In episode 443, James and Mike continue with Mike Kolber and we discuss the evidence around electronic cigarettes and their use for smoking cessation. Overall, the podcast ends up being smoking hot in so many ways.
Show notes
Tools for Practice
Electronic Cigarettes – Hoot that helps, hurts, or just hype?
In episode 442, James and Mike welcome back Mike Kolber to discuss all the evidence around biosimilars. The issue is exactly the same one we have had for decades with the question around brand name versus generic medications. Tune in and find out the answer.
Show notes
Tools for Practice
It’s all in the details… or is it? Biosimilars versus biologics for inflammatory conditions
In episode 441, James and Mike revisit the problem with guidelines. We talk about recent writings on the issues around guidelines. We discuss the main problems and believe it or not we give advice and suggestions for how to make them better.
Show notes
1) Health Affair
Fixing Clinical Practice Guidelines
2) Evidence vs Consensus in Clinical Practice Guidelines
JAMA 2019 Jul 19. doi: 10.1001/jama.2019.9751
3) The future of guidelines: Primary care focused, patient oriented, evidence based and simplified
In episode 440, Mike and James yet again invite Adrienne to go over all the evidence for treating toenail onychomycosis. We find that ~ 40% more people get better on oral treatments than on placebo. For topicals the number is closer to 10%. Topicals should likely only be used if there is <40% nail involvement.
Show notes
Tools For Practice
In episode 439, Mike and James invite Adrienne to take us through the impressively large amount of evidence for the PDE5 inhibitors for erectile dysfunction. We find that the NNTs are 2-3 for the not clearly defined endpoint of successful intercourse. There is a 20% absolute increase in adverse effects but almost no one stops using these medications because of these effects. Go figure.
Show notes
Tools For Practice
Taking a hard look at the evidence: Phosphodiesterase-5- inhibitors in erectile dysfunction
In episode 438, Mike and James discuss 4 studies that likely could change what you are doing, or saying to your patients in your practice. Hip replacements – they last longer than you may think, vitamin D – bigger isn’t better, actinic keratosis – 5-FU is best, and weight loss really does treat T2DM. Check it out.
Show notes
In episode 437, Mike and James invite Joey Ton to help us work through all the evidence around Platelet-Rich Plasma (PRP) injections for tendinopathies. The best evidence for Achilles tendinopathy, lateral epicondylitis, and rotator cuff tendinopathy shows no difference in pain, function or return to sport when PRP is compared to dry needling or saline.
Show notes
Tools for Practice
In episode 436, Mike and James invite Samantha Moe to help us work through the recent evidence suggesting that hydrocholorothiazide is associated with squamous cell skin cancer. We go over all the numbers and talk about how we use cohort data to figure out if an association needs to influence our clinical practice. As always it is tricky.
Show notes
Tools for Practice
Hydrochlorothiazide and Squamous Cell Skin Cancer: Remember when hypertension was easy?
In episode 435, Mike and James unravel the evidence around thyroid testing. We talk about an approach to deal with the lack of research and the variation in the measurement of TSH and many other things. At the end we both complain of fatigue, dry skin, puffy eyes, anxiety and depression – and immediately get a TSH test.
Show notes
1) Tools for Practice
Helping physicians fatigued by TSH Screening and Subclinical Hypothyroidism
2) Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline
In episode 434, James and Mike discuss the Treat Stroke to Target trial where subjects were randomized to attain different LDL levels in patients experiencing a stroke or TIA. We talk about whether the results of this trial mean you need to measure LDL levels or just give more statin. Listen to find out.
Show notes
A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke
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.
This pragmatic trial is now recruiting in BC. Make a difference and get involved with pragmatic trials (www.pragmatictrials.ca)
