In episode 169, Mike and James get back to listener questions. Our listeners lead us down the garden path and we end up talking about bladder irritants, riboflavin for migraine prophylaxis, placebo, and as always low doses. Mike rebels by taking a high dose of obecalp which leads to some very strange side effects.

Show notes

1) Is caffeine a bladder irritant?

Urol Ann 2011:3:14-8

JAMA 2004;291:986

2) Riboflavin in migraine prophylaxis

Neurology 1998;50:466-70

Headache 2004;44:885-90

Cephalgia 2010;30:1426-34

J Child Neurol 2008;23:1300-4

3) Tools for practice

Are antihypertensive medications effective for migraine prophylaxis?

Antidepressants for preventing headaches: Which work and how well?

4) Placebo effect 

Cochrane library CD003974 

5) Low dose

CMAJ 2011;183:65–9

In episode 168, Mike and James welcome back the returning Bruce Arroll who helps us out with the painful issue of how to diagnosis, treat and prevent gout. We crystallize the evidence and stick a needle into the beliefs about diet and colchicine dose. At the end we all go out to celebrate and drink milk and wine because neither are associated with developing gout.

Show notes

1) A Diagnostic Rule for Acute Gouty Arthritis in Primary Care Without Joint Fluid Analysis

Arch Int Med 2010;170:1120-6

2) Tools For Practice

Is colchicine an effective alternative to NSAIDs for the treatment of acute gout?

3) Moderate intake of purine-rich vegetables or protein is not associated with an increased risk of gout

N Engl J Med 2004;350:1093-103

4) Febuxostat vs allopurinol

N Engl J Med 2005; 353:2450-2461

In episode 167, we welcome back Bruce Arroll who, as he commonly does, helps us talk about common conditions and in this case it is the common cold. We discuss common diagnoses, common treatments and uncommonly, we pretty much agree with everything he has to say about this common ailment. 

Show notes

1) Intranasal zinc for the common cold

J Prim Health Care 2009;1:134-9

2) Phenylpropanolamine and stroke

N Engl J Med 2000;343:1826-32

3) Rapid response – letter BMJ on rebound from nasal decongestants

http://www.bmj.com/rapid-response

In episode 166, James and Mike battle the issue of low dose statins, high dose statins and also traffic noise to try to figure if we should consider high doses of statins. We discover that bigger is better but that a lot bigger ends up being just a little bit better.

Show notes

1) Tools For Practice

How does high dose statin compare to low dose in people with heart disease?

In episode 165, Mike and James talk about how should we diagnose type 2 diabetes and should we use A1c, FPG or OGTT or a magic crystal ball. At the end we come to the conclusion that you need to realize the vagueness of the diagnosis so you can be specific in your recommendations.

Show notes

1) Tools For Practice

Hemoglobin A1c for the diagnosis of Type II Diabetes

2) ESRD and Blindness risk

Ann Intern Med 1997;127:788-95

In episode 164, Mike and James finally get to another PREMIUM episode and boy is it ever premium. We discuss the latest HDL raising drugs, ASA after a DVT, and a new meta-analysis of metformin. With our usual skill, alacrity and boyish charm we give all our premium listeners their monies worth with practice changing evidence.

Show notes

1) Dalcetrapib (HDL raising) study stopped due to no benefit

Roche news release 

2) Genetic HDL  – no reduction in heart disease

Lancet doi:10.1016/S0140-6736(12)60312-2

3) WARFASA – Aspirin for Preventing the Recurrence of Venous Thromboembolism

N Engl J Med 2012;366:1959-67

4) A new metformin meta-analysis  – is it good or bad?

PLoS Med 9(4): e1001204. doi:10.1371/journal.pmed.1001204

In episode 163, Mike and James race to the end of their in-depth look at critical appraisal and as they get to the end their final kick is at some of the problems seen with meta-analyses. We discuss examples of how meta-analyses sometime go wrong and we do our best to make them right – with varying degrees of success.

Show notes

1) Glucose lowering meta-analysis

Ann Intern Med 2009;151:394-403

2) Beta-blocker meta-analysis

Lancet 2005;366:1545–53

3) PSA screening

BMJ 2010;341:c4543 doi:10.1136/bmj.c4543

3) Statin meta-analyses on mortality effect in primary prevention 

BMJ 2009;338:b2376

RR 0.88 (0.81-0.96) 

Arch Intern Med 2010;170:1024-31

RR 0.91 (0.83-1.01)

Arch Intern Med 2005;165:725-30

RR 0.86 (0.76 -0.99) 

Arch Intern Med 2006;166:2307-13

RR 0.92 (0.84-1.01) 

J Am Coll Cardiol 2008;52:1769-81

RR 0.93 (0.87-0.99)

4) Back pain meta-analysis

Cochrane CD000335

In episode 162, Mike and James decide to tackle the whole concept of meta-analyses and try their very best to shine a clear light on this important concept. By the end they have brought up so many different valuable points that they decide to add them all together to make their own misleading and deceptive meta-analysis.

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In episode 161, James and Mike finally get to the end of a very long series about how do a quick critical appraisal of an RCT. We talk about evaluating the harms found in the study and then discuss how to put the findings into context for an individual patient. At the end we conclude that the only well done and important studies to ever be published are the ones we have done and we leave it at that.

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In episode 160, Mike and James continue to tackle the issue of critical appraisal head on with an even more common-sense approach than the last episode. We talk about ignoring much of the text in the study, how to look at baseline characteristics and how to decipher the information provided in the outcomes table.

Show notes

The ACCORD study

N Engl J Med 2008; 358:2545-59