In episode 585, Mike and James finally get back to being PREMIUM. We review the REDUCE-AMI trial which tried to answer the question – do you need to use a beta-blocker after an MI if there is preserved ejection fraction? We also review a COPD trial that shows integrating respiratory specialists in primary care improves guideline adherence. However, the interesting finding is what happens to the quality-of-life change and hospitalizations. The results of both of these trials may surprise you.

Show notes
1) REDUCE-AMI- Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction
N Engl J Med 2024;390:1372-1381

2) Cluster randomised controlled trial of specialist-led integrated COPD care (INTEGR COPD)
Thorax 2024;79:209–218

In episode 571, James and Mike talk about 2 new papers – we learn what antibiotics we can use for community-acquired pneumonia and we also talk about the prevalence and management of dyslipidemia in Canadian primary care practices and find out who has this problem and who gets treated.

Show Notes
Identifying the Best Initial Oral Antibiotics for Adults with Community‐Acquired Pneumonia: A Network Meta‐Analysis
J Gen Intern Med. 2024 Feb 15.doi: 10.1007/s11606-024-08674-1.

Prevalence and management of dyslipidemia in primary care practices in Canada
Can Fam Physician. 2024 Mar;70(3):187-196.doi: 10.46747/cfp.7003187

In episode 550, James and Mike talk in a PREMIUM way about a new cholesterol lowering agent. Bempedoic acid is nothing tremendously exciting but what was very interesting was a subsequent publication that looked at a primary subset analysis, yet completely left out the secondary subset data. Have a listen and find out why.

Show Notes

Sensible Medicine
Lipid lowering – a Bempedoic Acid Subset Analysis – To be right, you have to also look at what is left

MyStudies

CFPC Learn

PEIP conference Oct 20-21, 2023

In episode 539, James and Mike focus in a PREMIUM way on the latest prostate cancer intervention trial. Patients with prostate cancer were randomized to active monitoring, surgery, or radiotherapy and followed for 15 years to see which was the best option. Have a listen and hear what was found.

Show Notes

1) Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer
N Engl J Med. 2023:10.1056/NEJMoa2214122

2) Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment
NEJM Evid 2023;2 DOI: 10.1056/EVIDoa2300018

In episode 533, Mike and James go PREMIUM yet again with new information on not so new primary care questions. We talk about FODMAP diets, intra-articular steroids, cannabis and time taken in family practice to do everything.

Show Notes
1) Diet or medication in primary care patients with IBS: the DOMINO study – a randomised trial supported by the Belgian Health Care Knowledge Centre (KCE Trials Programme) and the Rome Foundation Research Institute
Gut. 2022 Nov;71(11):2226-2232
2) Clinical effectiveness of one ultrasound guided intra-articular corticosteroid and local anaesthetic injection in addition to advice and education for hip osteoarthritis (HIT trial): single blind, parallel group, three arm, randomised controlled trial
BMJ. 2022 Apr 6;377:e068446
3) Revisiting the Time Needed to Provide Adult Primary Care
J Gen Intern Med. 2022 Jul 1 . DOI: 10.1007/s11606-022-07707-x

In episode 522, James and Mike quickly go over 3 new COVID trials that give useful PREMIUM information. BUT then we quickly go SUPER PREMIUM with evidence around the shelf life of medications and we discuss why the expiry dates on medications in almost no circumstances represent the date when medications should no longer be used.

Show Notes
1) Secondary Attack Rates for Omicron and Delta Variants of SARS-CoV-2 in Norwegian Households
JAMA. 2022 Apr 26;327(16):1610-1611. doi: 10.1001/jama.2022.3780
2)Randomized Trial of Metformin, Ivermectin, and Fluvoxamine for Covid-19
N Engl J Med 2022 Aug 18;387(7):599-610
3) Nirmatrelvir Use and Severe Covid-19 Outcomes during the Omicron Surge
N Engl J Med 2022; 387:790-798
4) Determination of albuterol and montelukast post-expiry drug strength by HPLC
Heliyon. 2022 Aug 5;8(8):e10104. doi: 10.1016/j.heliyon.2022.e10104
5) A systematic review of the stability of finished pharmaceutical products and drug substances beyond their labeled expiry dates
J Pharm Biomed Anal. 2019 Mar 20;166:222-235. doi: 10.1016/j.jpba.2019.01.016

Episode 517: PREMIUM – A podcast that hopefully won’t leave you breathless

In episode 517, Mike and James talk PREMIUMLY (not a word but it should be) about two new trials that looked at using fixed dose combinations of salbutamol/albuterol and a steroid on a PRN basis in patients with moderate to severe asthma. It seems to have an effect and it may make asthma treatment simpler, but it may also increase the costs when it comes to inhalers.

Show Notes
1) Albuterol–Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma
N Engl J Med 2022;386:2071-83.DOI: 10.1056/NEJMoa22031632
2) Reliever-Triggered Inhaled Glucocorticoid in Black and Latinx Adults with Asthma
N Engl J Med 2022;386:1505-18.DOI: 10.1056/NEJMoa2118813

In episode 510, Mike and James talk about a trial that looks at what happens when you discontinue antidepressants in primary care. We see there is about a 15% absolute difference in the chance of relapse – and we put all this into context because this is a PREMIUM podcast. We also discuss what happens…

In episode 501, Mike and James get back to being PREMIUM by talking about the impressive effect of Kangaroo care – listen to find out what that is. We also talk about the problem with guidelines around Vitamin D and yet again more evidence for delayed antibiotics.

Show Notes

1) Kangaroo mother care to reduce morbidity and mortality in low birthweight infants
Cochrane Database Syst Rev 2016 Aug 23;2016(8):CD002771
2) Immediate “Kangaroo Mother Care” and Survival of Infants with Low Birth Weight
N Engl J Med 2021;384:2028-38
3) Vitamin D recommendations in clinical guidelines: A systematic review, quality evaluation and analysis of potential predictors
Int J Clin Pract. 2021 Nov;75(11):e14805. doi: 10.1111/ijcp.14805. Epub 2021 Sep 15
4) Delayed Antibiotic Prescription for Children With Respiratory Infections: A Randomized Trial
Pediatrics. 2021 Mar;147(3):e20201323. doi: 10.1542/peds.2020-1323. Epub 2021 Feb 11.
5) Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis
BMJ 2021;373:n808

In episode 492, Mike and James delve into a couple of potentially practice-changing results. The first trial looked at the effect of different shoes for knee osteoarthritis. You might be surprised by the results. The second trial is the first ever look at a salt substitute and what it does, believe it or not, to cardiovascular events and death. Yeah! You might also be surprised by the results. Check out what was found in this PREMIUM podcast.

Show Notes

1) The Effect of Flat Flexible Versus Stable Supportive Shoes on Knee Osteoarthritis Symptoms: A Randomized Trial

Ann Intern Med. 2021 Apr 174:462-71

2) Effect of Salt Substitution on Cardiovascular Events and Death

N Engl J Med 2021; 385:1067-1077 DOI: 10.1056/NEJMoa2105675