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

In episode 177, Mike and James, both high as a kite on caffeine, discuss the health benefit evidence around coffee ingestion and also discus the evidence or lack thereof of the heath issues around the use of organic foods. At the end we come to the conclusion that ketchup is really the quintessential food and decide that it goes well with everything.

1) Association of Coffee Drinking with Total and Cause-Specific Mortality

Largest cohort N Engl J Med 2012;366:1891-1904

OTHER STUDIES

Ann Intern Med 2008;148:904-914

Eur J Epidemiol 2011 ;26:285-93

J Nutr 2010;140:1007-13

Br J Nutr 2008;99:1354-61

Diabetologia 2006;49:2618–2626

Diabetologia 2009;52:810–817

Arch Intern Med 1978;138:1472-5

Ann Epidemiol 1993;3:375-81

BMC Cancer 2011;11:96

Ann Oncol 2011;22:536-44

BJU Int 2010;106:762-9

Ann Oncol 2012;23:311-8 

J Natl Cancer Inst 2010;102:771–783 

J Epidemiol Community Health 2011;65:230-40

Am J Epidemiol 2011;174:993–1001 

Arch Intern Med 2000;160:3393-3400 

Arch Intern Med 2009;169:2053-2063

Arch Intern Med 2011;171:1571-1578

BMJ 2003 Feb 22;326:420

2) Are Organic Foods Safer or Healthier Than Conventional Alternatives?

Ann Intern Med 2012;157:348-66

3) TEC podcast survey link – PLEASE GIVE IT A GO

https://www.surveymonkey.com/s/MF7GRGM

In episode 176, we get back to a non-PREMIUM podcast and discuss the evidence around the venous thromboembolism risk associated with different types of hormonal contraception. In our ongoing desire to provide our podcast listeners with solid information both Mike and James started taking oral contraceptives a few years ago and they are glad to report that neither have developed any side effects (at least that they are willing to discuss) and, believe it or not, neither of them have become pregnant.

Show notes

1) What are the Venous Thromboembolism risks with varying Hormonal Contraception?

Tools for Practice

In episode 175, James and Mike discuss even more PREMIUM practice changing articles. We find out that pyelonephritis only needs 7 days of treatment and the new diabetes guidelines are finally changing to match the evidence – but you already heard the evidence on this from us when it first came out 2-3 years ago.

Show notes

1) 7 versus 14 days for pyelonephritis

Lancet 2012;380:484–90

2) New diabetes guidelines – finally a change

Diabetes Care 2012;35:1364-79

In episode 174, Mike and James discuss some PREMIUM practice changing articles around heart failure and salt and the quality of life associated with PSA screening. At the end we have a meal of chips, pickles, Big Macs, and salami to celebrate the completion of yet another PREMIUM podcast.

Show notes

1) Low sodium versus normal sodium diets 

Systolic heart failure

Heart 2012 doi:10.1136/heartjnl-2012-302337

Non-heart failure

Am J Hypertens 2011;24:843-53

2) Quality-of-life effects of prostate-specific antigen screening

N Engl J Med 2012;367:595-605

3) Furthering the prostate cancer screening debate (prostate cancer specific mortality and associated risks)

Can Urol Assoc J 2011;5:416–21

In episode 173, Mike and James welcome back Karim Khan to the podcast for a second time to continue the discussion about a variety of sports injuries. This time we focus more on chronic injuries like plantar fasciitis, shin splints and tennis elbow.

Show notes

Coming soon

In episode 172, Mike and James welcome Karim Khan a sports physician to the podcast, and a marathon discussion about a variety of sports injuries and treatments ensues. We sprint towards discussions of patellofemoral syndrome, ankle sprains, stretching, ice, and NSAIDs and collapse at the finish line 45 minutes later.

Show notes – to folllow

In episode 171, we finally finish answering, or at least trying to, listener questions. We talk about growth hormone, tramadol, and cardiovascular risk and then realize it is all for naught as we also find out that most published research findings are false. That being the case we go back and erase the previous 170 podcasts.

Show notes

1) Oral growth hormone secretagogue

J Clin Endocrinol Metab 2009;94:1198-206

2) Tramadol for osteoarthritis

Cochrane review CD005522

3) Why most published research findings are false

PLoS Med 2005 

In episode 170, James and Mike continue their quest to answer the questions of the universe but fail and barely give answers to the podcast listener enquiries. We talk about thiazides and potassium, constipation, hazard a definition of hazard ratios and as always rant and rave about the lipid hypothesis or lack thereof.

Show notes

NONE