Mayo Clinic Talks

Guest: Daniel P. Montero, M.D. (@DanMonteroMD) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Special Back to School Sports Medicine for the Primary Care Provider Series – Episode 2: Who can do these types of exams? What questions are important to cover in the history? What’s the ideal lead time prior to participation that patients should be screened? Dr. Montero discusses the ins and outs of pre-participation sports physicals and the common findings from his practice.

To hear more from Mayo Clinic Sports Medicine, follow them on Twitter @MayoClinicSport. 

Deeper Dive: 

• American Academy of Pediatrics – Pre-Participation Evaluation: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/PPE.aspx 

Guest: Ying Ying (Christina) Chen, M.D. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Preventative health care becomes more complicated as patients age. Do screening tests continue to improve the quality and duration of our elderly patient’s lives? Dr. Christina Chen discusses her process for determining the appropriateness of preventative health screening for patients over 65 and steps through what a generalist should know about the comprehensive geriatric assessment to help maximize independence for our patients. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Deeper Dive:

• US Preventative Health Task Force https://www.uspreventiveservicestaskforce.org/Page/Name/tools-and-resources-for-better-preventive-care  

Guest: Cara C. Prideaux, M.D. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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. To hear more from Mayo Clinic Sports Medicine, follow them on Twitter @MayoClinicSport. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

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 

Guest: Robert Haddon, M.D., M.S. & Maryjane (MJ) F. Harris, D.O. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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 on board 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 in-flight emergencies and the ethics involved. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guests: Robert Haddon, M.D., M.S. & Maryjane (MJ) F. Harris, D.O. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Stephanie L. Hansel, M.D., M.S. (@SLHanselMD)

Host: Darryl S. Chutka, M.D. (@ChutkaMD)

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.

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

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/ 

Guest: Matthew A. Bartlett, M.B., B.Ch., B.A.O. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guests: Catherine W. Njathi-Ori, M.D., Erin K. O'Brien, M.D. (@ErinOBrienMD), Nafisseh S. Warner, M.D. (@nafisseh_warner) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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.

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Stephen L. Kopecky, M.D. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Deeper Dive:

• 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 

Guest: Gregory A. Poland, M.D. (@drgregpoland)

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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.

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Deeper Dive:

• 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 
• 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 
• Poland CM, Poland GA. Vaccine education spectrum disorder: the importance of incorporating psychological and cognitive models into vaccine education. Vaccine. 2011 Aug 26;29(37):6145-8. https://doi.org/10.1016/j.vaccine.2011.07.131 

Guest: John B. Kisiel, M.D. (@DrJohnKisiel) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: J. Taylor Hays, M.D. (@jtaylorhays)

Host: Darryl S. Chutka, M.D. (@ChutkaMD)

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.

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Deeper Dive:

• 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 

Guest: Sandhya Pruthi, M.D. (@DrSandhyaPruthi)

Host: Darryl S. Chutka, M.D. (@ChutkaMD)

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.

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Deeper Dive:

• Breast cancer risk assessment tools:
  • Gail model https://bcrisktool.cancer.gov/
  • IBIS tool http://www.ems-trials.org/riskevaluator/ 

Guest: Ashley Laganiere, CVSO 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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? 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Deeper Dive: 

• National Association of County Veterans Service Officers: https://www.nacvso.org/
• Minnesota Association of County Veterans Service Officers: https://www.macvso.org/index.html
• VA Women’s Health Research Network: https://www.hsrd.research.va.gov/for_researchers/womens_health/ 
• Military Health and Health Care https://www.rand.org/topics/military-health-and-health-care.html 

Guest: Bobbi S. Pritt, M.D. (@ParasiteGal) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Deeper Dive:

• CDC Guidelines for Tick Bite Prophylaxis: https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophylaxis.html
• Dr. Pritt's “Creepy, Dreadful, Wonderful Parasites” blog https://parasitewonders.blogspot.com/ 

Guest: Kenneth G. Poole, Jr., M.D., M.B.A. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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?

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Deeper Dive:

• Dr. Poole’s 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 

Guest: Stacey A. Rizza, M.D. (@DrStaceyRizza) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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.

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Stacey A. Rizza, M.D. (@DrStaceyRizza) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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.

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Deeper Dive:

• Universal screening: https://doi.org/10.1016/j.mayocp.2012.06.021 

Guest: S. Vincent Rajkumar, M.D. (@VincentRK) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Deeper Dive:

• https://doi.org/10.1016/j.mayocp.2012.07.007 
• https://doi.org/10.1016/j.mayocp.2015.01.014 

Guest: Jeffrey S. Brault, D.O. (@JeffBrault) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Sharonne N. Hayes, M.D. (@SharonneHayes) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Deeper Dive:

• https://www.timesuphealthcare.org 

Guest: Richard J. Caselli, M.D. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

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. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Ying Ying (Christina) Chen, M.D. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

How does integrative medicine differ from alternative and complementary medicine? Are the practices evidence-based? How and when can these techniques be applied in your current practice? Listen as Dr. Christina Chen discusses the practice of integrative medicine and its impact on her patients. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Stephen P. Merry, M.D. 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

Primary care providers can make a difference in the health disparities experienced internationally. Impact can range from directly providing care to educating staff and building enduring local capacity. Listen for some points to consider when planning a global health trip or medical mission. How do you get started? What skills do you need as a health care provider? How do you pick a location? Where can you find more reliable in-depth information on global health? 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Anjali Bhagra, M.D. (@anjalibhagramd) 

Host: Darryl S. Chutka, M.D. (@ChutkaMD) 

How does our brain react to stress and setback? How can we harness what neuroscience tells us about these responses to combat the stresses in our lives we cannot currently change? Dr. Anjali Bhagra steps through the three F’s- focus, fatigue, and fear, to dig a little deeper into how we’re geared to respond and what we can do to intentionally navigate our responses. 

Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.