In episode 468, Mike and James start on a multi-podcast rant and talk about how misinterpretation and misdirection can lead us all down rabbit holes in many ways, not just in medicine.

In episode 467, Mike and James finish off talking with Jamie Falk about COPD/inhalers. We go over the some of the latest trials for the triple therapies and then wrap up all the evidence into a nice package and put a bow on it.

At the end we finally get to the issue of eosinophils and let you know if you need to know this number.

Show notes 

1) COPD handout + eosinophil stuff

In episode 466, Mike and James continue talking with Jamie Falk about everything COPD/inhalers. We go over the evidence for the steroid component of inhalers and then we start going over the triple therapies. But all Mike really wants to talk about are eosinophils – but that is PART III.

Show notes 

1) COPD handout

In episode 465, Mike and James invite Jamie Falk to go over all the data we have for the plethora of inhalers and COPD. We start with what we know about single puffers, how we decide whom to treat, and then when to try dual inhalers.

Show notes 

1) COPD handout

2) Should the number of acute exacerbations in the previous year be used to guide treatments in COPD?

European Respiratory Journal 2020; DOI: 10.1183/13993003.02122-2020

In episode 464, Mike and James and talk about 4 recent publications that should likely impact you practice if not today, then tomorrow. We talk about how long to give narcotics for acute MSK injuries, how to treat dyslipidemias, a non-steroid cream for psoriasis and a single dose of antibiotics for operative vaginal delivery.

Show notes 

1) Predictors of Prolonged Opioid Use After Initial Prescription for Acute Musculoskeletal Injuries in Adults: A Systematic Review and Meta-analysis of Observational Studies

Ann Intern Med. doi:10.7326/M19-3600

2) Management of Dyslipidemia for Cardiovascular Disease Risk Reduction: Synopsis of the 2020 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline

Ann Intern Med. doi:10.7326/M20-4648

3) Trial of Roflumilast Cream for Chronic Plaque Psoriasis

N Engl J Med 2020;383:229-39

4) Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial

Lancet 2019;393:2395

In episode 463, James and Mike talk about the latest reports of the results of the 2 COVID-19 vaccine trials. We give you all the numbers you need to know and maybe more importantly we discuss the nuances around industry bias, the approval process and general thoughts around vaccines in these crazy times.

Show notes 

The number for the COVID-19 vaccine so far

In episode 462, James and Mike invite Scott Garrison to talk about some important nuances around guideline recommendations and how low we should lower systolic blood pressure. We look in detail at the SPRINT trial and then come up with a reasonable (in our minds) approach to what thresholds we should use.

Show notes 

BEDMED

Website

pragmatictrials.ca

e-mail

pragmatictrials@ualberta.ca

REFERENCES
U-Shaped Mortality Curves for Systolic BP

1) Clarify Registry

Vidal-Petiot E, Ford I, Greenlaw N, et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet. 2016;388(10056):2142-2152.

2) ONTARGET and TRANSCEND Trials

Bohm M, Schumacher H, Teo KK, et al. Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. Lancet. 2017;389(10085):2226-2237.

3) Chinese Longitudinal Healthy Longevity Study

Lv YB, Gao X, Yin ZX, et al. Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study. BMJ. 2018;361:k2158.

4) Blood Pressure Trajectories in the 20 Years Before Death

Delgado J, Bowman K, Ble A, et al. Blood Pressure Trajectories in the 20 Years Before Death. JAMA Intern Med. 2018;178(1):93-99.

5) MDRD Trial

Lazarus JM, Bourgoignie JJ, Buckalew VM, et al. Achievement and safety of a low blood pressure goal in chronic renal disease. The Modification of Diet in Renal Disease Study Group. Hypertension. 1997;29(2):641-650

7) ACCORD Trial

Group AS, Cushman WC, Evans GW, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575-1585.

7) SPRINT Main Findings

Group SR, Wright JT, Jr., Williamson JD, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103-2116.

8) SPRINT Ambulatory BP Sub-study

Drawz PE, Pajewski NM, Bates JT, et al. Effect of Intensive Versus Standard Clinic-Based Hypertension Management on Ambulatory Blood Pressure: Results From the SPRINT (Systolic Blood Pressure Intervention Trial) Ambulatory Blood Pressure Study. Hypertension. 2017;69(1):42-50.

9) Concern over SPRINT BP Measurement Technique

Agarwal R. Implications of Blood Pressure Measurement Technique for Implementation of Systolic Blood Pressure Intervention Trial (SPRINT). J Am Heart Assoc. 2017;6(2)

Kjeldsen SE, Mancia G. Unobserved automated office blood pressure measurement in the Systolic Blood Pressure Intervention Trial (SPRINT): systolic blood pressure treatment target remains below 140 mmHg. Eur Heart J Cardiovasc Pharmacother. 2016;2(2):79-80.

10) Comparison of Unobserved Automated Office BP and Ambulatory BP

Seidlerova J, Gelzinsky J, Materankova M, Ceral J, Konig P, Filipovsky J. In the aftermath of SPRINT: further comparison of unattended automated office blood pressure measurement and 24-hour blood pressure monitoring. Blood Press. 2018;27(5):256-261.

Kjeldsen SE, Mancia G. Unattended automated office vs. ambulatory blood pressure in people with high cardiovascular risk: implications for understanding the SPRINT results. J Hypertens. 2019;37(1):6-8.

11) Unattended and Attended SPRINT BP Readings Not Different

Johnson KC, Whelton PK, Cushman WC, et al. Blood Pressure Measurement in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension. 2018;71(5):848-857.

12) Comparison Between SPRINT BP and Primary Care Office BP

Drawz PE, Agarwal A, Dwyer JP, et al. Concordance Between Blood Pressure in the Systolic Blood Pressure Intervention Trial and in Routine Clinical Practice. JAMA Intern Med. 2020.

In episode 461, James and Mike invite Tina Korownyk to talk about the important question of whether or not virtual visits are as good as face-to-face when it comes to diagnosing undifferentiated presentations.

Show notes 

Tools for Practice

Virtual visits versus face-to-face: Diagnostic accuracy in primary care

In episode 460, James and Mike invite Mike Kolber back again to answer the question does advising patients to abstain from alcohol reduce atrial fibrillation recurrence. The results may surprise you!

Show notes 

Tools for Practice

Be still my quivering heart: alcohol and atrial fibrillation

In episode 459, James and Mike invite Mike Kolber to talk about whether or not the increased rate of colorectal cancer in people under 50 means we should be screening earlier. We talk about all the numbers and put the risk into the context of the absolute numbers.

Show notes 

1) Tools for Practice

Is 45 really the new 50 in colorectal cancer screening?

2) Canadian task force on preventive health care – colorectal cancer 2016