Podcast Summary: AFP: American Family Physician Podcast

Episode 234 — July 2025 (Part 2)
Date: July 31, 2025
Hosts: Jake Anderson, Austin Cotter, Justin Chetiak (Residents and Faculty, University of Arizona College of Medicine – Phoenix Family Medicine Residency)
Main Topics: Intimate partner violence, top 20 primary care studies, carpal tunnel syndrome treatments, Benz Galantamine for Alzheimer's, bright light therapy for depression, VA/DoD suicide risk guideline

Episode Overview

This episode focuses on the latest clinical best practices and new research relevant to family physicians. The hosts break down important content from the July 2025 issue of American Family Physician, including:

• Identification and management of intimate partner violence (IPV)
• Highlights from the top 20 research studies of 2024 for primary care
• Updates on surgical/non-surgical carpal tunnel syndrome treatments
• A STEPS review of Benz Galantamine for Alzheimer’s
• The efficacy of bright light therapy for non-seasonal depression
• The new VA/DoD guideline for suicide risk assessment and management

Key Discussion Points & Insights

1. Intimate Partner Violence (IPV) [01:28–05:20]

• Prevalence & Demographics

  • "Intimate partner violence... affects nearly half of adult women and men in the United States." (Austin Cotter, 01:56)
  • Especially severe in multiracial, American Indian/Alaska Native women; transgender individuals are at highest risk.
  • Among youth under 18, 16–25% exposed; makes up ~20% of all childhood maltreatment (Austin Cotter, 02:16).

• Health Impacts

  • IPV linked to depression, suicidality, chronic pain, arthritis, and substance use (Justin Chetiak, 02:34).
  • In pregnancy: risk for preterm birth, fetal loss, maternal death (Austin Cotter, 02:47).
  • For children: increased risk for mental health issues and cycle of violence (Justin Chetiak, 02:58).

• Screening Recommendations

  • USPSTF: Screen all reproductive age women; no specific interval.
  • ACOG & HHS: Emphasize routine integration into women's health visits.
    • Screening tools: HARK, HITS (Justin Chetiak, 03:23)
  • WHO: No universal screening, recommend inquiry with related symptoms (Austin Cotter, 03:30).

• Universal Education vs. Universal Screening

  • Instead of only asking about violence, educate all patients on healthy relationships regardless of suspicion (Austin Cotter, 03:58).
  • Models like CUES and PAR help guide these conversations (Jake Anderson, 04:08).
  • Key: Disclose reporting laws, educate without pressuring disclosure, let patients decide what to share (Austin Cotter, 04:28).

• Trauma-Informed Care

  • "Empathetic listening, survivor-centered care, and multidisciplinary support are crucial..." (Jake Anderson, 05:00).
  • Advocacy is vital: "Your awareness and compassion can change lives." (Austin Cotter, 05:08)

2. Top 20 Research Studies of 2024 for Primary Care [05:20–11:24]

• Methodology

  • Annual review by experts scrutinizes over 20,000 studies; narrows to 20 most practice-changing.
  • POEMs = Patient-Oriented Evidence that Matters (Justin Chetiak, 06:03).

• Select Study Highlights

  • Probiotics for UTIs
    • Vaginal/oral probiotics reduce recurrence in premenopausal women.
      • "At 4 months... 70% [recurrence] placebo vs. 32% with both probiotics..." (Justin Chetiak, 07:42)
  • Gallstones: Watchful Waiting
    • Uncomplicated, symptomatic gallstones can be safely monitored.
      • "No need to rush to surgery without complications." (Austin Cotter, 07:51)
  • CGM in Type 2 Diabetes
    • No added benefit over traditional monitoring; may increase stress.
      • "Continuously watching that glucose causes stress." (Jake Anderson, 09:04)
  • Beta Blockers Post-MI with Preserved EF
    • No mortality or MI reduction in this group. (Austin Cotter, 09:25)
  • CBT for Long Covid Fatigue
    • NNT of 3 at 26 weeks for reducing severe fatigue. (Justin Chetiak, 09:57)
  • Bad News Delivery by Phone
    • No difference in anxiety, depression, or satisfaction compared to in-person.
      • "Use patient preference since knowing may be preferable to waiting." (Jake Anderson, 10:45)

3. Carpal Tunnel Syndrome: Surgical vs. Non-Surgical Treatment [11:24–13:40]

• Epidemiology & Diagnosis
  • Most commonly diagnosed musculoskeletal nerve compression; classic symptoms described.
• Treatment Evidence
  • 2024 Cochrane review:
    • Surgery leads to higher long-term satisfaction vs. splinting (NNT=4), but evidence unclear compared to steroid injections.
    • Lack of consistency in surgical techniques or comparator data (Austin Cotter, 13:00; Jake Anderson, 13:16).
  • Shared decision-making emphasized due to gaps in comparative research.

4. STEPS Review: Benz Galantamine for Mild/Moderate Alzheimer’s [14:01–17:53]

• Background

  • Benz Galantamine is a new delayed-release form, not directly studied in RCTs, but approved based on bioequivalence to galantamine.
    • "No published clinical trials of Benz Galantamine. It was approved for marketing based on evidence from bioavailability studies..." (Austin Cotter, 14:38)

• Safety & Tolerability

  • May cause rare skin reactions, bradycardia, GI symptoms (typical for cholinesterase inhibitors).

• Effectiveness

  • Based on galantamine data: modest improvements in cognition and function (score increase ~2.86 points ADA scale).

• Price

  • ~$800/month vs. ~$30 for regular galantamine (Austin Cotter, 16:54).

• Recommendation

  • Begin with galantamine due to cost; consider Benz Galantamine only if intolerant, given similar efficacy and a high price.
    • "Given the frequent intolerance of galantamine, Benz Galantamine can be considered if intolerance occurs." (Austin Cotter, 17:30)

5. POEM: Bright Light Therapy for Non-Seasonal Depression [17:53–20:05]

• Findings
  • Meta-analysis of 11 RCTs: Bright light therapy (10,000 lux for 30 minutes/day) improves remission rates for non-seasonal depression.
    • "Remission rates: 40.7% in the bright light group vs. 23.5% in the non-bright light group." (Jake Anderson, 19:34)
  • Benefits persist both short- and long-term (Austin Cotter, 19:06).
  • Recommendation: Offer/discuss bright light therapy with adults suffering from non-seasonal depression (Evidence Level 1A).

6. Practice Guideline: Assessment & Management of Suicide Risk (VA/DoD) [20:09–22:11]

• Guideline Highlights

  • Columbia Suicide Severity Rating Scale is recommended for screening.
  • Acknowledges screening tools predict less than half of completed suicides.
  • Key risk factors: MH illness, adverse events, physical illness, lethal means, social determinants.
  • Effective Interventions:
    • CBT reduces repeat attempts by >50%.
    • Brief follow-up (calls/texts/letters) also cuts attempt rates at 1 year (Jake Anderson, 21:07).
    • Means restriction works (firearms, drug quantities, physical barriers), though evidence "weak but favorable."
    • Clozapine (for schizophrenia) and single ketamine infusion (for acute suicidality) have supporting evidence.
    • Insufficient evidence for hotlines, gatekeeper training, or peer outreach.

• Notable Quote:

  • "It's encouraging that we have a low cost, low barrier intervention that empowers anyone with a phone or a piece of paper to potentially save a life." (Jake Anderson, 21:07)

Notable Quotes & Memorable Moments

• On the value of Universal Education for IPV:
  "This empowers patients to disclose if they choose and to share information with others." — Jake Anderson, [04:08]

• On negative findings for continuous glucose monitoring:
  "Continuously watching that glucose causes stress." — Jake Anderson, [09:04]

• On the beta blocker findings post-MI:
  "My hat just fell on the floor." — Jake Anderson, [09:49]

• On delivering bad news by phone:
  "Use patient preference since knowing may be preferable to waiting for many patients." — Jake Anderson, [10:45]

• On light therapy for depression:
  "Remission rates: 40.7% in the bright light group and 23.5% in the non-bright light group. So that seems substantial." — Jake Anderson, [19:34]

• On brief interventions for suicide prevention:
  "It's encouraging that we have a low cost, low barrier intervention that empowers anyone with a phone or piece of paper to potentially save a life." — Jake Anderson, [21:07]

Timestamps for Key Sections

• 01:28 — Intimate Partner Violence: Epidemiology to Trauma-Informed Care
• 05:20 — Top 20 Research Studies of 2024 Starts
• 06:57 — UTIs & Probiotics
• 07:44 — Gallstones: Watchful Waiting
• 08:16 — CGM for Type 2 Diabetes
• 09:25 — Beta Blockers after MI
• 09:57 — CBT for Long Covid
• 10:34 — Delivering Bad News by Phone
• 11:24 — Carpal Tunnel Syndrome: Surgical vs. Non-Surgical
• 14:01 — STEPS: Benz Galantamine for Alzheimer’s
• 17:53 — Bright Light Therapy for Non-Seasonal Depression
• 20:09 — VA/DoD Suicide Risk Guidelines

Summary

This episode delivers practice-changing insights and covers challenging primary care topics ranging from trauma-sensitive care to surgical decision-making. The hosts keep the tone conversational, evidence-based, and focused on actionable guidance for family physicians, echoing the mission of American Family Physician to bridge current research and daily clinical care.