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Medication Mythbusters – Home of the Best Science (BS) Medicine Podcast

Episode 52: CRP – An important part of a Comprehensive Risk Profile or a Completely Ridiculous Practice

Episode 52 goes back in time to look in more detail at what we talked about in episode 30; the whole issue of CRP measurement. Mike and James start at the “large” issue of intra-subject variability, then focus on the “small” impact CRP has on absolute risk assessment, and briefly discuss how “accurate” risk assessments are in the first place. Finally they come to the conclusion that, as with most of the podcasts, they are very accurately vague and there is huge intra-podcaster variability.

Show Notes

1) Issues of intra-subject CRP measurement variability

Clinical Chemistry 2001;47:444–50

2) Need for repeat and multiple values

Clinical Chemistry 1997;43:52–8

Ann Clin Biochem 2002;39:85-8

3) Impact on risk assessment of adding CRP to other risk factors

“Our findings suggest that routine measurement of these novel markers [CRP] is not warranted for risk assessment”

Arch Intern Med 2006;166:1368-73

“the addition of multimarker scores [CRP] to conventional risk factors resulted in only small increases in the ability to classify risk” 

NEJM 2006;355;2631-9

“CRP does not perform better than the Framingham risk equation for discrimination. The improvement in risk stratification or reclassification …is small and inconsistent”

Int J Epidem 2009;38:217–31

4) Reclassification in risk level when using CRP

Women

Ann Int Med 2006;145:21-9

Men

Circulation 2008;118:2243-51

Net reclassification less than that seen in the above studies

Circ Cardiovasc Qual Outcomes 2008;1:92-7

5) Issue of confidence intervals around risk assessments

J Cardiovasc Risk 2002;9:183-90

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Episode 51: More useful clinical trials – with a gentler touch – Part II

In episode 51, we again bring in the charming Dr. Tina Korownyk to help us work through 4 more recent studies that hopefully will have relevance to your practice. We find out that Vitamin B12 works for apthous ulcers, inhaled corticosteroids should be continued in pregnancy, that NSAID risks can be reduced – but not to zero, and an ARB (telmisartan) provides no benefit when given to stroke patients. Finally, it is revealed that Mike and James have very limited absolute charm.

Show Notes
1) Apthous ulcers – sublingual Vitamin B12

J Am Board Fam Med 2009;22:9 –16

2) GI protection for NSAIDs

Am J Gastroenterol  2009; 104:728-38

3) Asthma control in pregnancy – OK to use inhaled corticosteroids

Ann Allergy Asthma Immunol 2008;101:137–43

4) Telmisartan for stroke – no benefit

N Engl J Med 2008;359:1225-37

Episode 50: More useful clinical trials – with a gentler touch

In episode 50, we talk about 4 more clinical trials that might help you in your practice. We cover topics ranging from fever control with acetaminophen or ibuprofen, injections for rotator cuff injuries, diabetes, and osteoarthritis. Mike and James finally bring in a much needed female flavour to the show, by asking Dr. Tina Korownyk to help out with the evaluation of these studies. Unfortunately we quickly realise that the past 49 shows have, much to our chagrin, lacked any significant sex appeal.

Show Notes

1) Treatment of fever with acetaminophen, ibuprofen or both

BMJ 2008;337:a1302

Arch Pediatr Adolesc Med 2004;158:521-6

Lancet 1997;350:704-9

J Pediatr 1989;114:1045-8

2) Rotator cuff injections – do they need to go in the shoulder

BMJ 2009;338;a3112

3) Diabetes is NOT a CHD risk equivalent

Diabet Med 2009;26,142–8

4) Resistance/strength training for osteoarthritis

Arthritis Care Res 2008;59:1488–94

Episode 49: Becoming less anxious about anxiety disorders – Part II

In episode 49, we continue on from the previous anxiety ladened podcast, and cautiously delve into the whole area of treatment options for anxiety disorders. Mike and James do this by once again cautiously delving into the complex mind of our psychiatry colleague, Dr. Adil Virani. We end up with great advice but get no further insight into how men’s brains work – if in fact they do.

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