In episode 364, James, Mike, and primarily Bruce talk about an approach – Focussed Acceptance and Commitment Therapy (FACT) – that clinicians in primary care can use across a broad range of psychological problems. This type of 15-20 minute approach has been evaluated in many RCTs – so have a listen and reach for the behaviour and not the medication.
Show notes
1) Focussed Acceptance and Commitment Therapy Manual
2) An e-learning module on YouTube – Video 8 is the main one
In episode 363, James, Mike, Bruce and Helena continue to talk about depression in primary care. The key messages are that instead of calling it depression we should consider telling people they are “stuck”, negotiate non drug therapies like behavioural activation, do follow-up phone calls and basically NEVER prescribe an antidepressant on the first visit.
Show notes
In episode 362, James and Mike invite Bruce Arroll back to talk about his latest systematic review on antidepressants for treatment of depression in primary care. We quickly come to the realization that primary care is different than specialty care and that we need to talk first and prescribe later and have the clinician be the drug.
Show notes
1) Antidepressants for treatment of depression in primary care: a systematic review and meta-analysis
J Prim Health Care 2016;8:325–34
2) Effective management of depression in primary care: a review of the literature
In episode 361, James and Mike pull out the PREMIUM card and we digest two recent publications – a cohort study looking at the relation between percent of macronutrients ingested and CVD and mortality and then a much smaller trial of intensive lifestyle in T2DM. At the end we realize that if nutrition guidelines just stuck to looking at the evidence all would be good in the world – at least around eating.
Show notes
Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study.
Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial
In episode 360, Mike and James finally get to the end of their agitating three part series on treating agitation in dementia. In this episode we talk about the evidence for the non-drug treatments like group or individual activities, music therapy and sensory interventions. Sadly, there is still real uncertainty if these interventions work reliably.
Show notes
In episode 359, Mike and James continue to agitate over the evidence for treating agitation in dementia. We talk about the use of benzodiazepines, antidepressants cholinesterase inhibitors for this difficult to treat condition. The evidence ends up just increasing our level of agitation as these agents unfortunately really don’t do a heck of a lot for many people.
Show notes
In episode 358, Mike and James in an agitated and demented way deal with the evidence around agitation in dementia. We find that the antipsychotics have an effect that might be noticeable in 1 in 10 people but if a person responds it likely had nothing to do with the medication. How agitating is that?
Show notes
In episode 357. Mike and James invite Adrienne to help us work through all the studies that have looked at using riboflavin to prevent migraines. Unfortunately, the impact of riboflavin on migraines is consistently inconsistent and most RCTs found no reduction in migraine frequency. At least we have evidence for low-dose propranolol and amitriptyline.
Show notes
Tools for Practice
Riboflavin for Migraine Prophylaxis: Something “2-B” excited about?
In episode 356, Mike and James welcome Jamal Ramji to the podcast because we really needed to do something PREMIUM. We discuss a study of subclinical hypothyroidism and a low FODMAP diet for IBS. At the end we figure out that TSH is a no, but that the low FODMAP is a yes at least for 1 in 5-10 people.
Show notes
1) Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism
2) A Randomized Controlled Trial Comparing the Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D
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)
