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
In episode 433, Mike and James get all sweet on the latest diabetic trials from 2019. We provide the results, the critique and the context and we do it all with our usual level of charm and wit – which is by all accounts at a level similar to the size of the effect that many diabetes medications have on CVD events.
Show notes
In episode 432, James and Mike finish their review of the evidence around medications for systolic heart failure. In this episode our goal was to try to make sense of the process by adding as much art as possible to the evidence and also use a modicum of common sense. Let us know if we achieved our goal.
Show notes
In episode 431, James and Mike continue their review of the evidence around medications for systolic heart failure. In this episode we discuss betablockers, ACEIs, ARBs, MRAs and a few other key trials of somewhat newer agents.
Show notes
In episode 430, James and Mike do a review of all the best available evidence around medications for systolic heart failure. In this episode we start off by framing the risk associated with heart failure (mortality and hospitalizations for heart failure) and what the evidence is for exercise, salt, diuretics, digoxin and ISDN/hydralazine.
Show notes
In episode 429, Mike and James continue their discussion with Barb Farrell around deprescribing. We talk in generalities, with occasional brilliant specificity, about the PPI/benzos/antipsychotics/glucose lowering medication deprescribing guidelines. In the end we come up with the astounding idea that maybe some people are on too many medications.
Show notes
1) Deprescribing guidelines and related tools
3) Specific guidelines
Cholinesterase inhibitors and memantine
6) MedStopper
In episode 428, Mike and James invite Barb Farrell to discuss all the great work being done by the people at deprescribing.org. We discuss the general approach to deprescribing and why it is so important to keep this concept front and center of health discussions.
Show notes
1) Deprescribing guidelines and related tools
3) Specific guidelines
In episode 427, James and Mike invite Mark McConnell back to the podcast to discuss the philosophy around how not to do what didn’t need to be done. You start with a differential diagnosis then think about what are the possible causes of this presentation? Next, is the patient a candidate for the end product (med/surgery/device) should a diagnosis be found and are they interested in it (their values and preferences)? Then consider the best test(s) to diagnosis it if the patient makes that informed choice.
Show notes
1) Do You Need That Test?
2) Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000-2016
JAMA. 2019;322(9):843-856. doi:10.1001/jama.2019.11456
3) Toward a positive theory of consumer choice
Journal of Economic Behavior & Organization 1980;1:39-60
4) Prevalence and Cost of Care Cascades After Low-Value Preoperative Electrocardiogram for Cataract Surgery in Fee-for-Service Medicare Beneficiaries
JAMA Intern Med. doi:10.1001/jamainternmed.2019.1739
5) Treatment of Fatty Liver Disease—Time to Implement Common Sense Measures
JAMA Intern Med. 2019;179(9):1272-1273. doi:10.1001/jamainternmed.2019.2244
6) Competing demands and opportunities in primary care
Canadian Family Physician 2017;63:664-8
7) Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017
In episode 426, James and Mike discuss in a PREMIUM way the first large RCT of the polypill. This single pill version contained aspirin, atorvastatin, hydrochlorothiazide, and either enalapril or valsartan. Have a listen and find out what happened.
Show notes
Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial
Lancet. 2019 Aug 24;394(10199):672-683. doi: 10.1016/S0140-6736(19)31791-X
In episode 425, James and Mike invite Samantha back again to talk about the evidence around the incidence of opioid use disorder that we cause by prescribing opioids. The key issue seems to be whether or not your patient has a history of substance abuse.
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.
This pragmatic trial is now recruiting in BC. Make a difference and get involved with pragmatic trials (www.pragmatictrials.ca)
