In episode 150, the last for 2011, Mike and James elicit the help of Laurie Mallery and Paige Moorhouse from Halifax. Laurie and Paige guide us through a step-by step approach to deal with frailty and end of life care. We also discuss their PATH (Palliative and Therapeutic Harmonization) clinic developed for older people in Nova Scotia with chronic health conditions.

Show notes

1) Respecting frailty

J Med Ethics 2010. doi:10.1136/jme.2010.040147

2) PATH – Palliative and Therapeutic Harmonization Clinic

pathclinic.ca

In episode 149, Mike and James finally get to the last of the questions and discuss the use of vinegar for weight loss, surrogate markers and what to do about them, steroids for migraine, niacinamide for acne, statins for women, and what is the meaning of life. We discuss, all of these issues in depth and believe it or not at the end of the podcast we actually figure out the meaning of life but accidentally erase that part. We’ll bring that issue up at a later date in a PREMIUM podcast.

Show notes

1) Vinegar for weight loss

Bioscience, Biotechnology, and Biochemistry 2010:73:1837–43

2) Steroids for acute migraines

Academic Emergency Medicine 2008;15:1223–33
BMJ 2008;336:1359–61

3) Statins in women

Circulation 2010;121:1069-77

In episode 148, Mike and James return to the town of Questionville and attempt to answer riddles from near and far. Despite Mike having a cold, we tackle long acting insulins, exercise, multivitamins and varenecline with near Herculean-like abilities but provide answers that are much more on the mere-mortal side.

Show notes

1) Long acting insulins

CADTH report  Long-Acting Insulin Analogues for the Treatment of Diabetes Mellitus

Diabetes Care 2009;32:32-37

Adv Ther 2009;26:535-51

Tools for Practice – The long and short of long acting insulin analogues (versus NPH)

Tools For Practice – Strategies for initiating insulin in Type 2 Diabetics:  What is the optimal regimen for initiating insulin in type 2 diabetes?

2) Activity

QoL stuff

Arch Intern Med 2009;169:269-278

Pedometers

Can Fam Physician 2010;56:887

Exercise Improves: Sleep, osteoarthritis pain, depression, obesity, glucose, lipids, BP

Cochrane 2002;CD003404

J Gerontol A Biol Sci Med Sci 2008;63:997-1004

J Sports Med Phys Fitness 2007;47:462-7

Cochrane 2008:CD004366

Cochrane 2008:CD004376

Inactivity a bigger risk than weight

J Am Geriatr Soc 2010;58:234–241

Activity and mortality

Arch Intern Med 2007;167:2453-2460

JAMA 2003;289:2379-2386

NEJM 2002;347:716-25

JAMA 1995;273:1093-8

Circulation 2008;117: 614-622

PLOS 2008;5: e12.

More activity, better

Br J Sports Med 2008;42:238–243

NEJM 1999;341:650-8

Eur J Epidemiol 2009;24:181–192

RCT of activity vs angioplasty

Circulation 2004;109:1371-8

3) Multivitamin Evidence

A & E harmful

Can Fam Physician 2005;51:1471-2

Tools for practice #10 

Multivitamins unnecessary(among first to be stopped in polypharmacy)

JAMA 2010;304:1592-1601

Vitamin B increases mortality

BMJ 2010;341:c6273

4) Vitamin D

Vitamin D problems

JAMA 2010;303:1815-1822

Rheumatology 2007;46:1852–1857

Regular dose reduces mortality

Cochrane:CD007470

Reduces falls

BMJ 2009;339:b3692 doi:10.1136/bmj.b3692

Cochrane:CD007146

For fractures (yes with Ca+, unsure otherwise)

Cochrane:CD000227

Re-evaluating the whole reference range

J Clin Endocrinol Metab 2011;96:53–58

5) Calcium evidence

Can Fam Physician 2011;57:798

6) Varenicline for smoking cessation

Cardiovascular events

CMAJ 2011;183:1359-66

Pharmacotherapy for smoking cessation

CFP 2011;57:47