Episode 239 -- October 2025 -- Part 1 AFP: American Family Physician

Summary

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AFP: American Family Physician Podcast

Episode 239 – October 2025, Part 1
Date: October 15, 2025
Hosts: Dr. Steve Brown (B), Dr. Rachel Dunn (C), Dr. Emily Eisenberg (D)
Contributing Editor: Dr. Steven Brown

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Overview

In this engaging episode, the hosts break down key clinical reviews and discussions from the October 2025 issue of American Family Physician (AFP). Major topics include practical approaches to uterine fibroids, the state of community-based residency training, updated evidence on GLP-1 medications, nuanced management of heart failure with preserved ejection fraction (HFpEF), the comparative effectiveness of intravenous vs. oral iron in pregnancy and postpartum, and the evidence behind nicotine e-cigarettes for smoking cessation. The hosts round out the episode with lighthearted discussion on real versus fake health trends for “Spooky Season.”

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Key Discussion Points & Insights

1. Uterine Fibroids: Rapid Evidence Review

Drs. Keating Jones & Hansel, Wake Forest University
(01:23–06:45)

• Primary Care Management:
  • Fibroids often found incidentally; initial workup and treatment usually within scope of primary care.
  • Quote (D, 01:48): “This rapid review really helped sharpen my approach to managing fibroids or leiomyomas…this is definitely something we can manage in primary care.”
• Diagnosis:
  • No recommendation to screen asymptomatic women.
  • Risk factors: obesity, hypertension, nulliparity, vitamin D deficiency (B, 02:21).
  • Commonly identified during abnormal uterine bleeding workups (D, 02:40).
  • Fibroid symptoms correlate with location (classification 0–8), affecting bleeding or causing bulk symptoms (C, 03:04).
  • Imaging: Start with transvaginal + transabdominal ultrasound with Doppler; MRI or saline sonohistography may be needed (B, 03:23).
  • Labs: CBC, TSH, UA, vitamin D (treating deficiency may reduce size) (D, 03:44).
  • Quote (D, 03:44): “Treating deficiency may reduce fibroid size and halt tumor progression, which is something I had no idea about until reading this article.”
  • Rule out malignancy with endometrial biopsy in high-risk cases; imaging doesn’t distinguish fibroids from leiomyosarcoma (C, 04:04).
• Treatment:
  • Familiar first-line options: oral contraceptives, NSAIDs, levonorgestrel IUD.
  • GnRH agonists/antagonists: effective but short-term, expensive, with side effects (B, 04:41).
  • CME tidbit (D, 05:11): “GnRH antagonists are the most effective for halting bleeding.”
  • Tranexamic acid: indicated, but be cautious in patients with increased clotting risk (C, 05:20).
  • Alternative therapies: vitamin D, green tea extract (C, 05:20).
  • Surgical options: Hysterectomy (definitive), myomectomy (fertility-sparing), uterine artery embolization, radiofrequency ablation, MR-guided focused ultrasound – choice depends on future fertility desires and local resources (D, 05:48).
• Primary Care Takeaway:
  • Fibroid care is nuanced and well within family medicine’s scope (C, 06:26).
  • Quote (C, 06:26): “This review reinforces that they’re well within the scope of Family Med. With the right approach, we can manage most of these ourselves and guide patients through both diagnosis and treatment.”

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2. Community-Based Residency Training Policy Brief

Drs. Manfredonia & Hofstetler, Graham Center
(06:45–09:08)

• Historical Context & Problem:
  • Since Flexner Report (1910), most residency training is hospital/academic-based (C, 07:00).
  • Only 11.7% of graduating residents in 2016–2021 entered outpatient primary care (D, 07:04).
  • Contrasted with 34% of practicing physicians in outpatient primary care (D, 07:13).
  • Most primary care delivered in community, not hospital settings (C, 07:26).
• Community Training Stats:
  • Community-based tracks remain rare, though increasing (C, 07:49).
  • Uptick from 2.2% (2013) to 4.6% (2021) (D, 07:55).
  • In Wyoming & Montana, >50% of residents get community-based training (B, 08:07).
• Funding & Policy Solutions:
  • Teaching health centers established in 2011 (C, 08:14).
  • $174 million in 2022 for teaching health centers vs $16 billion for hospital programs (D, 08:25).
  • Shift Medicaid and other funds to expand community training (B, 08:32).
  • Impact: Improves prevention, chronic disease management, health outcomes (C, 08:47).
• Call to Action:
  • Despite positive trends, greater investment needed to address primary care crisis (D, 08:53).
  • Quote (D, 08:53): “We definitely need substantial public and private investing in primary care training outside of academic medical centers to sustain the workforce and improve overall population health.”

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3. Medicine by the Numbers: GLP-1 Receptor Agonists in CKD + Diabetes

Drs. Elliot & Frasca
(09:08–12:10)

• Updated Guidelines:
  • GLP-1 agonists advised as initial therapy (± metformin) for type 2 diabetes with cardiovascular, heart failure, or CKD risk (D, 09:25).
  • New Cochrane review (2025): 42 RCTs, ~48,000 adults (C, 09:51).
• Efficacy:
  • NNT for all-cause death = 77 over 26 weeks (C, 09:51).
  • NNT = 15 for broader cardiovascular composite (D, 10:20).
  • NNT = 48 for narrowed composite (death, MI, stroke) (D, 10:40).
• Kidney Outcomes:
  • Little/no difference in slowing progression to kidney failure (C, 10:48).
• Limitations:
  • No direct comparison to standard care or non-GLP-1 medications; limited harm data.
  • GLP-1’s adverse effects: nausea, vomiting, early satiety (D, 11:01).
  • Humorous quote (B, 11:15): “When GLP-1s first came out, I thought they only worked because they caused nausea and vomiting.”
• Practice & Outlook:
  • Assigned a “yellow” rating: promising, but need head-to-head trials and better safety data (C, 11:30).
  • Use is rising; hope for fewer coverage barriers as adoption grows (D, 11:48).

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4. Heart Failure with Preserved Ejection Fraction (HFpEF): Clinical Update

Drs. Barzin, Barnhouse & Cain, UNC
(12:34–15:46)

• Definition:
  • HFpEF = preserved ejection fraction but impaired relaxation/diastolic dysfunction (C, 12:45).
  • Symptoms similar to HFrEF: dyspnea, edema, exercise intolerance (C, 12:45).
• Management Strategy:
  • Focus on symptom relief, comorbidities, lifestyle (B, 13:04).
• Pharmacologic:
  • Loop diuretics: first-line for volume overload (C, 13:17).
  • SGLT2 inhibitors: for diabetes and non-diabetics, reduce hospitalizations (NNT = 28), possible mortality benefit (C, 13:17).
  • ACEi/ARB/ARNI/MRA: for blood pressure (B, 13:44).
• Non-Pharmacologic:
  • Weight loss (pharmacologic and lifestyle): improves quality of life — semaglutide and bariatric surgery show promise (C, 14:01).
  • Exercise (aerobic/resistance): improves capacity (C, 14:01).
  • CPAP for OSA; blood pressure management (C, 14:22).
• Atrial Fibrillation:
  • AFib in ~50% of HFpEF patients (C, 14:31).
  • Prioritize lifestyle (weight loss, alcohol reduction), standard rate/rhythm control, SGLT2 inhibitors may slow AFib (C, 14:31/D, 14:51).
  • Ablation considered, but evidence evolving (B, 14:51).
• Bottom Line:
  • No single therapy; combine meds with lifestyle (C, 15:03).
  • Quote (D, 15:31): “Core principle is tailoring therapies to comorbidities while also addressing quality of life.”

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5. Cochrane for Clinicians: IV vs. Oral Iron in Pregnancy & Postpartum Anemia

Dr. Foley, Harvard Medical School
(15:46–18:13)

• Efficacy:
  • IV iron raises hemoglobin 0.5 g/dL more than oral at 3–6 weeks, reduces risk of Hgb <11 at delivery (NNT = 11) (C, 16:12/B, 16:37).
  • Even stronger effect postpartum (NNT = 4 for Hgb <11 at 4–6 weeks) (B, 16:37).
• Patient-Oriented Outcomes:
  • No difference: postpartum hemorrhage, transfusion rates, breastfeeding (D, 17:12).
  • Better adherence with IV; oral has more constipation (B, 17:17/C, 17:39).
• Limitations:
  • Data mostly from India/Africa; more studies needed on long-term, patient-important outcomes (C, 17:39).

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6. FPIN Clinical Inquiry: Nicotine E-Cigarettes for Smoking Cessation

Drs. Montgomery & Beaverson, Univ. of Colorado
(18:13–20:17)

• Evidence & Effectiveness:
  • Nicotine e-cigarettes (EC) superior to NRT, non-nicotine EC, or no support (S.O.R. A) (C, 18:36).
  • Single RCT: ECs as effective as varenicline (S.O.R. B) (B, 18:51).
  • 2024 Cochrane review: 88 studies, 27,000+ patients, 47 RCTs (D, 19:01).
  • Example: 7 RCTs (2,500 pts) — EC better than NRT, RR = 1.59 (C, 19:12).
  • One RCT NNT = 5 against placebo for both varenicline and e-cigarette at 26 weeks; effect faded at 52 weeks (D, 19:28).
• Considerations:
  • Some may quit tobacco but continue using nicotine (B, 19:50).
  • Studies include cotinine/CO levels as objective measures (D, 19:59).
• Clinical Implication:
  • Nicotine ECs can be reasonable for motivated patients (C, 20:07).

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Quotes & Memorable Moments

• Vitamin D and fibroid management:
  • D (03:44): “Treating deficiency may reduce fibroid size and halt tumor progression, which is something I had no idea about until reading this article.”
• Self-deprecating and relatable humor about new therapies:
  • B (11:15): “When GLP-1s first came out, I thought they only worked because they caused nausea and vomiting.”
• Call for primary care advocacy:
  • D (08:53): “We definitely need substantial public and private investing in primary care training outside of academic medical centers to sustain the workforce and improve overall population health.”
• Core management principle for chronic disease:
  • D (15:31): “There’s no single drug that fixes HFpEF. The best outcomes come from combining pharmacologic and non pharmacologic care.”

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Special Segment: “Spooky Season” Real or Fake Health Trends Game

(20:17–24:25)

The hosts challenge each other to decipher real vs. AI-generated health trends, courtesy of ChatGPT—ranging from “dry scooping pre-workout powders” (real), to “digestive moon pauses” and “oxygen microdosing” (fake), with humorous commentary throughout.

• C (22:00): “I mean, I do tell my patients to eat a lot of cucumbers, so…”
• C (22:55, on ‘digestive moon pauses’): “That sounds a little AI generated to me.”
• Entire segment tone: Lighthearted, reflective of the friendly banter and approachability that define the show.

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Timestamps: Important Segments

• Uterine Fibroids Rapid Review: 01:23–06:45
• Community Residency Training Brief: 06:45–09:08
• GLP-1 Agonists in CKD/Diabetes: 09:08–12:10
• Heart Failure with Preserved EF: 12:34–15:46
• IV vs. Oral Iron in Pregnancy: 15:46–18:13
• Nicotine E-Cigs for Smoking Cessation: 18:13–20:17
• Spooky Season Real vs. Fake Health Trends: 20:17–24:25

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Conclusion

This episode distills critical, up-to-date evidence for frontline clinicians, emphasizes family medicine’s role in managing a wide range of conditions, and advocates for the profession’s future through system-level policy changes—all with educational depth and approachability. The "Spooky Season" segment offers levity while highlighting ongoing trends in health misinformation and the growing presence of AI in medicine.

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Transcript

[A]

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.

[B]

Welcome to the American Family Physician podcast for part one of the October 2025 issue. I'm Steve.

[C]

I'm Rachel.

[D]

I'm Emily.

[B]

We are residents and faculty, mostly residents, from the University of Arizona College of Medicine, Phoenix Family Medicine Residency. Today on the podcast we're going to talk about uterine fibroids, community based residency training, GLP1 medications heart failure with preserved ejection fraction intravenous versus oral iron and nicotine E cigarettes for smoking cessation.

[D]

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.

[B]

We're on a mission. Deliver okay, we're going to kick things off with uterine fibroids Rapid evidence review from Drs. Keating Jones and Hansel from Wake Forest University.

[D]

Here we go. This rapid review really helped sharpen my approach to managing fibroids or leiomyomas. They're incredibly common and I know I've had many patients come in with these incidental fibroids found on imaging immediately asking for an OB referral. But being able to walk through the diagnostic workup and initial treatment options helps reassure patients and can often delay and even avoid the need for referral. This is definitely something we can manage in primary care.

[C]

Absolutely. Fibroids show up all the time on my patients problem lists.

[B]

There's no current recommendation to screen asymptomatic women for fibroids. We need to keep this on the differential for a variety of concerns, especially since symptoms can be subtle and varied. Factors that increase the risk for fibroids include obesity, hypertension, nulliparity, and vitamin D deficiency.

[D]

I find that I most commonly diagnose fibroids during an abnormal uterine bleeding workup using the palm coin framework that I know we're all familiar with. But this was a really good reminder that fibroids can also present with fertility concerns, pelvic pain, or other bulk symptoms like abdominal distention or urinary and bowel changes. Bulk symptoms arise from that increased uterine.

[C]

Size and symptoms often track with location. Fibroids are classified from 0 to 8. Lower numbers are closer to the endometrium and more likely to cause bleeding. Higher numbers are subserosal and more likely to cause bulk symptoms. This further comes into play with treatment discussions.

[B]

That's super helpful. I did not know that the best initial imaging is a combination of transvaginal and transabdominal ultrasound with Doppler. You might also use additional studies like MRI or saline sonohistography if the first ultrasound is insufficient or if you're considering more advanced interventions.

[D]

Beyond imaging. Laboratory evaluation overlaps with much of the abnormal uterine bleeding workup, including things like a cbc, tsh, UA as well as a vitamin D level to assess if deficient as treating deficiency may reduce fibroid size and halt tumor progression, which is something I had no idea about until reading this article.

[C]

Before we jump further into treatment, a few important diagnostic reminders Endometrial biopsy should be performed when evaluating for abnormal uterine bleeding if risk for malignancy is high, such as for patients age 45 and over or under 45 with unopposed estrogen exposure. Also, it is difficult to distinguish a leiomyoma or benign fibroid from leiomyosarcoma on imaging alone. And while these are rare, risk factors that may raise cancer suspicion include history of radiation exposure, certain genetic syndromes, or prior use of tamoxifen.

[B]

Okay for treatment. We already are pretty familiar with many of these tools like oral contraceptives, NSAIDs and levonorgestrel IUDs which can all help reduce bleeding to various extents. GNRH agonists and antagonists are also options. We often use those as short term bridges before surgical management to help reduce bleeding or fibroid size. These medications can be more expensive, they can have more side effects and you might need hormonal add back therapy.

[D]

Yeah, and spoiler alert, the CME quiz question in Table 3 says that GnRH antagonists are the most effective for halting bleeding.

[C]

Interesting. Transexamic acid is also indicated for heavy menses in the setting of fibroids. But obviously one needs to be cautious about medical comorbidities that increase clotting risk. And there are some alternative therapies like vitamin D supplementation as Emily mentioned, and green tea extract which might help with symptoms.

[B]

What about like a tea with like green tea and vitamin D in it?

[D]

Perfect. You should make that.

[B]

Yeah, I'm patenting it right now.

[D]

Perfect. And for patients who ask about surgery, I do think it is helpful for us to be able to explain Some of the basics as to what they can expect, even if we're not the ones doing the procedures. Hysterectomy is definitive, but obviously not for those wanting future fertility. Myomectomy can preserve the uterus and fertility. And then there are procedures like uterine artery embolization, radio frequency ablation, and Mr. Guided focused ultrasound, all with varying rates of reintervention and dependent on specialist availability and resources.

[B]

All right, Rachel, so what are your takeaways from this article?

[C]

Good question. Thyroids are more nuanced than they sometimes seem, and this review reinforces that they're well within the scope of Family Med. With the right approach, we can manage most of these ourselves and guide patients through both diagnosis and treatment.

[D]

With confidence, Definitely.

[B]

Okay, we have a policy brief. Now, this is a Graham Center Policy one pager entitled Community Based Residency Training for Primary care physicians from Drs. Manfredonia and Hofstetler from Washington, D.C. since.

[C]

The 1910 Flexner Report, residents are trained mainly in academic centers.

[D]

Only 11.7% of graduating resident physicians between 2016 and 2021 entered the outpatient primary care workforce.

[B]

Oh my.

[D]

I know. Compared to 34% of total physicians currently working in outpatient primary care.

[B]

Yikes. So yeah, I know. The current system is not built to solve the primary care crisis.

[C]

Few residents train in community settings where most of primary care is being delivered.

[D]

Residents who do train in community based settings are more likely to work in these and underserved settings.

[B]

A narrow definition of community based training is any primary care resident, including family medicine, internal medicine, pediatrics or geriatrics, who trained in a teaching health center or rural training track.

[C]

The Graham center crunched the numbers and determined that community based training is increasing but is still a low number, which.

[D]

Is reassuring by the narrow definition. In 2013, 2.2% of residents trained in community settings compared to In 2021, 4.6% of residents trained in these settings.

[B]

It varies widely by state. In Wyoming and Montana, over 50% of residents train in community based settings.

[C]

Oh wow. Teaching health centers were established in 2011 by the Affordable Care act and Congress allocated $174 million to teaching health centers in 2022.

[D]

This is just a tiny amount compared to the $16 billion allocated to hospital based programs each year.

[B]

Oh my. A suggestion from these authors to expand community based training and rural training. States should shift Medicaid funds to community settings and also allocate non Medicaid funds to these programs.

[C]

This funding can positively impact health outcomes through prevention and chronic disease management.

[D]

While community based training is increasing slightly. We definitely need substantial public and private investing in primary care training outside of academic medical centers to sustain the primary care workforce and improve overall population health.

[B]

What color will it be this month? It's time for Medicine by the Numbers. Glucagon like peptide 1 receptor agonist for people with chronic kidney disease and diabetes. From Drs. Elliot and Frasca from Newport News, Virginia.

[D]

What color indeed. We're looking at the evidence behind the updated guidelines which now recommend GLP1 receptor agonists with or without metformin as initial therapy for type 2 diabetes in patients at risk for cardiovascular disease, heart failure or CKD, which to be honest, one could argue is basically all patients with type 2 diabetes. This 2025 Cochrane review provides some of the evidence behind that shift.

[C]

This review pulled data from 42 randomized control trials and over 48,000 adults who had both type 2 diabetes and chronic kidney disease across all stages and compared effectiveness and risks of GLP1 agonist compared with placebo. They found moderate certainty evidence that GLP1 receptor agonists probably reduce all cause death compared to placebo. Over A median of 26 weeks of follow up, the number needed to treat for this was 77. Okay.

[D]

Seeing one death prevented in every 77 patients treated over just 26 weeks, that's about six months is pretty striking. The cardiovascular outcomes were also notable for the broader composite cardiovascular death, non fatal mi, stroke, hospitalization or revascularization. That number needed to treat was 1 in 15.

[B]

Okay, wow.

[D]

For the narrower composite cardiovascular death, MI or stroke, it was 1 in 48, which is still pretty notable.

[B]

Yeah, yeah.

[C]

As for kidney outcomes, the review showed little to no difference between GLP1s and placebo in slowing progression to kidney failure, though that was author reported, not a dedicated outcome.

[D]

While these results are promising, there is no comparison to standard care or other diabetes medications and HARM data was very limited. But we know from practice that GLP1s often cause nausea, vomiting and early satiety.

[B]

When GLP1s first came out, I thought they only worked because they caused nausea and vomiting.

[C]

It's a fair hypothesis.

[B]

You're welcome for that little medical tidbit.

[D]

We're all learners here.

[B]

Exactly.

[C]

So overall, this medicine by the Numbers, gives the GLP1s a yellow rating with still somewhat unclear benefit as first line in this population. The cardiovascular data is promising, but we still need head to head studies and better harm data.

[D]

And I don't know about you all, but it really does feel like so many of us are already reaching for the GLP1s earlier in the treatment course for the right patient. They're just such a great option and may help delay the need for insulin. And hopefully if guidelines move in this direction, we'll begin to see fewer barriers from payers around prior authorization and step therapy.

[C]

We'll be right back.

[A]

The AFP podcast is brought to you by the American Academy of Family Physicians and by the Permanente Medical Group Incorporated. Ready to join multidisciplinary practice in Northern California, the Permanente Medical Group offers flexible schedules, a competitive salary and benefits package, plus Northern California home buying assistance and moving relocation allowance. Enjoy real work Life balance at Kaiser Permanente. Explore opportunities@northern california.permanente.org.

[B]

Next heart failure with preserved ejection fraction from Drs. Barzin, Barnhouse and Cain from the University of North Carolina we all know HFPEF.

[C]

Is heart failure with preserved ejection fraction. That means the EF looks normal, but the ventricle can't relax, so the filling pressures rise. Patients therefore develop dyspnea, edema and exercise intolerance.

[D]

So the treatment isn't the same as for HFrEF, right?

[B]

HFrEF and HFPEF are different. Mortality is just as high, but therapies are less defined. Management focuses on symptom relief, comorbidities and lifestyle interventions.

[C]

Okay, so let's talk about medications first. For volume overload, loop diuretics are first line. But for comorbidities, SGLT2 inhibitors are now recommended for patients with diabetes and heart failure and increasingly used in non diabetics. Also, they reduce hospitalizations with a number needed to treat of only 28 wow. And may modestly lower cardiovascular mortality even in patients without diabetes.

[B]

For blood pressure control, ACE inhibitors, ARBs and ARB, neprilysin inhibitors or mineralocorticoid receptor antagonists are guidelines supported. And even if data are less robust than in HFrEF.

[D]

And what about some of these non medicine options?

[C]

Absolutely. Lifestyle changes are critical in obesity related HFpEF, weight loss improves exercise tolerance and quality of life. Semaglutide has shown benefit and bariatric surgery may help, although evidence is limited. Exercise training, especially aerobic and resistance exercise, also improves functional capacity.

[B]

Don't forget our tricky comorbidities, hypertension and sleep apnea. Controlling blood pressure is essential.

[D]

And what about for atrial fibrillation?

[C]

AFIB is present in about half of HFPEF patients. Lifestyle interventions like weight loss and alcohol reduction are first line. Rate and rhythm control remain important. Though many antiarrhythmics lack proven benefit in HFpEF, some data suggest SGLT2 inhibitors may reduce AFIB progression.

[B]

Ablation can be considered if AFIB symptoms dominate, but evidence is still evolving so.

[D]

Big picture management seems to blend medicine and non medicine strategies exactly.

[C]

To summarize, for medications, loop diuretics are first line for symptoms. SGLT2 inhibitors for diabetes and beyond the ACEs, ARBs, RDs and MRAs are helpful for blood pressure control in terms of non medication strategies, weight loss, structured exercise programs, CPAP for OSA, and don't forget about lifestyle modification for afib.

[D]

It seems that the core principle really is tailoring therapies to comorbidities while also addressing quality of life. There's no single drug that fixes HFpEF. The best outcomes come from combining pharmacologic and non pharmacologic care.

[B]

Next, Cochrane for clinicians Safety and effectiveness of intravenous versus oral iron for treatment of anemia in the prenatal and postpartum periods this is from Dr. Foley from Harvard Medical School.

[C]

So our question is is IV iron better than oral iron in pregnancy?

[D]

Seems like this comes up all the time with our OB patients and postpartum patients.

[C]

Definitely.

[D]

In a Cochrane review of nearly 4,000 pregnant patients, mainly from India and Africa, IV and iron raised hemoglobin about 0.5 grams per deciliter more than oral iron at three to six weeks. It also reduced the chance of having a hemoglobin under 11 grams per deciliter at delivery. Relative risk of 0.85, meaning the number needed to treat is about 11.

[B]

And postpartum IV iron was even more effective. One analysis showed the risk of hemoglobin less than 11 at 4 to 6 weeks. Postpartum was cut by a third with IV iron with a relative risk of 0.66. Number needed treat of 4. There was also a big reduction in very severe anemia. Hemoglobin less than 7, relative risk of 0.16, although that evidence was low certainty.

[C]

Hmm, that sounds pretty impressive. What about specific patient outcomes?

[B]

Good question Rachel Poems Exactly.

[D]

Surprisingly, IV iron didn't change postpartum hemorrhage, transfusion rates or breastfeeding.

[B]

So that's a low effect. Adherence is better too. With IV Iron. Patients were 17 more percent likely to stick with IV iron, partly because it avoids side effects like constipation. In fact, constipation risk was much higher with oral iron, with a relative risk of 0.12 for IV versus oral.

[C]

So it seems that IV works faster and is easier to tolerate. But we still need more data. These Cochrane reviews aim to clarify the optimal route of treatment, but are limited in their lack of clinically relevant outcomes and also in the heterogeneity of outcomes reported in the trials. More studies are needed that focus on clinically important outcomes such as maternal morbidity and mortality, as well as symptoms of anemia and their effect on such parameters as maternal and infant well being, psychological outcomes and breastfeeding rates.

[B]

Closing things out with an FPIN Clinical Inquiry FPIN is the Family Physician Inquiries Network. Nicotine E Cigarettes as a Strategy for Smoking Cessation from doctors Montgomery and Beaverson from the University of Colorado, the clinical.

[D]

Question here is use of nicotine E cigarettes an effective strategy for tobacco smoking cessation?

[C]

The short answer is yes. The strength of recommendation is a For E cigarettes, increased cessation rates compared to nicotine replacement therapy, non nicotine E cigarettes, no support or behavioral support only.

[B]

There's also a single randomized controlled trial that nicotine E cigarettes are as effective as varenicline and that's a strength of recommendation.

[C]

B wow.

[D]

Our evidence Here is a 2024 Cochrane review of 88 studies with over 27,000 patients. 47 of the studies are RCTs.

[C]

As an example of a subset of these trials, seven trials and over 2,500 patients looked at nicotine E cigarettes compared to nicotine replacement therapy. Cessation rates were higher in the E cigarette group with a risk ratio of 1.59.

[D]

An RCT of 458 patients comparing varenicline to nicotine E cigarettes or placebo shows a number needed to treat a five for either treatment compared to placebo for smoking abstinence at 26 weeks. At 52 weeks, abstinence had decreased significantly and there was no statistically significant difference for either treatment and placebo users.

[B]

In some other studies I've seen, sometimes the patients may quit tobacco cigarettes but keep smoking the nicotine. So I sort of wonder about that.

[D]

I've seen that as well. Some of these studies reported actual inhaled carbon monoxide levels or serum cotinine measurements.

[C]

So it seems like for motivated patients, nicotine E cigarettes might be a reasonable option to help our patients quit tobacco cigarettes.

[B]

Nice. In honor of Spooky Season and everybody tells us we need to integrate AI more into primary care, we have a special game called Real or Fake Health Trends for Spooky Season. Okay, so Chat GPT has given me both real health trends Spooky real health trends that are not evidence based or fake health trends. Emily, we'll go with you first. Is this real or fake? Dry scooping Pre workout powders.

[D]

Dry scooping.

[B]

What does that mean, dry scooping?

[D]

Like just.

[C]

Just. Oh, just eating.

[D]

Just munching on the powder.

[B]

Yeah.

[D]

Oh, goodness. I wouldn't put it past them. I'm gonna say it's real.

[B]

That is real.

[C]

Like spoon challenge all over again.

[B]

Exactly. Rachel, is nature's ozempic eating lots of cucumbers? Is that a real or a fake health trend?

[C]

I almost feel like it's also real.

[B]

That is also a real health trend.

[C]

I know, man. I mean, I do tell my patients to eat a lot of cucumbers, so.

[B]

Okay, Emily, Spleen activation. Tapping. Gentle tapping below the left ribcage to stimulate immune readiness.

[C]

Oh.

[D]

Oh, that sounds very enticing.

[C]

To get the lymph flowing.

[D]

I mean, we do learn how to percuss in medicine and it sounds fairly similar.

[C]

Self percussing.

[D]

It almost sounds too normal. So I'm gonna say it's fake.

[B]

That is fake. That is a fake. Spooky Health. Health intervention. Rachel, how about digestive moon pauses. You wait exactly. You wait exactly 28 minutes after eating before standing up to mirror lunar digestive cycles.

[C]

That sounds. That sounds a little AI generated to me.

[B]

Super AI generated, but also perfect for Halloween.

[C]

I know.

[D]

Props for you.

[B]

Let's do a couple more here.

[D]

Maybe we need to try that one.

[C]

I do that every day.

[D]

I could be onto something.

[B]

Definitely. All right, is this real or is this fake, Emily? Mouth taping while sleeping.

[D]

Oh, absolutely. That's real.

[B]

Yeah. Totally not recommended, but it is a real thing that people are doing.

[D]

And an interesting look.

[B]

Exactly. All right, finally. Rachel, is this a real or a fake health trend? Oxygen microdosing. Sorry, I can't keep a straight face.

[C]

What would that entail, doctor?

[B]

Short bursts of precision breathing to train your red blood cells for better oxygen uptake.

[D]

Precision breathing.

[C]

Yes. I. Again, it sounds like AI might be.

[B]

I know, but. But genius.

[C]

Genius. I. I think we should try some of these.

[B]

Yes, absolutely.

[D]

My breathing is very much not precise.

[C]

No.

[B]

No.

[C]

Coming up on the next American Family oxygen microdosing.

[B]

Is it evidence based? What's the number needed to treat with oxygen microdosing to improve? Yeah, so there you go. A great use for AI in family.

[D]

Medicine, education, and extra spooky.

[C]

Send us your thoughts by emailing us@afpp.

[D]

Podcastafp.Org follow us on Instagram @afp journal. Please subscribe and rate us wherever you get your podcasts.

[C]

Escuchenos is en espanol a revista medica a FA pay.

[B]

Our podcast team is Jake Anderson. Puneet Baro Steve Brown, Justin Chettiak, Sarah Coles, Austin Cotter, Rachel Dunn, Emily Eisenberg, Elena Kelly, Chisum Okuagu, and Kari Staus.

[D]

Our sound and technical guru is Tyler Coles. Our theme song is written and recorded by family physicians Bill Dabs, Ryan Evans and Justin Jenkins.

[B]

This podcast is brought to you by the residents and faculty of the University of Arizona College of Medicine, Phoenix Family Medicine Residency Programs. We'll talk to you soon for the next edition of the American Family Physician Podcast.