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
In episode 424, James and Mike continue chatting with Samantha Moe about a number of useful studies in primary care. We talk about blood pressures in the elderly, negative urine cultures, melatonin and migraine, dementia and driving, and complementary health products for the common cold.
Show notes
In episode 423, James and Mike welcome Samantha Moe, a pharmacist and clinical evidence expert with the College of Family Physicians, to the podcast. We discuss studies on cannabis and risk of schizophrenia, the harms of PPIs, H pylori infections and duration of treatment, and blood pressure measurements over clothes or a bare arm.
Show notes
In episode 422, James and Mike, go MEGA-PREMIUM and discuss the most recent meta-analysis (yes, yet another one) around the use of statins in older people. We then quickly review an article that looks at whether or not the guidelines for monitoring chronic conditions in primary care are evidence based. We are “shocked” when we find out “There is no evidence to support frequency of testing of any test in any of the guidelines”.
Show notes
1) Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials
Lancet. 2019 Feb 2;393(10170):407-415. doi: 10.1016/S0140-6736(18)31942-1
2) Are guidelines for monitoring chronic disease in primary care evidence based?
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)
