In episode 110, in this final episode of the year James and Mike attempt to answer even more questions. They discuss the benefits and harms of using atypical antipsychotics in the elderly and decide that ‘microdoses’ is the correct answer. They get into a heated debate on the issue of the interaction with PPIs and clopidogrel and at the end both agree on the answer which is “Yes, but only on a Tuesday”. We finish off with a rousing discussion on the grapefruit/felodipine interaction and realise that neither of us like grapefruit so who cares. We both wish you and your family a Happy Holidays.

Show notes

1) Data on benefit

Psychother Psychosom 2007;76:213-8

Cochrane Library 2006:CD003476

2) Data on harm

Atypical meta-analysis (of trials not designed to assess harm)

JAMA 2005;294:1934-43

Cohort of conventional vs atypical

NEJM 2005;353:2335-41

CMAJ 2007;176:627-32

3) Actual RCT to assess risk benefit of withdrawal of antipsychotics

Lancet Neurol 2009;8:151–57

PLoS Med 5(4): e76.doi:10.1371/journal.pmed.0050076

4) One page summary of risks/benefits of anti-psychotics:

See Tools for Practice Website: http://www.acfp.ca/tfp_original.php

Specific reference: http://www.acfp.ca/docs10/Antipsychotics%20in%20Elderly%20_2_.pdf

In episode 109, Mike and James continue on with listener questions and start off trying to reduce the risk of using risk assessment tools and risk reduction information. They then delve into questions about tapering steroids, antidepressants, side effects from thiazides and sitagliptin and the amazing clarity of their answers is only outdone by the vagueness of their conclusions.

Show notes

1) Prediction with Framingham versus the real risk primary care patients

Heart 2009;95:125–9

2) Relative risk reduction with statins in primary prevention

BMJ 2009;338:b2376

ACP J Club 2009;151:14

Lancet 2005;366:1267–78

Diabetes – Lancet 2008;371:117–25

3) Issues with Framingham/UKPDS risk assessments

4) Tapering corticosteroids

Am J Med 2009;1222:977-91

5) Incomplete publication of antidepressant studies leading to bias (publication bias)

NEJM 2008;358:252-60

BMJ 2003;326:1171-3

6) Meta-analysis of antidepressants

Ann Intern Med 2005;143:415-26

Ann Intern Med 2008;149:734-50

Lancet 2009;373:746–58

Tools for Practice Website

http://www.acfp.ca/docs09/SecondGenerationAntidepressantsToolsforPracticefinal.pdf

In episode 108, Mike and James get back to listener questions and discuss drugs in the same class and different classes, get nowhere on a discussion about how to extrapolate 5-year data to infinity and beyond, get a little smelly with fish oil data, and find out that the new low dose colchicine is also high price which also stinks. Finally we sort out a steroid and sore throat issue and at the end both James and Mike find all their answers difficult to swallow.

Show notes

1) Fish oil

Arch Intern Med 2005;165:725-30

Can Fam Phys 2006;52:734-40

BMJ 2006;332:752-760

2) Colchicine – exclusive rights and high costs

N Engl J Med 2010;362:2045-7

3) Sore throat and steroids

www.emergency-medicine.jwatch.org/cgi/content/full/2009/828/1

In episode 107, Mike, James and Bruce Arroll once again team-up and this time bring you a cornucopia of dermatolgical evidence and advice. By the end of the podcast, both Mike and James develop psychogenic itch and Bruce successfully treats them with Kenacomb.

Show notes

1) DermNet NZ – pictures of more rashes than you could possibly imagine

http://dermnet.org.nz

2) Erythromycin for Pityriasis rosea

J Am Acad Dermatol 2000;42:241-4

3) Community-acquired pneumonia – covering for the atypicals – is it really needed?

BMJ 2005;330:456 doi:10.1136/bmj.38334.591586.82

4) Chronic erythromcin for COPD

Am J Respir Crit Care Med 2008;178:1139-47

5) TMP/SMX for head lice

Pediatrics 2001;107:e30

6) Send in pictures of your rashes and find out what it is

http://www.telederm.org/

7) Recurrent eczema – liquid bleach

Pediatrics 2009;123:e 808-14

In episode 106, James and Mike welcome back our good friend and colleague from New Zealand, Bruce Arroll. Out of respect, we made sure there were no earthquakes during his visit because earthquakes, as we found out, can be somewhat depressing. On that note, Bruce brings us some very useful information about non-drug treatments for depression and towards the end Mike and James breath deeply, meditate, problem solve and then write about it in their gratitude diaries and lo-and-behold we finish the podcast feeling much better than when we started – always a good thing.

Show notes

Seeing patients weekly

BMJ 2001;323:1011

Exercise

Cochrane Library

Practice nurse phone call

Arch Fam Med 2000;9:700-8

Gratitude diaries

Am Psychologist 2005;60:5:410–421

Breathing

Int J Nurs Stud 2010;47:1346–1353

Meditation

www.calm.auckland.ac.nz

J Consult Clin Psychol 2008;76:966-78

Light therapy

Cochrane Library

Problem solving

BMJ 1995;310:441-5

Cognitive behavioural therapy

10 Minute Consultation By Lee David

J Affect Disord 1998;49:59-72