In episode 117, Mike and James delve into the first of a few podcasts on options for atrial fibrillation. In this first podcast they look at ways to assess risks and talk at length about a web-based tool that makes the process as easy as possible. The process is so easy that the hearts of both Mike and James start to flutter yet only one of them decides to take warfarin. You decide whom that is.

Show notes

1) Risk calculators for atrial fibrillation

The best/easiest way to present information about the risks associated with atrial fibrillation and the benefits and harms of therapy – from peterloewen.com

SPARC – Stroke Prevention in Atrial Fibrillation Risk Calculator

Other Afib calculators

md+calc

QxMD

2) Some useful Afib numbers

In episode 116, James and Mike take a re-look, with some new evidence, at the use of antibiotics for acute otitis media in children and come to the conclusion that antibiotics do have an effect and produce side effects. They both agree that if the child is really sick you may as well give antibiotics and if they aren’t really sick then you can wait. At the end of the podcast Mike agrees that this information doesn’t in anyway change what he already was doing. But at least he is now supported by 2 articles in the New England Journal of Medicine – which makes everything feel so much better.

Show notes

1) Two new otitis media trials

N Engl J Med 2011;364:116-26

N Engl J Med 2011;364:105-15

2) Systematic review of otitis media treatment

JAMA 2010;304:2161-9

In episode 115, Mike and James, in yet another stellar PREMIUM performance, provide the listening audience with the definitive answer on the cardiovascular risks associated with the NSAIDs. They then bring in a guest (Winnie-the-Pooh) to discuss in a sweet fashion whether or not there are any benefits from using honey for cough in children. At the end we are unable to recommend or not recommend honey, and so uncharacteristically Winnie-the Pooh bites both James and Mike and they end up on NSAIDs for the pain. 

Show notes

1) Cardiovascular safety of NSAIDs – or lack thereof

BMJ 2011; 342:c7086 doi: 10.1136/bmj.c7086

2) Acetaminophen/paracetamol

Causes liver damage and is “bad”

BMJ 2010; 341:c6764 doi: 10.1136/bmj.c6764

Hang-on, is it really bad or is it really safe? – and just how do you define narrow therapeutic ratio?

BMJ 2011; 2011; 342:d625 doi: 10.1136/bmj.d625 

“Other than citing a narrow therapeutic index, defined by the FDA as exceeding the daily 4,000 mg recommended maximum dose, between the therapeutic and toxic doses of acetaminophen, the FDA did not present any evidence upon which to validate their recommendation to reduce the daily dose from 4,000 to 3,250 mg”

Clin Toxicol 2009;47:784-9

2) Honey and cough in children 

J Alt Compl  Med 2010;16:787-93

In episode 114, James and Mike finally bring some topical information to the TEC podcast listeners by reviewing the available evidence for topical NSAIDs. We find out that they do work and that they should be considered a useful tool in your “how should I treat pain” armamentarium. Mike and James at the end of the podcast make a resolution to send all our PREMIUM podcast subscribers – if you aren’t one yet get on with it – a vat of a generic topical NSAID to help them with the intermittent pain associated with listening to the podcasts.

Show notes 

1) Tools for Practice – Topical NSAIDs: Do they top Placebo or Oral NSAIDs?

2) Evidence for topical NSAIDs

Cochrane Library Review – CD007402

BMJ 2004;329:324.doi:10.1136/bmj.38159.639028.7C 

BMC Musculoskeletal Disorders 2004 5:28 doi:10.1186/1471-2474-5-28.

J Rheumatol 2006;33:1841–4

Bandolier, 2003 April

Pain Medicine 2010;11:535–49

BMJ 2008;336:502-3. doi:10.1136/bmj.39490.608009.

NICE OA Guideline