In episode 355, James and Mike finish delving into the issues around lab reporting and measurements. We finally get to some potential solutions (sort of) with how to deal with the variation seen around all lab values/measurements. We focus primarily by describing the variation around the top 20-30 lab tests because there is no way to get away from the inherent biologic variation seen with all these tests. Hopefully, if one appreciates the variation, one can use good clinical skills and judgment when it comes to interpreting lab tests. Or maybe the entire podcast series  just makes your blood pressure up – which as we talk about in the podcast, BP changes are difficult to evaluate. 

Show notes

Handout

Lab Test Variation Table

In episode 354, James and Mike continue to delve into the issues around lab reporting and measurements. In this part, we talk about the variation seen with blood pressure measurements, glucose and Vitamin D as further examples of what clinicians need to be aware. Having this insight should give you more confidence to interpret lab values, or just frustrate the heck out of you. You decide. 

Show notes

Handout

In episode 353, James and Mike continue to delve into the issues around lab reporting. In this part, we talk about the variation seen with every measurement. We talk about reference change values and what they mean for clinical practice. We use examples of bone density and cholesterol to explain some of the nuances and problems associated with test variance. The bottom line is that cholesterol and BMD measurements, with rare exception, are of no clinical value. Yikes!

Show notes

Handout

In episode 352, James and Mike start to delve into the issues around lab reporting and the numbers that are reported and what the numbers really mean. We talk about the highs and the lows and the variability associated with measurement and realize at the end that, while lab tests may have important variability, the quality of our podcasts never varies – which may or may not be a good thing.

Show notes

Handout

In episode 351, Mike and James welcome Danielle and Joey to the podcast and they go all PREMIUM on us. The new dynamic duo go over studies from 2 important areas – O2 for COPD and bariatric surgery for diabetes. At the end of the podcast we realize that Mike and James are superfluous when it comes to the podcast quality and usefulness – sad!

Show notes

1) O2 in COPD

A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation

N Engl J Med 2016;375:1617-27

Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial

JAMA 2017;317:2177-86

2) Bariatric surgery for diabetes

Bariatric Surgery versus Intensive Medical Therapy for Diabetes – 5-Year Outcomes 

N Engl J Med 2017;376:641-51

In episode 350, Mike and James talk about the evidence around sleep restriction. The evidence is fairly solid and the results typically suggest an impact greater than sleeping pills with sleep restriction improving sleep for one in every two to six patients compared to sleep hygiene alone.  At the end of the podcast, James realises that Mike presented the evidence while being fast asleep – showing that the concept of sleep restriction actually works.

Show notes

Tools For Practice

Trouble Sleeping: Spend less time in Bed? 

Simplified Sleep Restriction for Insomnia handout

In episode 349, Mike and James talk about the evidence around screening otherwise asymptomatic adults with a complete blood count. While it feels like it should be a good thing to do, the evidence is pretty clear that it doesn’t provide any benefit even though ~ 10% of tests will be abnormal. Basically no one benefits and serious disease is virtually never found.

Show notes

Tools For Practice

CBC (Confusing Broad Check) for Screening?

In episode 348, Mike and James invite Mike Kolber yet again and he urgently works us through the evidence for treating hypertensive urgency. At the end we realize that asymptomatic patients with BPs >180/110 mmHg can be dealt with addition or initiation of oral agents at presentation with close outpatient follow-up. Even though it is “urgent” we don’t need to panic.

Show notes

Tools For Practice

Clinical Question: What are the risks for asymptomatic patients who present with significantly elevated blood pressure?

In episode 347, Mike and James get Mike Kolber to work us through all the evidence around chewing gum after bowel surgery. Believe it or not there are lots of studies and believe it or not there is reasonable benefit. The only tricky part would be to try to get hospitals to implement this protocol. 

Show notes

Tools For Practice

Clinical Question: Does chewing gum after surgery improve bowel function? 

In episode 346, Mike and James have Adrienne work us through the rest of the evidence for medications used to treat nausea and vomiting around pregnancy. We specifically look at the evidence for diclectin, B6 alone, ginger and ondansetron and then try to figure out what we would use.

Show notes

Handout