In episode 181, James and the two Mikes (Alan and Kolber) discuss two new drugs – one for constipation (prucolapride) and one for gout (feboxustat). We conclude that despite the fact there are studies for both of these drugs published in the New England Journal of Medicine, they really are not ready for primetime.
Show notes
1) Prucolapride

In episode 180, Mike and James invite Mike Kolber back to go over the three major trials that have compared warfarin to the new oral anticoagulants. We try, with limited success, to put all the science into perspective. At the end of the podcast, against all odds, we each have a stroke and a major bleed at the same time which dampens our recommendations.

Show notes

1) Tools for Practice

Novel Oral Anti-coagulants (NOACs): is newer better? 

2) peterloewen.com for stroke risk and benefit calculator 

In episode 179, we again ask Tina Korownyk to join us to help with the topic of screening for lung cancer. We review the most recent study that looked at the risks and benefits of screening high-risk individuals (smoking history of at least 30 pack-years) with low dose CT. At the end we come up with the shocking conclusion that we need to discuss the benefits and risks with patients and that smoking cessation should be a priority.

Show notes

1) RCTs of low dose CT for lung cancer screening

NEJM 2011;365:395-409

ACP Journal Club. 2011;155:JC5-6

Am J Respir Crit Care Med 2009;180:445-453

2) Other useful info

Thorax 2012;67:296-301

Cochrane Database Syst Rev 2004:CD001991

Radiology 2005;235:259-65

Annals of Internal Medicine 2011;155:137-44

JAMA 2012;307:2418-2429

International Journal of Cancer 2007;120:868-74

http://www.lung.org/lung-disease/lung-cancer/lung-cancer-screening-guidelines/lung-cancer-screening.pdf

J Thorac Cardiovasc Surg 2012;144:33-8

JAMA 2005;294:1505-1510

In episode 178, Mike and James invite Tina Korownyk to discuss the evidence around antibiotic choice for respiratory infections. We discuss issues surrounding the choice of treatment for CAP and upper respiratory infections in a very atypical way by suggesting that covering for atypicals may not be necessary. As we typically do we digress at the end and inappropriately recommend amoxicillin for hypertension and erectile dysfunction.

Show notes

1) Systematic review of community acquired pneumonia

BMJ 2005;330:456–60

2) Hospitalized community acquired pneumonia broad versus narrow spectrum

Cochrane Library CD004418

Arch Intern Med 2005;165:1992–2000

3) Choice of antibiotic for CAP

“Currently available evidence from RCTs is insufficient to make evidence-based recommendations for the choice of antibiotic to be used for the treatment of CAP in ambulatory patients”

Cochrane CD002109

4) Duration of treatment for CAP

“The evidence of this review suggests that a short course (three days) of antibiotic therapy is as effective as a longer treatment (five days) for non-severe CAP in children under five years of age. However, there is a need for more well-designed RCTs to support our review findings”

Cochrane CD 005976

5) Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo- controlled study

Lancet 2007;369:482–490

6) 1st-line versus 2nd line antibiotics for acute exacerbation of chronic bronchitis

Chest 2007;132:447-55

7) Amoxicillin versus amoxicillin/clavulanate in AECOPD

Int J Chron Obstruct Pulmon Dis. 2009;4:45-53. 

8) Sinusitis

Pediatrics 1986;77:795–800

Pediatrics 2001;107:619–258. Canadian Bacterial Surveillance Network

http://microbiology.mtsinai.on.ca/research/cbsn/default.asp