Episode 233 -- July 2025 -- Part 1 AFP: American Family Physician

Summary

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AFP: American Family Physician Podcast

Episode 233 – July 2025, Part 1

Date: July 15, 2025
Host/Contributors: Jake Anderson, Kari Stauss, Puneet Bharot, Elena Kelly (residents/faculty, University of Arizona College of Medicine – Phoenix)
Contributing Editor: Dr. Steven Brown

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Overview

In this episode, the team discusses key clinical pearls from the July 2025 issue of American Family Physician. Featured topics include: managing foreign bodies in the ear, nose, and throat; updates on topical anti-inflammatories for eczema; the utility and risks of intravenous antihypertensives in hospitalized adults; best practices for developmental screening; practical applications of dialectical behavior therapy (DBT) in primary care; and recent evidence for universal RSV prophylaxis in infants.
The presenters deliver guidance for frontline family physicians, share their own clinical experiences, and highlight patient-oriented evidence for improved everyday practice.

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Key Discussion Points and Insights

1. Foreign Bodies in the Ear, Nose, and Throat

[01:16–07:20]

• Prevalence & Risks: Foreign bodies in the ear, nose, and throat are common, especially in children but also in adults. Timely, safe removal is crucial to avoid complications.
• Ear Foreign Bodies
  • Common objects: beads, toys, insects, food, cotton.
  • Evaluation: Initial otoscopy for object identification and canal/membrane assessment.
  • Removal depends on: patient cooperation, visualization, and choice of technique (instrumentation/irrigation).
  • Key caution: "Do not use irrigation for batteries, absorbent materials, or fully occlusive objects." (Kari Stauss, 03:53)
  • For suspected tympanic membrane perforation or severe pain, "do not pass go"—refer.
• Nasal Foreign Bodies
  • Symptoms: often asymptomatic but may present with unilateral epistaxis, purulent discharge, or mouth breathing.
  • Removal: usually with instruments; ENT referral if above inferior turbinate or for button batteries.
  • Memorable case: “Preseptal cellulitis...was all being spurred by a button battery that was up the nose that they’d missed.” (Jake Anderson, 05:00)
  • “Parent’s kiss” technique: Caregiver blows into the child’s mouth while holding the unaffected naris—the maneuver is about 60% effective ([05:32–06:17]).
• Throat Foreign Bodies
  • Always a medical emergency if airway compromised. Immediate intervention for obstruction; if partial, look for stridor/choking/respiratory difficulty.
  • Automatic referral to ED with possible sedation and endoscopic removal (especially for batteries).

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2. Topical Anti-Inflammatories for Eczema (Cochrane Review)

[07:20–09:59]

• Main findings: Most effective treatments for atopic dermatitis are topical steroids, Janus kinase inhibitors, and calcineurin inhibitors.
  • “The most benefit was topical calcineurin inhibitors such as tacrolimus, and then topical corticosteroids, then finally Janus kinase inhibitors.” (Elena Kelly, 08:16)
• Potency matters: Very potent topical corticosteroids outperformed others in continuous outcome studies; tacrolimus a runner-up.
• Side effects: Local reactions most common with calcineurin and PDE4 inhibitors. No increased pigment changes with any. Short-term steroid use (≤3 weeks) did not increase skin thinning, but long-term use (6–60 months) showed some atrophy.
• Cost: “A 60-gram tube of clobetasol is less than half of the same amount of tacrolimus and about 88 times less expensive than ruxolitinib, which is a Janus kinase inhibitor.” (Kari Stauss, 09:40)
• Guideline alignment: “Studies are still needed...Overall, though, topical corticosteroids and topical calcineurin inhibitors are in line with recommendations from the American Academy of Allergy, Asthma and Immunology.” (Kari Stauss, 09:59)

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3. Intravenous Antihypertensives in Hospitalized Non-Cardiac Adults

[10:17–13:30]

• Clinical Inquiry: Does treating hospital inpatients for hypertension with IV antihypertensives improve outcomes?
• Evidence review: Multiple large cohort studies reviewed.
  • Harm identified: “Use of IV antihypertensives...is associated with significant harm.” (Elena Kelly, 10:53)
    • Increased risk of myocardial infarction
    • Greater acute kidney injury
    • Higher incidences of stroke, ICU transfers, mortality, and longer length of stay (Puneet Bharot, 12:14, 12:50)
  • Risks increase with the number of doses given.
• Guidelines: The American Heart Association does not support IV antihypertensive therapy for asymptomatic hypertension in hospitalized, non-cardiac patients. Emphasize close outpatient follow-up if started.
• Take Home: Avoid reflexive use of IV antihypertensives in the hospital for patients without acute symptoms.

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4. Approach to Developmental Screening and Surveillance

[14:00–17:01]

• Why screen? Early identification and intervention for developmental delay improves patient outcomes; therapy improves autism outcomes (Elena Kelly, 14:20).
• Surveillance vs. Screening
  • Surveillance: Ongoing observation, tracking developmental milestones (not formally validated for effectiveness).
  • Screening: Use of standardized tools (e.g., Ages & Stages, MCHAT) at specified well-child visits.
    • AAP recommends universal screening at 9, 18, 30 months and autism-specific screening at 18 & 24 months (Elena Kelly, 15:20).
    • The USPSTF rates evidence as insufficient to mandate universal screening.
  • Consider sex-specific differences (Puneet Bharot, 15:53).
• Equity consideration: Increased detection can worsen wait times for services, especially in marginalized populations ([16:05]).
• Referral pathways: All states must provide evaluation/treatment through IDEA; referral focus varies by age group (Jake Anderson, 16:49).
• Role of PCP: Ongoing follow-up ensures appropriate diagnosis, intervention, and developmental tracking.

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5. Dialectical Behavior Therapy (DBT) in Primary Care

[17:13–19:53]

• Context: Many adults with depression do not access care; family physicians are vital touchpoints.
• What is DBT? Developed for chronic suicidality; now effective in borderline personality disorder, PTSD, adolescent self-harm/suicidality.
• Implementation in primary care: Even a single five-minute encounter can introduce DBT skills while patients await specialist care (Elena Kelly, 18:59).
• Example skill: Box breathing (inhale-hold-exhale-hold for 4 seconds each, repeat).
  • “You can even practice that with the patient right there in the exam room.” (Jake Anderson, 19:18)
• Resources: “Doing Dialectical Behavior Therapy” by Kerner, free apps (e.g., Simple DBT Skills, Diary Card, DBT Coach), and dialecticalbehaviortherapy.com ([19:53]).

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6. Universal RSV Prophylaxis in Infants: Real-World Results

[20:16–21:54]

• Study: Spain implemented universal RSV prophylaxis for infants using nirsevimab.
• Results:
  • “A 57.5% decrease in episodes of lower respiratory tract infections and a 59.2% decrease in acute bronchiolitis to 63.1% decrease in related hospital admissions ICU admissions.” (Puneet Bharot, 21:16)
• Population-level benefit: Evidence supports substantial impact on pediatric respiratory illness and hospitalization rates.
• Evidence quality: Level 2B (population-based retrospective cohort); other factors may contribute, but effects are large (Elena Kelly, 21:35).

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Notable Quotes & Memorable Moments

• On unusual nasal foreign body complications:
  “Preseptal cellulitis...was all being spurred by a button battery that was up the nose that they’d missed.” — Jake Anderson ([05:00])
• On the “parent’s kiss” technique for nasal foreign bodies:
  “Surprisingly, it’s about 60% successful, so definitely worth a try if you’re worried about a foreign body in the nares.” — Elena Kelly ([05:47])
• On topical steroid cost:
  “A 60-gram tube of clobetasol is less than half of the same amount of tacrolimus and about 88 times less expensive than ruxolitinib.” — Kari Stauss ([09:40])
• On IV antihypertensives in hospital:
  “Use of IV antihypertensives in these patients increases the risk of acute kidney injury by approximately 1.5 times, and it also doubles the risk of myocardial injury and inpatient mortality.” — Elena Kelly ([12:27])
• On DBT in primary care:
  “These interactions can take as little as five minutes, depending on patient understanding symptoms and their presenting challenges.” — Elena Kelly ([18:34])
• On the impact of universal RSV prophylaxis:
  “Holy cow, those are some big relative improvements.” — Jake Anderson ([21:33])

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Summary Table: Important Segments & Timestamps

| Topic | Speakers | Timestamps | |-------------------------------------------|-----------------------------|-------------| | Foreign Bodies Ear/Nose/Throat | Entire Panel | 01:16–07:20 | | Topical Anti-inflammatories for Eczema | Entire Panel | 07:20–09:59 | | IV Antihypertensives in Hospitalized pts | Entire Panel | 10:17–13:30 | | Developmental Screening & Surveillance | Entire Panel | 14:00–17:01 | | Dialectical Behavior Therapy in Primary | Entire Panel | 17:13–19:53 | | Universal RSV Prophylaxis Impact | Entire Panel | 20:16–21:54 |

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Conclusion

This episode delivers high-yield updates across diverse topics commonly encountered in primary care. Highlights include pearls for recognizing and managing foreign bodies, evidence-based eczema treatments with a pragmatic lens on cost and safety, a cautionary tale regarding inpatient antihypertensive practice, nuanced developmental screening guidance, practical DBT skills for mental health in primary care, and major public health gains via universal RSV prophylaxis.
The panel’s conversational tone, clinical anecdotes, and focus on actionable, patient-oriented evidence make this episode especially valuable for busy clinicians.

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Transcript

[Podcast Host/Producer]

The AFP Podcast is brought to you by the American Academy of Family Physicians and by alidade, the largest network of independent primary care. ALIDADE provides actionable insights and workflow support for clinicians to keep their patients healthy while generating more revenue through value based care. Learn more about ACO partnership [e-mail] welcome.

[Jake Anderson]

To the American Family Physician podcast for part one of the July 2025 issue. I'm Jake.

[Kari Stauss]

I'm Kari.

[Jake Anderson]

And I'm Puneet and we are residents and faculty, mostly residents, of the University of Arizona College of Medicine, Phoenix Family Medicine Residency. Today on the podcast we'll talk about foreign bodies, topical anti inflammatories for eczema, intravenous antihypertensives in hospitalized adults, developmental screening, dialectical behavior therapy, and universal respiratory syncytial virus prophylaxis.

[Kari Stauss]

The opinions expressed in the podcast are our own and do not represent the opinions of the American Academy of Family Physicians. The editor of American Family Physician or Banner Health do not use this podcast for medical advice. Instead, see your own family doctor for medical care.

[Jake Anderson]

We'Re on a mission Delivering the best from a physician on a mission Delivering the First up we have a main topic, foreign bodies in the ear, Nose and throat, and it comes to us from Dr. Wilson from the University of Missouri Kansas City School of Medicine. We're going to take a look at a common clinic and urgent care ER presentation here, guys, right? Both in young children and adults who may be experimenting with foreign objects. And am I right?

[Puneet Bharot]

Totally so.

[Jake Anderson]

Foreign bodies in the ear, nose and throat are quite common and can pose a significant threat, along with complications if not removed in the appropriate manner.

[Kari Stauss]

As far as foreign bodies in the ears, common objects include beads, small plastic toys, pebbles, food material, cotton, and insects. Patients are usually asymptomatic and these events are usually witnessed by caregiver or parent. So how would we evaluate these patients?

[Elena Kelly]

Initial otoscopy is needed to assess and identify the foreign body, especially for any occlusion of the auditory canal and to assess the tympanic membrane. Removal is the tricky part since the auditory canal is sensitive to pressure, especially over the osseous portion of the canal.

[Jake Anderson]

As far as how to remove the foreign object, it really comes down to three cooperation of the patient, visualization of the object, and a removal method using either instrumentation or irrigation.

[Kari Stauss]

Table 1 in the article provides an overview of managing common foreign bodies, including their associated symptoms and method of removal.

[Elena Kelly]

Okay, so let's say that we have a patient that's in an adequate position and they're cooperating without need for additional restraint or sedation. Where do we go next?

[Kari Stauss]

Essentially, the next step is irrigation of the external auditory canal with sterile saline for removal of either a dead insect or small or loose plastic fragments. Tap water can be used, but use caution since this may increase the risk for malignant otitis in patients with immunosuppression. For insects, specifically, the use of peroxide or light assistance can actually draw the insect out of the ear canal.

[Elena Kelly]

Okay, so what is the key takeaway here?

[Jake Anderson]

It sounds like the ability to stabilize and safely remove the object without trauma to the nearby area is our main priority. And if we cannot perform the removal in our clinic, referral to nearby urgent care or emergency department is recommended.

[Kari Stauss]

I agree. And additionally, another take home point is that we should not use irrigation to remove batteries, any absorbent materials, or fully occlusive objects. It really comes down to the patient's presentation. Are they in severe pain, is there a concerning object, and is there visualization.

[Puneet Bharot]

Of a perforated tympanic membrane?

[Kari Stauss]

If so, do not pass go.

[Elena Kelly]

In addition to the ears, another common orifice for exploration are the nares, usually nasal. Foreign bodies do not cause symptoms, but may include unilateral epistaxis, purulent nasal discharge, or mouth breathing due to nasal obstruction. Rarely, delay in recognition can lead to sinusitis.

[Kari Stauss]

Similarly to the ears, most nasal foreign bodies that are lodged can be removed with instrumentation, specifically a nasal speculum. If the foreign body is above the inferior turbinate, ENT referral is recommended. Additionally, button batteries still pose the highest risk of chemical burn and subsequent tissue necrosis, which does warrant an urgent referral to an ent.

[Jake Anderson]

When I was a resident, I had a patient who presented with pre septal cellulitis that was not improving despite IV antibiotics like in the hospital. And and they realized it was all being spurred by a button battery that was up the nose that they'd missed.

[Elena Kelly]

Oh, geez.

[Jake Anderson]

Cause they saw preceptal cellulitis and didn't think about foreign body in the nose. Wild, right?

[Elena Kelly]

Yikes. Yeah, that is a very interesting presentation.

[Jake Anderson]

Another very interesting technique specifically for removal of foreign body objects from the nose is called the parents kiss.

[Kari Stauss]

Oh yeah. I learned that this can be an effective technique of providing positive pressure which can essentially help remove the foreign objects from the nares.

[Puneet Bharot]

So how does it work?

[Elena Kelly]

It's strange, but essentially the parent or caregiver seals their mouth over the child in its entirety and delivers a slow breath upon sensing some resistance from the glottis, indicating Closure, they deliver a sharp and forceful puff of air. Surprisingly, it's about 60% successful, so definitely worth a try if you're worried about a foreign body in the nares.

[Jake Anderson]

Yeah, that's so cool. So if the kid can't, like, coordinate plugging one of their nares and, like, you know, breathing it out themselves, try this parents kiss approach.

[Kari Stauss]

I love the name.

[Puneet Bharot]

To finish off the trifecta, we have foreign bodies in the throat with specific concern for an airway compromise.

[Elena Kelly]

And essentially, all airway foreign bodies present as medical emergencies. So the first priority is always to determine whether the airway is stable or compromised. Obviously, if there is a complete airway obstruction, this requires emergent intervention. However, partial airway obstruction can also present with stridor, choking, coughing, dysphagia, or even dysphonia if the foreign object has progressed down the airway and often goes to the right main bronchus, resulting in dyspnea, wheezing, and possible retractions.

[Jake Anderson]

Essentially, if you're suspecting a foreign body in the airway, they should be promptly seen in an emergency department for sedation with a chest X ray and probably endoscopic removal.

[Elena Kelly]

I think I saw this the most when I was in the emergency department, especially with button batteries. Those are very concerning due to the caustic nature, and it usually led to some type of endoscopic retrieval.

[Jake Anderson]

Yeah, good. Up next, we have a Cochrane for clinicians, and it comes to us from Doctors Yancy and Green from Carl R. Darnell Army Medical center in Fort Cavazos, Texas.

[Kari Stauss]

I'm sure we've all seen many cases of eczema, otherwise known as atopic dermatitis. And sometimes we are scratching our head.

[Puneet Bharot]

For what is truly the most effective treatment for symptoms and most cost effective.

[Jake Anderson]

I see what you did there.

[Puneet Bharot]

Thank you.

[Elena Kelly]

Definitely. I usually reach for topical steroids as the first line.

[Puneet Bharot]

Let me tell you about this Cochrane review. It included several RCTs that studied topical corticosteroids, topical calcineurin inhibitors, PDE4 inhibitors, Janus kinase inhibitors, and aryl hydrocarbon receptor activator. Wow, that's a mouthful. Outcomes were patient reported eczema symptoms across all outcomes. The best treatments were topical steroids, Janus kinase inhibitors and calcineurin inhibitors.

[Elena Kelly]

Right. When using a binary reporting system, meaning patient reported symptoms were present or absent, the most benefit was topical calcineurin inhibitors such as Tacrolimus, and then topical corticosteroids, then finally Janus kinase inhibitors.

[Puneet Bharot]

And if reporting patient symptoms or signs reported by clinicians, On a continuous outcome, very potent topical corticosteroids came out as the winner with tacrolimus as the runner up.

[Jake Anderson]

All right, so that's good to know the effective ones. Let's consider side effects for a second. So, regarding application site reactions, this is most likely to happen with calcineurin inhibitors and PD4 inhibitors. Compared to placebo, topical corticosteroids were actually the least likely to cause application site reactions.

[Kari Stauss]

Steroids for the win.

[Elena Kelly]

Indeed. I even read that pigmentation changes were not more likely with any of those above studied drugs.

[Kari Stauss]

Yeah, and skin thinning with short term use of topical corticosteroids of any potency was not increased, which was a length of about three weeks. Although it appears that longer term use, which was defined as anywhere from six to 60 months of steroid use, did result in some skin thinning when compared to the calcineurin inhibitors.

[Jake Anderson]

Okay, so we've talked about effectiveness and we've talked about skin side effects. How much do these therapies cost?

[Kari Stauss]

Yeah, so about that. A 60 gram tube of clobatasol is less than half of the same amount of tacrolimus and about 88 times less expensive than ruxolitinib, which is a Janus kinase inhibitor.

[Jake Anderson]

Whoa.

[Elena Kelly]

Dang. Maybe reaching for those steroids first line is still the move.

[Kari Stauss]

Yeah, that's pretty significant. Studies are still needed to evaluate the long term effectiveness and safety of these agents. Overall, though, topical corticosteroids and topical calcineurin inhibitors are in line with recommendations from the American Academy of Allergy, Asthma and Immunology.

[Jake Anderson]

Next up, we have an FPIN clinical inquiry and it comes to us from physicians and librarian team of doctors Conrad Wessling and Harper from St. Joseph Hospital family Medicine Residency Program in Denver, Colorado, and Stephanie Weldon from Intermountain Health.

[Kari Stauss]

The FPIN team answered a great question here. In adults hospitalized for non cardiac diagnoses, does treatment of hypertension with intravenous antihypertensives improve outcomes?

[Jake Anderson]

Yeah, it's such a common practice. Right. I see this all the time. Fortunately, I'm seeing it less often now. And let's get into why I say fortunately.

[Elena Kelly]

To answer it, the FPIN team identified a number of cohort studies, both retrospective and prospective, from the last few years. And there were some common themes that quickly emerged. Use of IV antihypertensives in adults with hypertensive blood pressure who have been hospitalized for non cardiac causes is associated with significant harm.

[Kari Stauss]

Yes, indeed. Let's dive into some more specifics. So, in looking at the two large prospective cohort studies that were included. One was a 2021 study of over 22,000 adults admitted for non cardiac reason, about 5,900 of which required new treatment for hypertension during their hospitalization.

[Elena Kelly]

In those that received IV antihypertensives, which was about 1,500 of them, there was a higher risk of myocardial infarction and acute kidney injury compared with those who received no treatment.

[Jake Anderson]

The second prospective cohort study looked at over 42,000 adults, again admitted for non cardiac reasons who had received blood pressure medications after the time of admission. They compared those that received as needed BP meds versus a scheduled regimen of BP meds and of the as needed medications, 93% were IV meds, but both IV and oral were included in this group.

[Kari Stauss]

They found that patients that received as.

[Puneet Bharot]

Needed compared to scheduled BP meds were at higher risk of stroke, acute kidney injury and mortality, and they had a longer median length of stay. This risk seems to go up with the number of as needed doses that are given.

[Elena Kelly]

Now. Obviously with these cohort trials you can't establish causation. However, the conclusion of the F PEN team is as follows. Use of IV antihypertensives in these patients increases the risk of acute kidney injury by approximately 1.5 times, and it also doubles the risk of myocardial injury and inpatient mortality.

[Kari Stauss]

It may also increase the risk of.

[Puneet Bharot]

Stroke and ICU transfer and length of hospital stay. Risks of end organ damage and death increase with a higher number of IV antihypertensive doses.

[Elena Kelly]

Additionally, the American Heart Association's scientific statement on management of elevated blood pressure in the acute setting aligns with this Routine use of IV antihypertensives to treat asymptomatic hypertension is not supported by evidence. They recommend a high threshold for initiation or intensification of antihypertensive treatment in the inpatient setting. If such treatment is started, the patient should have close outpatient follow up to assess the appropriateness of the regimen.

[Jake Anderson]

More after this.

[Podcast Host/Producer]

The AFP podcast is brought to you by the American Academy of Family Physicians and by the AAFP Insurance Program, congratulating third year residents on reaching an important milestone. Complimentary group life and disability insurance coverage is now available to all PGY3 family residents. Learn more and enroll today at aafpins.com NOCOST premiums are paid for through the AAFP Insurance Program.

[Jake Anderson]

We have another main topic approach to developmental screening and surveillance in young children.

[Kari Stauss]

So let's not delay our next topic.

[Elena Kelly]

Oh my gosh.

[Jake Anderson]

Let'S get into why we care. We are all familiar with the fact that we don't screen for something in medicine if it doesn't change management right.

[Elena Kelly]

Exactly when identified early early treatment of developmental delay is associated with improved outcomes when compared to untreated peers and therapies for autism improved function in language and social domains. This is a sort B level rating that children identified early should be referred for early intervention programs.

[Kari Stauss]

The million dollar question though is how we survey or screen.

[Puneet Bharot]

Surveillance refers to monitoring growth, obtaining a.

[Kari Stauss]

Developmental history and observing the child.

[Puneet Bharot]

We all remember painstakingly learning the developmental milestones in medical school, but the extent to which milestone checklists can accurately detect developmental delays has not actually been formally studied.

[Jake Anderson]

Screening, on the other hand, refers to the administration of screening tools to assist in detecting delays with validated screening tools including Ages and Stages Questionnaire, the Modified Checklist for Autism and Toddlers, and the MCHAT Revised with Follow up and others.

[Elena Kelly]

Universal screening for developmental delays is controversial. The American Academy of Pediatrics recommends universal developmental screening at 9, 18 and 30 month well child checks along with focus screening for autism spectrum disorder at 18 and 24 month visits. However, the USPSTF has cited insufficient evidence, a grade I recommendation supporting universal administration of validated screening tools to evaluate the presence of autism spectrum disorder or speech and language delays and disorders. Due to the lack of longitudinal studies.

[Puneet Bharot]

Plus some evidence even points out that some milestones may be achieved by females earlier than males, so some screening tools that are sex non specific may actually under diagnose females at risk.

[Jake Anderson]

The decision to use tools and which tools must be based on individual practice. These screening tools have been shown to increase detection of developmental delays, but higher rates of detection can lead to longer wait times for consulting services, especially for patients from marginalized communities where resources for testing and treatment are already limited.

[Kari Stauss]

Wow, really makes me rethink my own.

[Elena Kelly]

Practice for sure if identified all states must provide evaluation and treatment for children with suspected developmental disability through the Individuals with Disabilities Education act, which generally includes children younger than three being referred to early intervention programs or older children through their school district programs.

[Jake Anderson]

Additionally, referrals for younger children should focus on physical, cognitive, social and communication skills, while referrals for older children emphasize occupational, physical and speech and language therapies.

[Puneet Bharot]

These patients need to have continued follow up with their pcp. This can help to ensure that appropriate diagnostic testing and treatment occur and of course to help track development progression.

[Jake Anderson]

Next up we have a curbside consult, Dialectical behavior Therapy, a brief counseling skill for clinical practice, and it comes to us from Drs. Bilotis Cherubini, and Dixon from family medicine residency at Travis Air Force Base in California.

[Elena Kelly]

We know that patients experiencing mental health disorders encounter several barriers to accessing appropriate and timely treatment.

[Puneet Bharot]

The estimated prevalence of Depression is nearly 10% of US adults, but less than half of these patients receive treatment from a healthcare professional.

[Jake Anderson]

And part of the solution to this, of course, is family medicine. A 2022 study found that primary care physicians delivering mental health interventions during standard appointments were associated with improved patient engagement, satisfaction, and trust.

[Elena Kelly]

One potentially newer or novel skill set and solution that physicians can implement in primary care is dialectical behavior therapy.

[Kari Stauss]

Dialectical behavior therapy is a robustly researched treatment protocol originally developed to apply standardized.

[Puneet Bharot]

Behavioral treatment for chronic suicidality. Its effectiveness in addressing emotional dysregulation has been demonstrated in the treatment of several mental health diagnoses in adults, including borderline personality disorder and post traumatic stress disorder, and also self harm and suicidal ideation in adolescents.

[Elena Kelly]

Learning and then teaching dialectical behavior therapy skills can be challenging when treating high risk patients with clinically complex needs, but it can be effective when the treatment may be limited based on location, lengthy wait times, or availability of specialist mental health professionals. These interactions can take as little as five minutes, depending on patient understanding symptoms and their presenting challenges.

[Puneet Bharot]

Implementation of dialectical behavior therapy skills may serve as a temporary strategy, providing support and a bridge to specialty behavioral health care.

[Elena Kelly]

One specific example of how to include teaching of these skills in everyday practice is explaining the utility of deep breathing as a strategy to increase their tolerance for distress.

[Jake Anderson]

So, for instance, you could share with your patient box breathing, which is inhaling for a count of four seconds, holding your breath for another four seconds, slowly exhaling for four seconds, and again holding your breath out for four seconds. And you can even practice that with the patient right there in the exam room.

[Kari Stauss]

Should we practice it now?

[Jake Anderson]

I think so.

[Elena Kelly]

I feel calm already.

[Jake Anderson]

Me too.

[Elena Kelly]

Great.

[Puneet Bharot]

Me too. There's a number of resources that you can share with your patients, including the book Doing Dialectical Behavior Therapy, A Practical Guide by Kerner, free phone apps like Simple DBT Skills, Diary Card and DBT Coach, and other websites like dialecticalbehaviortherapy.com we're.

[Jake Anderson]

Going to wrap things up with a poem. Remember, poem stands for Patient Oriented Evidence that Matters. Very nice, guys. This one comes to us from pharmacist and EBM guru Dr. Alan Shaughnessy.

[Kari Stauss]

RSV prophylaxis with bifortis, the monoclonal antibody.

[Puneet Bharot]

Nirsevimab is effective in decreasing emergency visits and hospitalizations in infants and with bronchiolitis when administered to the entire population.

[Jake Anderson]

Boom.

[Elena Kelly]

So essentially, Spain introduced universal prophylaxis for RSV in all infants before the 2023-2024 RSV season. They also allowed for catch up dosing for infants younger than six months during this time period.

[Jake Anderson]

And then to assess the effectiveness of this universal intervention, the authors compared episodes of respiratory illness in 15 Spanish pediatric emergency departments throughout the country during the November to January 2023 to 2024 season with the same time span in previous years.

[Puneet Bharot]

Results showed a 57.5% decrease in episodes of lower respiratory tract infections and a 59.2% decrease in acute bronchiolitis to 63.1% decrease in related hospital admissions ICU admissions.

[Jake Anderson]

Holy cow, those are some big relative improvements.

[Elena Kelly]

Yeah, this was a population based retrospective COHORT study with Level 2B evidence, so there can be some other factors that explain the difference, but this is definitely impressive.

[Jake Anderson]

Send us your thoughts by emailing [e-mail].

[Kari Stauss]

Follow on Instagram fpjournal. Please subscribe and rate us wherever you get your podcasts.

[Podcast Host/Producer]

Escuchanos en Espanol A Revista Medica a.

[Elena Kelly]

FFPE Our podcast team is Jake Anderson, Puneet Bharot, Steve Brown, Justin Chetiak, Sarah.

[Podcast Host/Producer]

Coles, Austin Cotter, Rachel Dunn, Emily Eisenberg.

[Elena Kelly]

Elena Kelly, Chisum Okuagu, and Kari Stauss. Our sound and technical guru is Tyler Coles. Our theme song is written and recorded by family physicians Bill Dabbs, Ryan Evans, and Justin Jenkins.

[Jake Anderson]

This podcast is brought to you by the residents and faculty of the University of Arizona College of Medicine, Phoenix Family Medicine Residency Programs.

[Puneet Bharot]

We'll talk to you soon for the next edition of the American Family Physician Podcast.