In episode 421, Mike and James discuss the best available evidence around the newer and typically more expensive iron formulations used for iron deficiency anemia. We find the newer iron formulations are inferior to older ferrous salts when it comes to treating anemia and the evidence that newer formulations have less adverse effects is at best inconsistent.
Show notes
Tools for Practice
In episode 420, James and Mike welcome back Bruce Arroll to talk about approaches to how we should talk about, discuss, chart and treat mental health issues. We discuss avoiding psychiatric labels, consider giving transdiagnostic labels, and doing functional assessments around work, love, and play.
Show notes
1) Transdiagnostic Symptom Clusters and Associations With Brain, Behavior, and Daily Function in Mood, Anxiety, and Trauma Disorders
JAMA Psychiatry. 2018 Feb 1;75(2):201-9
2) The psychopathology of James Bond and its implications for the revision of the DSM-(00)7
Med J Aust. 2015 Dec 14;203(11):452-6.
3) Saving Normal: An Insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, Big Pharma and the medicalization of ordinary life
Psychotherapy in Australia, Vol. 19, No. 3, May 2013: 14-18
5) Reforming disease definitions: a new primary care led, people-centred approach
BMJ Evidence Based medicine doi:10.1136/ bmjebm-2018-111148
FACT- work/love/play
Limit the problem focus
1) work – 1 to 10
2) love (friends) – 1 to 10
3) love (intimates) – 1 to 10
4) love (family) – 1 to 10
5) play – 1-10
In episode 419, Tina, Mike and James finish talking about managing opioid use disorder in primary care. We find that positive reinforcement and brief counseling can be of some value but not the opposite – we realize we should treat this in a similar way to a chronic condition. We also realize that the evidence around urine drug testing and contracts is at best confusing and very limited.
Show notes
Opioid use disorder in primary care: PEER umbrella systematic review of systematic reviews
Can Fam Physician. 2019 May;65(5):e194-e206
Managing opioid use disorder in primary care: PEER simplified guideline
In episode 418, Tina, Mike and James continue to talk about managing opioid use disorder in primary care. We talk about tools used for case finding and decide the POMI tool is the most useful. We also discuss whether or not tapering is useful and look at the naltrexone data.
Show notes
Opioid use disorder in primary care: PEER umbrella systematic review of systematic reviews
Can Fam Physician. 2019 May;65(5):e194-e206
Managing opioid use disorder in primary care: PEER simplified guideline
In episode 417, Mike and James invite Tina Korownyk to talk about all the work our PEER group did in developing a simplified guideline for managing opioid use disorder in primary care. We talk about how the guideline was put together, how the group decided on the questions that needed to be answered around opioid use disorder and what the evidence says around where can opioid use disorder be treated.
Show notes
Opioid use disorder in primary care: PEER umbrella systematic review of systematic reviews
Can Fam Physician. 2019 May;65(5):e194-e206
Managing opioid use disorder in primary care: PEER simplified guideline
In episode 416, James and Mike talk about the recently released CABANA study, the largest and longest trial done on catheter ablation for symptomatic atrial fibrillation. We find that in general the ablation group had fewer negative clinical outcomes and an improved quality of life. At the end we briefly discuss a paper that evaluated the level of evidence that supports the ~ 6000 recommendations in the cardiology guidelines from ACC/AHA/ESC.
Show notes
1) Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial
JAMA. 2019 Mar 15. doi: 10.1001/jama.2019.0693
2) Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With Atrial Fibrillation The CABANA Randomized Clinical Trial
JAMA. 2019 Mar 15. doi: 10.1001/jama.2019.0692
3) Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018
JAMA. 2019 Mar 19;321(11):1069-1080. doi: 10.1001/jama.2019.1122
In episode 415, Mike and James continue with an overview of the evidence around depression. In this episode we talk about the use of antipsychotics for depression or augmentation of antidepressants, stopping antidepressants and the chances of withdrawal, and non-medication treatments.
Show notes
In episode 414, Mike and James continue with an overview of the evidence around depression. In this episode we talk about antidepressant management nuances from lower doses, to dose escalation, switching, and the time to response.
Show notes
In episode 413, Mike and James continue with an overview of the evidence around depression. In this episode we talk about the evidence around the effectiveness of antidepressants and learn if they work, how well they work, and if any one is better than the others.
Show notes
In episode 412, Mike and James do an overview of the evidence around depression. In this episode we talk about ruling out depression and the struggle of how to look at antidepressant evidence.
Show notes
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)
