In episode 365, Mike and James invite Tony Nickonchuk to talk about the very important and broad topic of social determinants of health. We find when it comes to what makes us sick, approximately 75% of our health issues happen to our patients and us before they or we engage the health care system. That’s important to know.
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In episode 364, James, Mike, and primarily Bruce talk about an approach - Focussed Acceptance and Commitment Therapy (FACT) - that clinicians in primary care can use across a broad range of psychological problems. This type of 15-20 minute approach has been evaluated in many RCTs – so have a listen and reach for the behaviour and not the medication.

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In episode 363, James, Mike, Bruce and Helena continue to talk about depression in primary care. The key messages are that instead of calling it depression we should consider telling people they are “stuck”, negotiate non drug therapies like behavioural activation, do follow-up phone calls and basically NEVER prescribe an antidepressant on the first visit.

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In episode 362, James and Mike invite Bruce Arroll back to talk about his latest systematic review on antidepressants for treatment of depression in primary care. We quickly come to the realization that primary care is different than specialty care and that we need to talk first and prescribe later and have the clinician be the drug.

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In episode 361, James and Mike pull out the PREMIUM card and we digest two recent publications – a cohort study looking at the relation between percent of macronutrients ingested and CVD and mortality and then a much smaller trial of intensive lifestyle in T2DM.

In episode 360, Mike and James finally get to the end of their agitating three part series on treating agitation in dementia. In this episode we talk about the evidence for the non-drug treatments like group or individual activities, music therapy and sensory interventions. Sadly, there is still real uncertainty if these interventions work reliably.

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In episode 359, Mike and James continue to agitate over the evidence for treating agitation in dementia. We talk about the use of benzodiazepines, antidepressants cholinesterase inhibitors for this difficult to treat condition. The evidence ends up just increasing our level of agitation as these agents unfortunately really don’t do a heck of a lot for many people.

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In episode 358, Mike and James in an agitated and demented way deal with the evidence around agitation in dementia. We find that the antipsychotics have an effect that might be noticeable in 1 in 10 people but if a person responds it likely had nothing to do with the medication. How agitating is that?

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