In episode 139, James and Mike and Tina Korowynk talk about the available evidence for therapies for irritable bowel syndrome and our good friend and colleague Mike Kolber drops in for a few minutes at the end “runs through” the reality of the situation. We then talk about the recent publication of the largest trial of Cold-FX and find that what wasn’t shown to be statistically different is at least if not more important than what was shown to be statistically different.

Show notes

1) IBS evidence

Cochrane Library

2) The latest Cold-FX trial

Influenza Research and Treatment Volume 2011, Article ID 759051

In episode 138, MIke and James celebrate their triumphant return from New Zealand by inviting Tina Korownyk to help explain the risks associated with CT scans and other forms of radiation. In addition, we ask her to help Mike with his fear of airport scanners and find out that just because a full body search feels good that doesn’t make it right.

Show notes

1) Tools for practice

CT scans and other forms of low-dose ionizing radiation – What is the risk of cancer?

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In episode 137, James and Mike welcome Mark McConnell back to podcast land to discuss the latest change in diabetes management guidelines. Mark leads us through a great discussion about how the VA has decided to do a bit of an about face, and incorporate not only evidence but also patient values and preferences into their most recent glucose control guidelines. At the end we all agree that an A1C measurement, no matter if it is 7, 8, or 9, is just a number and is not the ultimate endpoint for proper diabetes care.

Show notes

1) VA-DoD Update of Diabetes Guidelines

2) Glycemic control in type 2 diabetes: time for an evidence-based about-face?

Ann Intern Med. 2009 Jun 2;150(11):803-8. Epub 2009 Apr 20

3) The ACCORD Trial and control of blood glucose level in Type 2 diabetes mellitus

Arch Intern Med 2009;169:150-4

In episode 136, James and Mike once again raise the content bar level with the premium of all PREMIUM podcasts. We talk about a study that looked at the effect of ezetimibe plus simvastatin and we get a very clear answer but unfortunately the question that was asked was completely wrong. We then bring the podcast to a rising never ending crescendo by discussing a “pivotal” trial comparing psyllium to prunes in chronic constipation and low and behold the answer is extremely useful and relevant to day-to-day practice. 

Shownotes

1) SHARP TRIAL

Lancet 2011;377:2181-92

2) The PRUNE trial

Aliment Pharmacol Ther 2011;33:822–8

3) An Evidence-Based Approach to the Management of Chronic Constipation in North America

Am J Gastroenterol 2005;100 Suppl 1:S5-S21

In episode 135, Mike and James and Adil finally get to the end of their antipsychotic tetralogy as they tackle the especially difficult issue of the use of antipsychotics in the elderly. The problem is non-pharmacological treatments do very little, and one is left with having to decide whether or not to use drugs. We discuss the evidence of effectiveness (or lack thereof) of these drugs and the very real potential for harm. At the end, Adil makes both Mike and James agitated and he sedates them with a high dose of a very fine cognac. 

Show notes

1) Non-pharmacological interventions

Aging Ment Health 2009;13:512-20

2) Use of antipsychotics for psychosis of dementia

Int J Geriatr Psychiatry 2007;22:475-84

Psychother Psychosom 2007;76:213-8

Cochrane Database Syst Rev. 2006 Jan 25;(1):CD003476. 

3) Adverse effects of the antipsychotics

JAMA 2005;294:1934-43

NEJM 2005;353:2335-41

Ann Intern Med 2007;146:775-86

4) DART-AD study – effect of stopping antipsychotics

Lancet Neurol 2009;8:151–7

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

5) Tools for practice

What are the Risks and Benefits of Stopping Antipsychotics in the Elderly?

In episode 134, we get into the nitty gritty of choosing a second drug for schizophrenia if the first one doesn’t work or is not tolerated. In general, it appears there is some evidence to favour clozapine over other agents but the difference isn’t great and as with virtually all of medicine one has to intermingle the available evidence with a good dose of art to make a beautiful therapeutic picture.   

Show notes

1) CATIE

N Engl J Med 2005;353:1209–23

2) CUtLASS 1

Arch Gen Psychiatry 2006;63:1079–87

3) A meta-analysis of the efficacy of second-generation antipsychotics 

Arch Gen Psychiatry 2003;60:553-64

2) Clozapine versus other atypical antipsychotics for schizophrenia

Cochrane library

3)Clozapine versus typical neuroleptic medication for schizophrenia

Cochrane library

4) CATIE – clozapine versus other agents who do not respond to prior atypical antipsychotic treatment 

Am J Psychiatry 2006;163:600–10

In episode 133, Mike and James again welcome Adil Virani to help us along with our antipsychotic drug discussion. We discuss the differences between the first and second generation antipsychotics, how to start, and when to consider a depot preparation. At the end of the podcast James realises that he has basically been hearing voices for the entire podcast but was reassured to find out the voices were actually Mike and Adil’s and that in general, they were telling the truth. 

Show notes

1) CATIE

N Engl J Med 2005;353:1209–23

2) CUtLASS 1

Arch Gen Psychiatry 2006;63:1079–87

Schizophr Bull 2006;32:715–23

3) Haloperiodol vs risperidone

N Engl J Med 2002;346:16-22

In episode 132, Mike and James bring back their good friend and psych colleague Adil Virani, to help out in thinking about the use of antipsychotics. In part 1, we talk about schizophrenia in general and start to get into a discussion of the use of antipsychotics for this condition and how to decide what drugs to choose. However, at the end our thought process becomes a bit scattered and we decide to leave the discussion about the specific drugs to the next podcast.

Show notes

None

In episode 131, Mike and James have invited Denise Campbell-Scherer into the podcast world to help us discuss the issue of multimorbidity when it comes to guidelines and chronic medical conditions. We talk about how to think about this issue when it comes to research and practice and we very quickly realise it is tricky and it demands that clinicians need to realise that guidelines are system-based and not patient specific focussed. At the end we decide that we need to take care of patients and not disease states.

Show notes

1) Multimorbidity: a challenge for evidence-based medicine

Evidence-Based Medicine 2010;15:165-6

2) The quality of life and time associated with treating chronic conditions

JAMA 2005;294:716-724

In episode 130, Mike and James run directly into the face of the evidence around exercise and really sweat out the weightiness of the results. We actively find out that it’s primarily all about quality of life, and that Mike bikes and James rollerblades to keep themselves as close to perfect physical specimens as possible. At the end we find out they also both take medications for delusions of grandeur.

Show notes

1) Activity-related benefits

Cochrane 2002;(4):CD003404

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

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

Cochrane 2008 Oct 8;(4):CD004366

Cochrane 2008 Oct 8;(4):CD004376

Arch Intern Med 2007;167:2453-60

JAMA 2003;289:2379-86

NEJM 2002; 347 (10): 716-25

JAMA 1995; 273 (14): 1093-8

Circulation 2008;117: 614-22

PLOS 2008; 5(1): e12

2) Quality of life and dose response

Arch Intern Med 2009;169:269-78

Circulation 2010;122:743-752

Br J Sports Med 2008;42:238–43

NEJM 1999;341:650-8

Eur J Epidemiol 2009;24:181–192

3) Exercise for overall benefit not on surrogate markers

J Appl Physiol 2008;105:766–8

4) RCT evidence on exercise

Circulation 2004;109:1371-8

Am J Med 2004;116:682–92

5) Motivating patients

JAMA 2007;298:2296-304

Res Q Exerc Sport 2009;80:648-55

Int J Behav Nutr Phys Act 2008;5:44

Diabetes Care 2009;32:1404-10

Arch Intern Med 2007;167:2453-60

JAMA 1995;273:1093-8

Ann Fam Med 2008;6:69-77

Am J Public Health 1998;88:288-91