To Be Effective, Noninvasive Tool in Identifying Patients With SIBO and Lactose Intolerance

(AUDIO) There are disparities in the sensitivities and specificities of glucose and lactose hydrogen breath tests used to diagnose small intestine bacterial overgrowth and to distinguish patients with irritable bowel syndrome from healthy individuals. Just how useful are these tests? Insights from an expert here.

Breath Tests in Irritable Bowel Syndrome Dx: A Useful Tool

According to the CDC, there have been 2636 cases of West Nile virus infection this year. Cases have been reported in every state except Alaska and Hawaii. The CDC further reports that 53% of the cases have been classified as neuroinvasive, and there have been 118 deaths to date.

So what does this mean for you, your practice-and your patients?

We’ve invited Dr John Brusch to shed some light on the West Nile Virus and to share some clinical tips and guidance. Dr Brusch is Associate Chief of Medicine for Cambridge Health Alliance and Assistant Professor of Medicine at Harvard Medical School. He also serves as managing editor for the Infectious Disease section of e-medicine; he is associate editor of 

and serves as an ad hoc reviewer for the 

European Journal of Clinical Microbiology and Infectious Diseases.

It is high season for this potentially deadly viral infection, cases of which have been reported in every state. Will you be prepared? Guidance here from an expert.

West Nile Virus

Your daily dose of clinical news you may have missed.

Daily Dose: Use of Multiple Specimen Types in RSV Testing

Adding paired serology and sputum to nasal swab/nasopharyngeal swabs RT-PCR increased RSV detection by 50% to 66% on average, respectively. 

Use of Multiple Specimen Types in RSV Testing May Improve Detection Rates, Suggests New Review and Meta-analysis

Drug-resistant cases of Candida auris continue to spread across the US after an alarming 95% rise in cases of the fungal infection in 2021.

Candida auris: US Case Count Rising Rapidly 

The 5-in-1 vaccine candidate, if approved, would provide the broadest meningococcal serogroup coverage and simplify the vaccination schedule. 

Meningococcal ABCWY Vaccine Candidate Meets All Endpoints in Pivotal Phase 3 Trial 

The FDA authorized Pfizer's bivalent vaccine as a booster dose for children aged under 5 years who received 3 doses of monovalent vaccine. 

FDA: More Children Can Receive Pfizer-BioNTech Bivalent COVID-19 Booster

In the US, COVID-19 primary series vaccination is recommended for everyone 

 and older, however, vaccine misinformation and hesitancy are still rampant and can touch everyone. Parents and older children may have a host of questions and concerns they want to discuss with their physician regarding COVID-19 vaccination and booster shots. Terry Brenneman, MD, recently sat down with 

and shared concerns he has been hearing from patients and how physicians can help educate their patients on COVID-19 vaccination. Dr Brenneman is a pediatrician and founder of North Raleigh Pediatric Group in North Carolina.

Videos

How can clinicians help parents of school-aged children foster wellbeing now that pediatric COVID-19 vaccination and booster doses are recommended? 

Coronavirus

Immunization

Fostering Wellbeing in School-aged Children during COVID-19

"COVID really did bring home the message that obesity is a disease," says renowned obesity researcher and thought leader Donna Ryan, MD. In all age groups and across racial and ethnic groups, she points out in a recent interview, higher BMI has been associated with greater risk of hospitalization, ICU admission, and mortality

Speaking in early January with Patient Care

 Online, Ryan also reviewed and had high praise for a newly published Cleveland Clinic study that showed the remarkable impact of bariatric surgery on reducing vulnerability to 

 among patients with obesity. She explains the details.   

is professor emerita at the Pennington Biomedical Research Center in Baton Rouge, LA, and immediate past president of the World Obesity Federation. She directed clinical research for 22 years at Pennington Biomedical and her own research encompasses key roles in the DASH (Dietary Approaches to Stop Hypertension), POUNDS Lost, DPP (Diabetes Prevention Program) and Look AHEAD studies. Ryan's continuing research interests focus on translation of effective weight management into primary care practices.

The following transcript has been edited lightly for style. 


Patient Care Online. Have there been lessons learned during 

, about research about treatment, about patient care, that you think will help support treatment going forward?

 You know, Grace, COVID, really did bring home the message that obesity is a disease. People who have obesity—and the higher the BMI, the greater the risk for all the bad outcomes of COVID—have increased risk of hospitalization, of landing in the ICU, of requiring invasive mechanical ventilation, and death. And this is in all age groups. As you know, age is another big risk factor for big COVID outcomes. But in all age groups, the higher the BMI, the higher the risk, and in all races. So, it really has brought home that obesity is a disease, it's not a cosmetic problem. It is a disease.

And so, some of the studies that have been done around obesity and COVID—well, but first all the vaccine trials demonstrated that no matter what your BMI, you had a very good chance, an excellent chance of getting immunized appropriately. So, we worried that people with obesity, that their immune systems would not respond to the vaccines as well. But in the studies that were done with our vaccines, trials with incredible efficacy of preventing severe disease of COVID, it’s equally true—no matter what your BMI. BMI doesn’t play a role. What this means is that our patients with obesity need to get vaccinated, and they need to be advocates for vaccination.

Another really important study came out this year and it was it was published just recently by 

 who is a bariatric surgeon at Cleveland Clinic. He went into the Cleveland Clinic databases, their electronic health records, and he identified people who had had bariatric surgery and had lost weight. And he compared the outcomes of COVID infection in those patients to matched controls, who had the same BMI, but who did not have bariatric surgery. The patients who lost weight with bariatric surgery had much reduced complications of their COVID disease; they were diagnosed less frequently, because they were less symptomatic. They were hospitalized less, they were less likely to get in the ICU, they had lower rates of mechanical ventilation, and they also had lower mortality rates. Weight loss is good for you. That's what that study shows.

PCO. And a very interesting way to go about matching the two groups.

 You know, we're seeing more use of real-world data, of the electronic health record, and it's a good thing. I really give Cleveland Clinic and Ali Aminian some kudos and a round of applause for bringing us that study.

VIDEO Interview: The COVID-19 pandemic has closed what discussion remained about the status of obesity as a disease, according to obesity expert Donna Ryan, MD. 

COVID-19 is a Cruel Reminder that Obesity IS a Disease, says Thought Leader Donna Ryan, MD

People who are hesitant about vaccines and those who have accepted them have something in common, notes Afton Kapuscinski, PhD, and that "something" is their concern for their own safety and that of their loved ones. The difference between the 2 "populations," she observes, lies in 

In an interview this week with Patient Care

Online, Dr Kapuscinski, director of the Psychological Services Center at Syracuse University and as assistant teaching professor of psychology, pointed out that what an individual views as most threatening about the COVID-19 pandemic environment at any point will shape decisions about their behavior, and that includes getting vaccinated.   

Early in our conversation she pointed to the very recent shift in vaccine acceptance among those living in areas where the SARS-CoV2 Delta variant is prevalent and infections are surging. It would seem that for some, the threat level has changed, increasing the desire for protection. Dr Kapuscinski sees opportunity here for primary care. She believes they "... have an opening here, because many people, in fact, are on the fence." Their caution, Kapuscinski explains, should not be perceived as resistance but as a chance to meet them on the fence and reduce the perception of threat. She has more interesting thoughts, here. 

Your COVID-19-vaccinated patients and the ones "on the fence" share a fear, but of different unknowns. Reduce the threat for the fence sitters, says Afton Kapuscincki, PhD. 

Infection

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