In episode 71, James starts off with a plea for a pledge and then the “Two Mikes” discuss the whole issue of what to do with the new evidence around PSA screening. We find out that if you believed in it before you’ll likely continue believing and if you didn’t believe in it you will still think that way – isn’t evidence wonderful? At the end James hopes you will continue to believe the podcast should continue.

Show Notes

1) Drop James an email at jmccorma@interchange.ubc.ca

2) The two latest studies on PSA screening

NEJM 2009;360:1310-19

NEJM 2009;360:1320-8

3) A useful PSA screening document

ICES 2002 – PSA physician reference document – a pdf

In episode 70, we continue with the “Two Mikes” and discuss a number of issues surrounding asthma treatment. We debate back and forth on the use of LABAs and their use alone or in combination and then come to complete agreement on the duration of prednisone for acute exacerbations. During the podcast James tries to steal the mic away and gets into trouble with Mike because Mike thought James was trying to steal Mike away from Mike.

Show Notes

1) LABAs in patients with asthma – risks and benefits

Cochrane 2008;4:CD006923

Cochrane 2008;3:CD006363

Cochrane 2009;2:CD006924

Cochrane 2009;3:CD006922

NEJM 2009;360:1592-95

2) Short course (3 days) of oral steroids for asthma exacerbations

Medical Journal of Australia 2008;189:306–10

3) Doubling the dose of inhaled corticosteroids provides no benefit but what about quadrupling the dose?

Lancet 2004;363:271-5

Thorax 2004;59:550–6

Am J Respir Crit Care Med 2009;180:598-602

In episode 69, the “Two Mikes” are back at it and they use their mics to dispense some really great prescriptive advice for patients with asthma and no heart burn pain and backs and knees which do have pain. James sits back and goes along for the ride but develops back and knee pain by the end, and the Mikes recommend a full body CT scan.

Show Notes

1) In patients with uncontrolled asthma and no GERD, the use of a PPI does not improve asthma symptoms

N Engl J Med 2009;360:1487-99

2) The use of PPIs and other GERD treatment in patients with asthma and acid-reflux symptoms shows no benefit in asthma symptoms

Chest 2005;128:1128–35

Cochrane Review 2003, No.: CD001496

2) Lumbar imaging for low-back pain without indications of serious underlying conditions does not improve clinical outcomes

Lancet 2009;373:463–72

3) Incidental meniscal findings on MRI of the knee are common in the general population and increase with increasing age

N Engl J Med 2008;359:1108-15

4) Arthroscopic surgery for osteoarthritis of the knee – no benefit

N Engl J Med 2002;347:81-8

In episode 68, we get to the “heart of the matter” of stroke prevention for atrial fibrillation. We find out from Peter Loewen, that it is all a numbers game, and he gives us the tools to deal with this issue. We talk about warfarin and ASA and clopidogrel with respect to their benefits and harms. At the end of the podcast Peter tells us about dabigatran, which obviates all the messages we provide in this podcast. Mike develops an intracranial bleed during the podcast, Peter and James act concerned but continue on because that is what Mike would have wanted.

Show Notes

1) Estimating the risk of strokes in a patient with atrial fibrillation

CHADS2 score

JAMA 2001;285:2864-70

A useful electronic resource from peterloewen.com

Web-based calculator

2) Warfarin versus ASA in atrial fibrillation patients > 75 yrs old

Lancet 2007;370:493–503

3) Clopidogrel and atrial fibrillation

ACTIVE W

Clopidogrel plus ASA versus warfarin (in patients suitable for warfarin)

Lancet 2006;367:1903-12

ACTIVE A

ASA plus clopidogrel vs ASA (in patients not suitable for warfarin)

NEJM 2009;360:2066-78

4) Vitamin K supplementation for labile INRs

Blood 2007;109:2419-23

5) Brief stops in warfarin – what do you do?

Cohort studies (no RCT yet, will get when BRIDGE finished)

Arch Intern Med 2008;168:63-9

Mayo Clin Proc 2008;83:639-45

6) Dabigatran versus warfarin for stroke prevention in atrial fibrillation

RE-LY

N Engl J Med 2009;361:1139-51