AFP Podcast Episode 245 – January 2026, Part 1

Date: January 15, 2026
Hosts: Jake Anderson, Emily Eisenberg, Kari Staus, Justin Chediak
Contributing Editor: Dr. Steven Brown

Episode Overview

This 10th anniversary episode of the AFP Podcast brings together faculty and residents from the University of Arizona College of Medicine–Phoenix to review clinical highlights from the January 2026 issue of American Family Physician. The hosts deliver evidence-based updates on recently approved medications, practice guidelines, and the latest studies in family medicine. Key topics include a new acid-suppressing drug, strategies for newborn respiratory distress, updated vaccination schedules, calcium supplementation in pregnancy, resistant hypertension management, and emerging blood-based colorectal cancer screening tests.

Key Discussion Points & Insights

10 Years of AFP Podcast: Reflection and Milestones

• Celebration of the Podcast’s 10th Year:
  • The hosts open with reflections on a decade of podcasting (00:29).
  • Steve Brown: “As of this morning, the podcast has been downloaded 8,440,802 times to be exact.” (01:07)
  • Jake Anderson: “It’s hard to believe that what started as a wild ride has now been happening twice monthly for 244 episodes.” (01:00)
  • Team highlights include launching the Spanish-language Revista Médica (2022), over 60 resident hosts, and ongoing community support.

New Medication: Vinoprazan for Acid-Related Disorders ("STEPS" Review)

Segment starts: 03:22

Mechanism & Indications

• Emily Eisenberg:
  • “Vinoprazan, brand name Voquezna ... is labeled for healing and maintenance treatment of erosive esophagitis and heartburn associated with erosive esophagitis as well as treatment of GERD and as part of triple therapy or double therapy for H. Pylori.” (03:57)

STEPS Framework

• Safety: Risks are similar to other long-term acid suppressants—examples include risk of fractures, C. diff, B12 deficiency, low magnesium, and caution in severe renal or liver impairment. (04:30)
• Tolerability: Comparable discontinuation rates to lansoprazole (0.9–2.3%). (04:59)
• Effectiveness:
  • Comparable to lansoprazole for healing erosive esophagitis.
  • Superior to placebo for non-erosive GERD (NNT = 6 for symptom-free status at 4 weeks).
  • More effective than lansoprazole triple therapy for H. pylori, especially in clarithromycin-resistant cases (NNT = 3 in resistant cases). (05:41)
• Price: $200/month vs $15–$30 for lansoprazole. (06:03)
• Simplicity: Once daily; can be taken with or without food. (06:18)

Bottom Line

• Kari Staus:
  • “Vinoprazan is superior to placebo for treatment of non-erosive GERD ... and more effective than lansoprazole triple therapy for eradication of H. Pylori.” (06:25–06:36)

Newborn Respiratory Distress: Evaluation & Management

Segment starts: 06:45

Epidemiology & Recognition

• Up to 10% of newborns need respiratory support, ~5% require advanced resuscitation. (06:57)
• Signs: Grunting, nasal flaring, retractions, RR > 60.
• Main risk considerations: Gestational age, amniotic fluid, maternal/perinatal factors, and umbilical cord management. (07:27)

Initial Management

• Begin with drying, stimulation, and airway positioning.
• Positive pressure ventilation if HR < 100 or apnea/gasping; escalation per neonatal algorithm. (07:51)

Case-Based Differential

• TTN (Transient Tachypnea of Newborn):
  • Classic after elective C-section, especially with macrosomia/gestational diabetes (incidence up to 30%).
  • Self-resolving; supportive care only. (08:33)
• Meconium Aspiration Syndrome:
  • “More common in near/post-term infants ... routine endotracheal suctioning is no longer recommended ... management is also supportive.” (09:29)
• RDS (Respiratory Distress Syndrome):
  • “Most commonly presents in premature infants due to immature lungs and surfactant deficiency ... symptoms worsen over first 48 hours.” (10:26)
  • Use of maternal corticosteroids (24–36+6 weeks) reduces risk.
• Infectious causes (Pneumonia):
  • Hard to distinguish from sepsis; high mortality. (11:08)
• Other:
  • Congenital (cardiac, diaphragmatic), metabolic, or airway abnormalities. (11:39)

Takeaway

• Kari Staus: “Early recognition, stabilization and keeping a broad differential are going to be keys to optimizing outcomes for these newborns.” (12:02)

Immunization Update: 2025 Recommendations

Segment starts: 12:12

• AAFP’s 2025 immunization schedule differs in several ways from the CDC’s, notably strengthening recommendations for COVID-19 and influenza vaccination in children.
  • COVID-19:
    • Universal vaccination for children 6–23 months and high-risk 2–18-year-olds. (12:57)
    • Vaccine type by age: Moderna (<5), Pfizer/Moderna (5–11), and Novavax options (12+). (13:19)
    • CDC recommends shared decision-making; AAFP favors universal approach.
    • Recommends COVID-19 vaccination during pregnancy.
  • Influenza:
    • CDC recommends only single-dose vials (thimerosal-free).
  • Pneumococcal:
    • Vaccinate all adults ≥50 (previously 65+). (14:42)
  • Meningococcal:
    • New PenMeNV vaccine covers Groups A, B, C, W, Y. (15:11)
  • Chikungunya:
    • Vaccine for travelers to epidemic areas or long-term stays in at-risk countries. (15:34)
  • RSV:
    • Expanded RSV recommendations for 50–59 year-olds at risk and new monoclonal antibody options for infants. (16:00)

Calcium Supplementation in Pregnancy: Beyond Preeclampsia

Segment starts: 16:39

Research Overview

• Cochrane review of 19 RCTs (16,000+ pregnancies) on calcium’s effect on non-hypertensive outcomes (e.g., preterm birth, low birth weight).
  • Calcium may slightly reduce late preterm birth (RR 0.8; minor absolute benefit).
  • Little/no effect on earlier preterm birth, low birth weight, maternal/fetal adverse outcomes. (17:40–18:26)
  • No increased risk of harms (GI, kidney stones, anemia). (18:26)

Practice Implications

• Justin Chediak:
  • “Calcium supplementation is still best supported for preeclampsia prevention in patients with low dietary intake.” (18:50)

Resistant Hypertension: Evaluation & Optimizing Management

Segment starts: 19:17

Definitions

• Hypertension: Office ≥140/90, Home ≥135/85, 24-hr ≥130/80. (19:31)
• Resistant hypertension: Uncontrolled BP with 3 optimal agents (one a thiazide diuretic). (20:01)

Accurate BP Measurement

• Multiple steps to ensure correct readings (cuff size, position, rest, caffeine/nicotine abstinence, empty bladder, no talking). (20:31)

Treatment Approach

• Lifestyle:
  • Exercise reduces SBP by 4–9 mmHg; DASH diet by 8–14; 10kg weight loss by up to 20 mmHg. (21:26)
• Medication:
  • Prefer combo low-dosage over maxed monotherapy—adding a second agent is ~5x more effective. (22:02)
  • After CCB/ARB/ACE/thiazide, next add mineralocorticoid antagonist if still uncontrolled. (22:23)

Summary Quote

• Jake Anderson:
  • “If your patient’s blood pressure is still above goal, the preferred fourth agent to start is a mineralocorticoid receptor antagonist.” (22:45)

DNA-Based Blood Test for Colorectal Cancer Screening

Segment starts: 23:28

Study Review

• 27,000 patients: Blood test vs colonoscopy.
  • Detects ~80% of colorectal cancers (esp. stage 2–4). (24:02)
  • Major Limitation: Only 12.5% sensitivity for advanced adenomas (pre-cancer), much worse than FIT stool test.

Clinical Implications

• Concern: False reassurance, potential reduction in use of proven screenings (FIT, colonoscopy), possible negative effect on CRC prevention and outcomes. (24:23)
• Emily Eisenberg: “Bottom line, despite impressive numbers on paper, this blood test isn’t ready to replace existing screening... stick with what we know definitely saves lives.” (24:38)

Notable Quotes & Memorable Moments

• On Podcast Longevity:
  • Steve Brown: “...didn’t even know after the very first pilot that this would happen at all.” (01:07)
• On Transitional Newborn Care:
  • Emily Eisenberg: “Even umbilical cord management can really impact how smoothly a newborn transitions after birth.” (07:27)
• On Medication Costs:
  • Jake Anderson: “The cost of vonoprazan is approximately $200 for a one month supply. In contrast, a one month supply of lansoprazole costs approximately 15 to $30.” (06:03)
• On Hypertension Management:
  • Justin Chediak: “The addition of a second antihypertensive agent is five times more effective at lowering systolic blood pressure than doubling the dose of the original agent.” (22:02)
• On CRC Screening:
  • Emily Eisenberg: “Screening is about preventing cancer, not just detecting it late.” (24:23)

Timestamps for Key Segments

• Podcast milestones and community reflections: 00:29–02:23
• Vinoprazan STEPS review: 03:22–06:45
• Newborn respiratory distress: 06:45–12:12
• Immunization guidelines update: 12:12–16:12
• Calcium supplementation in pregnancy: 16:39–19:03
• Resistant hypertension management: 19:17–22:45
• DNA-based colorectal cancer screening: 23:28–24:57

Tone & Style

The hosts maintain a conversational, collegial, and occasionally humorous style, mixing puns, clear teaching points, and personal perspective. The tone is engaging but always grounded in evidence and practical advice.

This summary captures the full sweep and spirit of AFP Podcast Episode 245, delivering key clinical updates and practice-changing pearls for busy family medicine clinicians.