In episode 606, Jamie and James go over the best available evidence we have for the medications used in overactive bladder, with a focus on a newer agent mirabegron. We end up having to discuss the exciting topics of number of voids and dry mouth and at the end we give you all the numbers you need to have an evidence-based conversation with your patients.

Show Notes
1) Tools For Practice
Avoiding the void? Mirabegron for overactive bladder

2) PEIP Conference Edmonton October 17-18, 2025

In episode 605, James and Jamie get Emelie Braschi to answer a simple and common clinical question. ASA versus direct oral anticoagulants – which one is safer with regard to bleeding? As always it comes down to the numbers and we go over all those numbers and put them into the overall benefit and harm ratio for Afib.

Show Notes
1) Tools For Practice
An ASA a day keeps the Afib at bay?

2) SparcTool – Stroke Prevention in Atrial Fibrillation Risk Tool

3) PEIP Conference Edmonton October 17-18, 2025

In episode 604, James and Mike K get Jennifer Young to tackle the topic of nose bleeds and what the evidence shows around the use of topical tranexamic acid and how it compares to other treatments. We go over all the endpoints and give you all the numbers.

Show Notes
1) Tools For Practice
Stop the Drip: Tranexamic Acid Solution for Nosebleeds

2) PEIP Conference Edmonton October 17-18, 2025

In episode 603, James and Mike K invite Jennifer Young back to the podcast to talk about the best available evidence for topical minoxidil and hair growth. We discuss outcomes such as the numbers of hairs per squared centimeter – the main outcome reported – but when available, we also other report on other outcomes and also the side effects. So, if you want to know about numbers of hair per squared centimeter and all the other numbers, tune in.

Show Notes
1) Tools For Practice
Topical minoxidil for androgenetic alopecia: When blood pressure agents make you hairy
2) PEIP Conference Edmonton October 17-18, 2025

In episode 602, James and Mike Kolber go over the best available evidence for the benefits and the harms for one of the most commonly used classes of medications – proton pump inhibitors. We find out the benefit numbers are much larger than the harm numbers. Check out the podcast to get all the numbers you need to help people make decisions.

Show Notes
1) Tools For Practice
Side effects of long-term PPI use: Leaving a bad taste in your mouth?
Proton Pump Inhibitors (PPIs): Is Perpetual Prescribing Inevitable?

2) PEIP Conference Edmonton October 17-18, 2025

3) SPARCTool

4) RX files PPI
Stopping your Proton Pump Inhibitor or “PPI”

THE CASE
Dr Ashville is training to be a family physician and gets a phone call from a disgruntled patient called Jane Brown. She got a message saying “As your Cardiovascular risk is now 10% it is recommended you take a statin medication”. She is a bit cross she didn’t get a proper conversation about a new prescription but her main question is…”How likely am I to actually benefit from this treatment? Is it really worth it?” Dr Ashville realises they have been “following a protocol” and is not exactly sure how to answer and decides to talk the issue over with the clinician supervising their medical education.

Show Notes

1) A Primer on Statistics
Doing statistics can be difficult but understanding them can be fairly simple

2) GP Evidence – great evidence synopsis site

3) PEER Evidence – relevant evidence for family physicians and other primary care providers

In episode 601, James and Mike invite Jennifer Young back to the podcast to go over all the evidence we have for pregabalin and gabapentin in patients with fibromyalgia. During the discussion we find out how many people actually get a ≥30% reduction in pain compared to placebo. We even look at some information about different doses. All the numbers are revealed by the end of the podcast – and we give tips and suggestions throughout. Check it out.

Show Notes
1) Tools For Practice
Pharm for Fibro, Round 2: Can gabapentinoids ease the pain?

2) MEME Conference 2025 in Vancouver – May 9/10, 2025

In episode 600, James and Mike invite Jamie Falk back to the podcast again and we talk about if exercise helps movement in Parkinson’s disease. You might be surprised by the size of the effect so have a listen and get all the evidence and numbers you need.

Show Notes
Tools For Practice
Exercise for Parkinson’s Disease: More movement = Better movement?

MEME Conference 2025 In Vancouver – May 9/10, 2025

In episode 69, the “Two Mikes” are back at it and they use their mics to dispense some really great prescriptive advice for patients with asthma and no heart burn pain and backs and knees which do have pain. James sits back and goes along for the ride but develops back and knee pain by the end, and the Mikes recommend a full body CT scan.

Show Notes

1) In patients with uncontrolled asthma and no GERD, the use of a PPI does not improve asthma symptoms

N Engl J Med 2009;360:1487-99

2) The use of PPIs and other GERD treatment in patients with asthma and acid-reflux symptoms shows no benefit in asthma symptoms

Chest 2005;128:1128–35

Cochrane Review 2003, No.: CD001496

2) Lumbar imaging for low-back pain without indications of serious underlying conditions does not improve clinical outcomes

Lancet 2009;373:463–72

3) Incidental meniscal findings on MRI of the knee are common in the general population and increase with increasing age

N Engl J Med 2008;359:1108-15

4) Arthroscopic surgery for osteoarthritis of the knee – no benefit

N Engl J Med 2002;347:81-8

In episode 68, we get to the “heart of the matter” of stroke prevention for atrial fibrillation. We find out from Peter Loewen, that it is all a numbers game, and he gives us the tools to deal with this issue. We talk about warfarin and ASA and clopidogrel with respect to their benefits and harms. At the end of the podcast Peter tells us about dabigatran, which obviates all the messages we provide in this podcast. Mike develops an intracranial bleed during the podcast, Peter and James act concerned but continue on because that is what Mike would have wanted.

Show Notes

1) Estimating the risk of strokes in a patient with atrial fibrillation

CHADS2 score

JAMA 2001;285:2864-70

A useful electronic resource from peterloewen.com

Web-based calculator

2) Warfarin versus ASA in atrial fibrillation patients > 75 yrs old

Lancet 2007;370:493–503

3) Clopidogrel and atrial fibrillation

ACTIVE W

Clopidogrel plus ASA versus warfarin (in patients suitable for warfarin)

Lancet 2006;367:1903-12

ACTIVE A

ASA plus clopidogrel vs ASA (in patients not suitable for warfarin)

NEJM 2009;360:2066-78

4) Vitamin K supplementation for labile INRs

Blood 2007;109:2419-23

5) Brief stops in warfarin – what do you do?

Cohort studies (no RCT yet, will get when BRIDGE finished)

Arch Intern Med 2008;168:63-9

Mayo Clin Proc 2008;83:639-45

6) Dabigatran versus warfarin for stroke prevention in atrial fibrillation

RE-LY

N Engl J Med 2009;361:1139-51