Hi Everyone – Not really a podcast this week but hope you find it useful/entertaining. Would love feedback. The video can also be found on YouTube at http://youtu.be/QUW0Q8tXVUc . If you like it let people know.
In episode 211, Mike and James bring you brief reports of studies that reinforce previous messages. We go all eclectic from honey to lubricant to steroids to salt to omega-3’s and much more. At the end we cross our fingers and hope our informed luck continues.
Show notes
1) Honey for cough
Pediatrics 2012;130;465;on line
2) Self monitoring blood glucose
3) Lubricant on a speculum
Obstet Gynecol 2012;119:227–31
4) Tennis elbow
6) A1c and functional impairment
J Am Geriatr Soc 2012;60:1215–21
7) Pancreatitis and cholesterol drugs
8) Chlorthalidone vs HCTZ
9) Heart failure and salt – retraction
In episode 210, the Mikes and James discuss the evidence for probiotics for preventing antibiotic induced C. difficile and antibiotic induced diarrhea. We find that the evidence is solid and consistent and supports their use. At the end of the podcast we all get tired of the bathroom humor and decide to retreat to our individual thrones.
Show notes
1) Tools for Practice
Do probiotics prevent Clostridium difficile associated diarrhea in patients taking antibiotics?
In episode 209, Mike and James finally get back to podcasting after a bit of a break. We briefly discuss what we did in Australia and then we limp around the evidence for the use of viscosupplementation for knee osteoarthritis. We find that as the quality of the trials go up the evidence of benefit goes down. At the end we encapsulate everything we know into a pamphlet.
Show notes
2) Tools for Practice
In this very special episode, Mike and James discuss the whole concept of Minimally Disruptive Medicine with one of its founders, Victor Montori. We discuss the principles of reducing the
burden of treatment, encouraging coordination in clinical practice, acknowledging
comorbidity in clinical evidence, and prioritizing from the patient’s perspective. At the end we all realize we tend to be conservative when ignorant and that is OK.
Show notes
1) Minimally Disruptive Medicine
2) Useful shared-decision links
http://shareddecisions.mayoclinic.org
http://statindecisionaid.mayoclinic.org
In episode 208, James and Mike PREMIUM to the max with three interesting studies that could change your practice. We talk about duration of steroids for COPD exacerbations, when to start allopurinol after a gout attack and which NSAIDs are the safest from a cardiovascular perspective. You need to hear all about this!
Show notes
1) Starting allopurinol right after an acute attack of gout
2) COPD steroid treatment for acute exacerbations – 5 days or 14 days
JAMA 2013;309(21):doi:10.1001/jama.2013.5023
3) NSAIDs and cardiovascular risk
In episode 207, Mike and James keep up the pressure on blood pressure measurements. We talk about the magnitude of the benefit, the variability of all these measurements and get into the whole starting and stopping approach. At the end of the podcast we decide the bottom line is to not panic, sit back, put up your feet and relax and try to get your patients to do the same thing.
Show notes
1) NICE – Clinical management of primary hypertension
in adults
2) Blood pressure variability
In episode 206, James and Mike start to tackle the holy gospel of blood pressure measurements and interestingly feel under pressure the entire way due to the trickiness of the evidence. We discuss office measurements, automated measurements, home measurements, 24-ambulatory measurements and at the end realize we have likely raised the blood pressure of our listeners but on principle we refuse to measure it.
Show notes
1) Screening
Canadian Task Force on Preventive Health Care and the Canadian
Hypertension Education Program
2) Automated blood pressures
3) MAPEC study
Chronobiol Int 2010;27:1629-51
4) Waste and Harm in the Treatment of Mild
Hypertension
JAMA Intern Med. 2013;():1-2. doi:10.1001/jamainternmed.2013.970.
doi:10:1001/jama.2010.920
5) Mild hypertension – effect of propranolol in mild hypertension
In episode 205, Mike and James continue with their discussion on the use of A1c levels in type-2 diabetes. We discuss the variability in the measurement of A1c and given this, how tricky it is to use the A1c once therapy has been started. We also discuss the magnitude of the vascular benefit of therapies that change A1c and come to the conclusion that with all this confusion “minimally disruptive medicine” seems to make a lot of sense.
Show notes
1) The variability of the A1c test
http://diabetes.niddk.nih.gov/dm/pubs/A1CTest/#11
2) Calculators for converting glucose to A1c and vice versa
In episode 204, James and Mike get into a discussion about the use of A1c levels for diagnosing and treating type-2 diabetes. We discuss screening recommendations and the impact an elevated A1c has on cardiovascular disease and other outcomes. At the end we realize the key message is that we have to let patients know that having an elevated A1c does not indicate impending doom.
Show notes
1) Impact of screening for type-2 diabetes
2) Recommendations on screening for type 2 diabetes in
adults
CMAJ 2012;184 no.15 doi:10.1503/cmaj.120732
3) Hemoglobin A1c for the diagnosis of Type II Diabetes
4) Lifetime risk of dialysis and blindness
Estimated benefits of glycemic control in microvascular complications
in type 2 diabetes
Ann Intern Med 1997;127:788-95
For the risks calculated in the podcast we used a version of
the UKPDS risk engine that is not presently publically available – UKPDS risk
engine v3.0b2
6) Risk of dialysis in type 2 diabetes
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