In episode 46 we speak with one of the gurus of drug safety, Dr. Bruce Psaty, to get some insight on the whole issue of identifying the good and bad things that drugs can do. We come to the conclusion that high quality information is ultimately what is needed if we are to understand what drugs can and cannot do. Both Mike and James lament on their ability to produce high quality information.
In our 45th episode, we review a few more practice changing studies with Dr Mike Kolber. We go through the renal outcomes of a large trial of ACE or ARB or together, the benefits of medical therapy to pass of renal stones and then we journey into another evidence void to review the most recent antibiotic prophylactic guidelines from NICE (UK) and the US. At the end James tries to sort out which Mike is the expert and which one is just opinion, and he can’t so he enrolls them both in an RCT without their consent.
Show Notes
1) Renal outcomes with ACE & ARB (alone or combined).
Canadian Hypertension Education Program (CHEP) urges physicians NOT to combine ACE & ARB
2) Medical therapy for renal stone passage.
3) Antibiotic Prophylaxis for Infective Endocarditis
J Am Coll Cardio 2008;52:676-85
Who gets prophylaxis
In Episode 44, we review another collection of practice changing articles and are joined by Dr. Mike Kolber. The first case and study considers the use of metformin in gestational diabetes and the trial leads to a longer discussion of the challenges of prescribing in pregnancy. The second case and study concerns the use of ondansetron for vomiting in pediatric patients. James interrupts the two Mikes frequently but never knows which one.
Show Notes
1) Metformin for gestational diabetes
2) Glyburide for gestational diabetes
3) Persistent pulmonary hypertension of the newborn
4) Risk of depression relapse in pregnancy
5) Vomiting in kids and ondansetron
Arch Pediatr Adolesc Med 2008;162: 858-65
Dosing: Ondansetron usually 1 dose: IV 0.15-0.3 mg/kg or oral 2-8 mg (range based on weight) or 1.6-4 mg (range based on age)
In episode 43, we take our last run/jog at the problem of obesity by exercising our right to talk about the benefits of increasing activity. James tells the listening audience that Mike is 5’ 6” and weighs 250 lbs and Mike demonstrates to James how to become more active by chasing him around the studio with a hockey stick – but only metaphorically speaking, as Mike lives in Edmonton and James lives in Vancouver.
Show Notes
1) Latest NEJM paper on different “diets”
2) Activity-related benefits – morbidity and mortality
Arch Intern Med 2007;167:2453-60
NEJM 2002;347:716-25
Cochrane Database SystRev 2002:CD003404
J Gerontol A Biol Sci Med Sci 2008;63:997-1004
J Sports Med Phys Fitness 2007;47:462-7
Cochrane Database SystRev. 2008;CD004366
Cochrane Database SystRev. 2008;CD004376
4) Impact of exercise on weight
JAMA 2003;290:1323-30 JAMA 2003;289:323-30
5) Exercise versus angioplasty
6) Do patients adhere?
7) Write a prescription for lifestyle – reminders etc
Am J Public Health 1998;88:288-91
8) Pedometers
THE NUTRITION PROPOSITION BOOK
Check it out at nutritionproposition.com and think about picking up a copy on Amazon. All the evidence you ever wanted about nutrition and the only nutrition book that won’t tell you what to eat.
This pragmatic trial is now recruiting in BC. Make a difference and get involved with pragmatic trials (www.pragmatictrials.ca)
