In episode 608, Tina and James invite Jennifer Young back again to the podcast to go over the evidence we have for a simple but important question around buckle fractures – does treating with a soft bandage versus a rigid splint/cast produce different clinical outcomes? The answer is quite clear around what we should do. Check out what we found.
Show Notes
1) Tools For Practice
Use the soft touch for buckle fractures?
In episode 607, Tina and James invite Caitlin Finley to go over what the group found with regard to the best available evidence around surgical frenotomy. We look at the effect the surgery has on breast pain, self-reported breastfeeding improvement, and infant weight gain. Tune in as you might be impressed with the absolute benefits.
Show Notes
1) Tools For Practice
Trying Tongue-Tie Treatment: Does Frenotomy Fix Feeding Frustrations?
THE CASE
It is Friday, the end of a long and busy week and a sunny weekend is calling you. Your tasks this afternoon includes seeing some patients who have complex comorbidity and have been booked in for medication reviews. Next up is a longstanding patient, aged 76 who is on 14 different medication, for several different conditions, 2 more drugs than she was on just 3 months ago. How does this feel? Perhaps a bit daunting? Perhaps the clinician isn’t confident they know what to do about this polypharmacy although they have a gut feeling that this many drugs in an older person could be a problem. Perhaps they feel that this review is a dull chore, or that any attempt to reduce medications will be resisted by the patient and cause criticism from the specialist teams who are involved in her care. Perhaps they feel alone and that other people are not working on reducing medications
Show Notes
THE CASE
You have just seen James aged 37 about an ankle sprain. He says he also wants to ask about an exercise test. He has just got a new job and the company have offered him a cut price “Private medical well man appointment which includes tests that your own GP doesn’t do including an Exercise ECG”. James says “It costs £75 Do I need an exercise ECG and why don’t GPs offer this?”
Show Notes
1) Screening: Evidence and Practice 2nd edition
2) UK National Screening Committee
3) Canadian Task Force on Preventive health care
Breast cancer tools
In episode 606, Jamie and James go over the best available evidence we have for the medications used in overactive bladder, with a focus on a newer agent mirabegron. We end up having to discuss the exciting topics of number of voids and dry mouth and at the end we give you all the numbers you need to have an evidence-based conversation with your patients.
Show Notes
1) Tools For Practice
Avoiding the void? Mirabegron for overactive bladder
In episode 605, James and Jamie get Emelie Braschi to answer a simple and common clinical question. ASA versus direct oral anticoagulants – which one is safer with regard to bleeding? As always it comes down to the numbers and we go over all those numbers and put them into the overall benefit and harm ratio for Afib.
Show Notes
1) Tools For Practice
An ASA a day keeps the Afib at bay?
2) SparcTool – Stroke Prevention in Atrial Fibrillation Risk Tool
3) PEIP Conference Edmonton October 17-18, 2025
THE CASE
Mrs Green aged 60 comes complaining that she feels fatigued and tired, although there are no specific symptoms and she has no fever, pain, bowel upset, bleeding, nor any mental health symptoms. She is sleeping normally and doing all her usual activities easily, and working full time. She is happily married and has no children by choice. She is not clinically anaemic, chest and abdominal exam is normal. Her doctor does “some tests” FBC CRP E and E LFT GGT coeliac screen TFT, B12 folate serum iron, HBa1c, Vitamin D urinalysis myeloma screen HIV hepatitis screen and ends up with about 25 (maybe even 30 or 40??) results to digest and interpret. The serum phosphate is a little low, the sodium is 134 (NR 135–146 mmol/L) the HGBA1C is 38, risen from 32 last year at a “health check” The patient sees the results as she has direct access to her electronic record and rings up saying “What do I need to do about these abnormal results and what tests should I do next? Why did you do an HIV test are you saying I am promiscuous? Can I have a whole-body scan to see what’s wrong?” It says on google I have got pre diabetes!
Show Notes
1) Your results may vary: the imprecision of medical measurements
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m149
2) GET A LIST OF THE VARIATION OF MEASUREMENTS FOR COMMON TESTS FROM THE ABOVE REFERENCE
In episode 604, James and Mike K get Jennifer Young to tackle the topic of nose bleeds and what the evidence shows around the use of topical tranexamic acid and how it compares to other treatments. We go over all the endpoints and give you all the numbers.
Show Notes
1) Tools For Practice
Stop the Drip: Tranexamic Acid Solution for Nosebleeds
In episode 603, James and Mike K invite Jennifer Young back to the podcast to talk about the best available evidence for topical minoxidil and hair growth. We discuss outcomes such as the numbers of hairs per squared centimeter – the main outcome reported – but when available, we also other report on other outcomes and also the side effects. So, if you want to know about numbers of hair per squared centimeter and all the other numbers, tune in.
Show Notes
1) Tools For Practice
Topical minoxidil for androgenetic alopecia: When blood pressure agents make you hairy
2) PEIP Conference Edmonton October 17-18, 2025
In episode 602, James and Mike Kolber go over the best available evidence for the benefits and the harms for one of the most commonly used classes of medications – proton pump inhibitors. We find out the benefit numbers are much larger than the harm numbers. Check out the podcast to get all the numbers you need to help people make decisions.
Show Notes
1) Tools For Practice
Side effects of long-term PPI use: Leaving a bad taste in your mouth?
Proton Pump Inhibitors (PPIs): Is Perpetual Prescribing Inevitable?
2) PEIP Conference Edmonton October 17-18, 2025
3) SPARCTool
4) RX files PPI
Stopping your Proton Pump Inhibitor or “PPI”
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.
