In this pseudopodcast, James let's you know what is likely going to be happening with the podcasts and Bob and James, with limited success, make pharmacokinetics and drug levels interesting.
Show Notes
In episode 71, James starts off with a plea for a pledge and then the “Two Mikes” discuss the whole issue of what to do with the new evidence around PSA screening. We find out that if you believed in it before you’ll likely continue believing and if you didn’t believe in it you will still think that way – isn’t evidence wonderful? At the end James hopes you will continue to believe the podcast should continue.
Show Notes
1) Drop James an email at jmccorma@interchange.ubc.ca
2) The two latest studies on PSA screening
In episode 70, we continue with the “Two Mikes” and discuss a number of issues surrounding asthma treatment. We debate back and forth on the use of LABAs and their use alone or in combination and then come to complete agreement on the duration of prednisone for acute exacerbations. During the podcast James tries to steal the mic away and gets into trouble with Mike because Mike thought James was trying to steal Mike away from Mike.
Show Notes
1) LABAs in patients with asthma – risks and benefits
2) Short course (3 days) of oral steroids for asthma exacerbations
Medical Journal of Australia 2008;189:306–10
3) Doubling the dose of inhaled corticosteroids provides no benefit but what about quadrupling the dose?
In episode 69, the “Two Mikes” are back at it and they use their mics to dispense some really great prescriptive advice for patients with asthma and no heart burn pain and backs and knees which do have pain. James sits back and goes along for the ride but develops back and knee pain by the end, and the Mikes recommend a full body CT scan.
Show Notes
1) In patients with uncontrolled asthma and no GERD, the use of a PPI does not improve asthma symptoms
2) The use of PPIs and other GERD treatment in patients with asthma and acid-reflux symptoms shows no benefit in asthma symptoms
Cochrane Review 2003, No.: CD001496
2) Lumbar imaging for low-back pain without indications of serious underlying conditions does not improve clinical outcomes
3) Incidental meniscal findings on MRI of the knee are common in the general population and increase with increasing age
4) Arthroscopic surgery for osteoarthritis of the knee – no benefit
In episode 68, we get to the “heart of the matter” of stroke prevention for atrial fibrillation. We find out from Peter Loewen, that it is all a numbers game, and he gives us the tools to deal with this issue. We talk about warfarin and ASA and clopidogrel with respect to their benefits and harms. At the end of the podcast Peter tells us about dabigatran, which obviates all the messages we provide in this podcast. Mike develops an intracranial bleed during the podcast, Peter and James act concerned but continue on because that is what Mike would have wanted.
Show Notes
1) Estimating the risk of strokes in a patient with atrial fibrillation
CHADS2 score
A useful electronic resource from peterloewen.com
2) Warfarin versus ASA in atrial fibrillation patients > 75 yrs old
3) Clopidogrel and atrial fibrillation
ACTIVE W
Clopidogrel plus ASA versus warfarin (in patients suitable for warfarin)
ACTIVE A
ASA plus clopidogrel vs ASA (in patients not suitable for warfarin)
4) Vitamin K supplementation for labile INRs
5) Brief stops in warfarin – what do you do?
Cohort studies (no RCT yet, will get when BRIDGE finished)
6) Dabigatran versus warfarin for stroke prevention in atrial fibrillation
RE-LY
In episode 67, we address ischemic stroke of arterial origin and go over some core therapies (ASA, dipyridamole, clopidogrel and warfarin). We also discuss complications of anti-thrombotics and the options for patients with a GI bleed on ASA. Although Peter attempts to guide us through the maze of evidence, all three of us get lost and have trouble finding our way back. Mike rightly corrects James about one of his comments and James responds in a purely professional manner.
Show Notes
1) ASA post-stroke – low dose
ATTC 2009
2) Clopidogrel versus ASA
CAPRIE
3) ASA and clopidogrel versus clopidogrel
CHARISMA
MATCH
4) ASA versus warfarin post-stroke
WARSS
5) Dipyridamole plus ASA
ESPS-2
ESPRIT
PRoFESS
7) GI bleeding and ASA
PPI added to ASA versus clopidogrel alone
H. pylori eradication plus proton pump inhibitor versus H. pylori eradication alone
Clopidogrel plus a PPI – interaction or not
In episode 66, we embark on a journey of epic proportions; at least relative to our understanding. With the help of Peter Loewen, we outline the anti-platelet options in secondary prevention of heart disease. We discuss at length the use ASA and clopidogrel but also touch on additional agents like warfarin, dipyridamole and others. Where the evidence is clear, we create opacity and where it is gray, we go dark. Both Mike and Peter end up in a quagmire and James offers them help by throwing them a string of one-liners and a bottle of low-dose ASA.
Show Notes
Secondary prevention with antiplatelets
1) ATTC Meta-analysis – aspirin in primary and secondary resistance
2) CURE trial – clopidogrel added to aspirin
3) Anti-platelets in patients with a history of vascular disease or other predisposing condition – absolute benefit – 3.6% over 2 years (combined CVD events)
4) Low-dose aspirin – absolute benefit – around 3.3% combined CVD events and 1.5% mortality over 3 yrs
5) CHARISMA – Clopidogrel and aspirin vs aspirin
N Engl J Med 2006; 354:1706-17
6) Half of the benefit of clopidogrel occurs in the first month of use Clopidogrel for the treatment of adult patients following acute coronary syndrome
In episode 65, we start back at it with a discussion of using antiplatelets to decrease the chance of MIs and strokes. In this podcast, we cover the whole primary prevention aspect of these agents and we bring in our good friend and colleague Peter Loewen to help us with the numbers. Mike claims he, as a family doctor, is usually able to make a diagnosis of gender in his patients but refuses to do so in James’ case.
Show Notes
1) Primary Prevention with ASA (women and men)
ATTC 2009
2) ASA in Type II diabetics (primary prevention)
POPADAD study
JPAD study
PPP study
Canadian Diabetes Guideline (specifically, ASA)
3) Adding Clopidogrel to ASA in primary Prevention
CHARISMA Study (primary prevention sub-group)
4) Peripheral vascular disease
Clopidogrel
CAPRIE
5) Peter Loewen
In episode 64, we finish off the listener questions and comments and clarify the murkiness, or murkify the clariness, around a number of cardiovascular issues. By the end of the podcast, both Mike and James are heavier because they eat up all the “sweet” comments made by their listeners.
Show Notes
1) BMJ hypertension meta-analysis
2) Atenolol lowers blood pressure but no effect on cardiovascular outcomes
3) First-line drugs for hypertension
4) UKPDS spin
5) Effect of intensive control of glucose on cardiovascular outcomes – meta-analysis
6) Felodipine and cardiovascular outcomes
In episode 63, we again let the listeners take control as we try to deal with the excellent questions and comments that come our way. We get into a heavy discussion around issues of weight and weight loss. Mike asks James a number of questions that make him squirm and James thanks him because fidgeting is a great way to burn calories.
Show Notes
1) InfoPOEMS
2) Association between authors’ published positions and their financial relationships with manufacturers
3) J or U shape curve for BMI and mortality
4) Orlistat – the setting effects the results Effect in primary care study
Effect in tertiary care study
5) Comparison of weight loss diets
6) Fidgeting burns calories
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)
