Challenge your beliefs on the efficacy of pervasive treatments used in dementia with expert Eric Widera, MD, Professor and clinician-educator in the Division of Geriatrics at the University of California-San Francisco. We explore the use of cholinesterase inhibitors, antipsychotics for behavior disturbances, feeding tubes, medications and supplements used for weight gain (inspired by Choosing Wisely and the American Geriatric Society’s “Ten Things Clinicians and Patients Should Question”). Plus, we introduce our new correspondent, Dr. Leah Witt, Geriatrics Fellow at UCSF.

Written and produced by: Jordana Kozupsky, NP, Nora Taranto, MS3, Leah Witt, MD; Edited by: Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

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Time Stamps

• 00:00 Disclaimer
• 00:37 Guys set up the show
• 02:00 Dr Widera’s bio
• 03:15 Getting to know our guests
• 13:10 Picks of the week
• 16:40 Clinical case: new diagnosis of dementia
• 17:40 Discussing dementia with patients and caregivers
• 23:42 Cholinesterase inhibitors
• 27:35 Stopping cholinesterase inhibitors
• 33:35 Follow up to therapy
• 36:05 Dealing with behavior disturbances
• 39:15 DICE approach
• 44:17 Risks of antipsychotic medications
• 48:00 Use of benzos or sedative hypnotics
• 49:45 Melatonin for delirium or sleep
• 52:00 Mirtazapine
• 53:54 Clinical case: patient with dementia not eating
• 54:40 Feeding tubes
• 59:40 Dysphagia and NPO orders
• 62:04 Misinformation on malnutrition and girth creep
• 65:10 Thickened liquid challenge
• 70:25 Appetite stimulants
• 72:38 Megestrol
• 73:54 Take home points from Dr Widera
• 79:17 Outro

Tags: dementia, donepezil, cholinesterase, inhibitor, antipsychotic, behavior, disturbance, agitation, benzodiazepine, supplement, feeding, tube, restraints, thickened, liquids, geriatric, choosing, wisely, american, society, ags, assistant, care, doct

It's a potpourri of Infectious Diseases with tips from expert, Dr Paul Sax, MD, Clinical Director of the Division of Infectious Diseases at Brigham and Women's Hospital, and Professor of Medicine at Harvard Medical School. We discuss the man flu, the flu vaccine, travel medicine, malaria, lyme disease, post lyme syndrome, chronic lyme, shingles, cellulitis, abscesses, antibiotics, c diff, antibiotic associated diarrhea, the dangers of fluoroquinolones, why doxycycline is awesome, and more! Told you it was a potpourri. Dr Shreya Trivedi joins Matt and Paul as guest host.

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at [email protected].

Time Stamps:

• 00:00 Announcement
• 01:38 Intro
• 03:46 Picks of the Week
• 06:47 Guest bio
• 08:47 Getting to know our guest
• 15:40 Flu vaccination
• 19:54 Barriers to the flu vaccine
• 23:34 Can you give the flu vaccine to an ill patient
• 24:14 Man flu
• 26:27 Travel Medicine
• 30:35 Tick bites
• 33:49 Lyme serologies
• 35:38 Lyme prophylaxis
• 37:37 Chronic lyme disease and post lyme syndrome
• 38:55 Penicillin and antibiotic allergies
• 41:48 Fluoroquinolones and adverse reactions
• 45:24 Should antibiotics be given after an I&D of an abscess 
• 49:34 Antibiotic associated diarrhea, C diff
• 52:10 Probiotics, stool transplantation, and C diff
• 54:50 Shingles, recurrent zoster, complications, and the new subunit vaccine
• 61:45 Using salad tongs at a buffet
• 63:04 Take home points
• 64:26 Outro

Tags: 

ID, infectious, diseases, disease, flu, influenza, lyme, doxycycline, cdiff, antibiotics, infection, cellulitis, abscess, vaccine, zoster, shingles, malaria, travel, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Ease the tension around blood pressure goals in older adults and get inside the hypertension guidelines released by the ACP and ACC/AHA in 2017 with the sagacity of Dr. Mary Ann Forciea, MD, MACP, Professor of Medicine at University of Pennsylvania. We cover: how to properly measure blood pressure, how to diagnose hypertension, blood pressure targets, why BP goals differ by society, how to guidelines are written and how to interpret them with a critical eye, plus a hot take on the 2017 ACC/AHA guidelines. Dr. Shreya Trivedi joins as cohost. Special thanks to Hannah Abrams for her wonderful infographics and to Dr Trivedi for compiling our show notes.

Time Stamps

• 00:00 The setup
• 02:15 Disclaimer
• 03:32 Picks of the Week
• 08:13 Getting to know Dr Forciea
• 13:35 Broad overview and a clinical case of geriatric hypertension
• 14:45 Brief history on BP targets
• 18:05 How do you measure a blood pressure? What type of monitors are available?
• 22:13 How to standardize BP in the office?
• 23:55  Ambulatory BP monitoring
• 24:55 Home blood pressure monitoring
• 26:11 Standing blood pressure readings and orthostatic hypotension
• 27:53 How guidelines are written
• 30:51 Evaluating evidence quality and strength of recommendation
• 32:35 Timeline and process for guideline generation
• 34:27 How to read guidelines with a “critical eye”
• 36:15 Return to our case of uncontrolled hypertension
• 38:25 Blood pressure targets from ACP guidelines and BP management in frail older adults
• 40:33 Counsel patients on BP targets   
• 42:25 Low diastolic blood pressure
• 45:35 SPRINT and the ACP BP guidelines
• 48:58 Take home points from Dr Forciea
• 50:07 HTN targets and pay for performance in clinical practice
• 51:45 Curbsiders recap the ACP guidelines
• 53:45 Matt and Paul recap the AHA guidelines
• 54:47 AHA definitions of hypertension
• 56:15 Diagnosing hypertension and how to measure a blood pressure
• 60:35 Choosing a blood pressure monitor and HBPM
• 62:29 Blood pressure goals in ACC guidelines
• 66:08 Non-pharmacologic measures
• 69:15 Will we follow these new strict targets?
• 72:45 Outro

Tags:hypertension, blood, pressure, monitor, cuff, heart, aha, acc, act, stroke, cardiac, cardiovascular, event, guidelines, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resid