In episode 358, Mike and James in an agitated and demented way deal with the evidence around agitation in dementia. We find that the antipsychotics have an effect that might be noticeable in 1 in 10 people but if a person responds it likely had nothing to do with the medication. How agitating is that?
Show notes
In episode 357. Mike and James invite Adrienne to help us work through all the studies that have looked at using riboflavin to prevent migraines. Unfortunately, the impact of riboflavin on migraines is consistently inconsistent and most RCTs found no reduction in migraine frequency. At least we have evidence for low-dose propranolol and amitriptyline.
Show notes
Tools for Practice
Riboflavin for Migraine Prophylaxis: Something “2-B” excited about?
In episode 356, Mike and James welcome Jamal Ramji to the podcast because we really needed to do something PREMIUM. We discuss a study of subclinical hypothyroidism and a low FODMAP diet for IBS. At the end we figure out that TSH is a no, but that the low FODMAP is a yes at least for 1 in 5-10 people.
Show notes
1) Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism
2) A Randomized Controlled Trial Comparing the Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D
In episode 355, James and Mike finish delving into the issues around lab reporting and measurements. We finally get to some potential solutions (sort of) with how to deal with the variation seen around all lab values/measurements. We focus primarily by describing the variation around the top 20-30 lab tests because there is no way to get away from the inherent biologic variation seen with all these tests. Hopefully, if one appreciates the variation, one can use good clinical skills and judgment when it comes to interpreting lab tests. Or maybe the entire podcast series just makes your blood pressure up – which as we talk about in the podcast, BP changes are difficult to evaluate.
Show notes
In episode 354, James and Mike continue to delve into the issues around lab reporting and measurements. In this part, we talk about the variation seen with blood pressure measurements, glucose and Vitamin D as further examples of what clinicians need to be aware. Having this insight should give you more confidence to interpret lab values, or just frustrate the heck out of you. You decide.
Show notes
In episode 353, James and Mike continue to delve into the issues around lab reporting. In this part, we talk about the variation seen with every measurement. We talk about reference change values and what they mean for clinical practice. We use examples of bone density and cholesterol to explain some of the nuances and problems associated with test variance. The bottom line is that cholesterol and BMD measurements, with rare exception, are of no clinical value. Yikes!
Show notes
In episode 352, James and Mike start to delve into the issues around lab reporting and the numbers that are reported and what the numbers really mean. We talk about the highs and the lows and the variability associated with measurement and realize at the end that, while lab tests may have important variability, the quality of our podcasts never varies – which may or may not be a good thing.
Show notes
In episode 351, Mike and James welcome Danielle and Joey to the podcast and they go all PREMIUM on us. The new dynamic duo go over studies from 2 important areas – O2 for COPD and bariatric surgery for diabetes. At the end of the podcast we realize that Mike and James are superfluous when it comes to the podcast quality and usefulness – sad!
Show notes
1) O2 in COPD
A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation
Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial
2) Bariatric surgery for diabetes
Bariatric Surgery versus Intensive Medical Therapy for Diabetes – 5-Year Outcomes
In episode 350, Mike and James talk about the evidence around sleep restriction. The evidence is fairly solid and the results typically suggest an impact greater than sleeping pills with sleep restriction improving sleep for one in every two to six patients compared to sleep hygiene alone. At the end of the podcast, James realises that Mike presented the evidence while being fast asleep – showing that the concept of sleep restriction actually works.
Show notes
Tools For Practice
In episode 349, Mike and James talk about the evidence around screening otherwise asymptomatic adults with a complete blood count. While it feels like it should be a good thing to do, the evidence is pretty clear that it doesn’t provide any benefit even though ~ 10% of tests will be abnormal. Basically no one benefits and serious disease is virtually never found.
Show notes
Tools For Practice
THE NUTRITION PROPOSITION BOOK
Check it out at nutritionproposition.com and think about picking up a copy on Amazon. All the evidence you ever wanted about nutrition and the only nutrition book that won’t tell you what to eat.
