In episode 411, Mike and James get annoyed – obviously in a nice way – having to talk about a new cohort study on eggs and an RCT of yet another omega-3 product. We try to put them into the context of all the other evidence available for these “products”.

Show notes

1) Effect of a high-egg diet on cardiometabolic risk factors in people with type 2 diabetes: the Diabetes and Egg (DIABEGG) Study-randomized weight-loss and follow-up phase

Am J Clin Nutr. 2018 Jun 1;107(6):921-931. doi: 10.1093/ajcn/nqy048

2) Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality

JAMA. 2019;321(11):1081-1095. doi:10.1001/jama.2019.1572

3) Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia

N Engl J Med. 2019 Jan 3;380(1):11-22. doi: 10.1056/NEJMoa1812792. Epub 2018 Nov 10

In episode 410, Mike, James, and Adrienne discuss the evidence around antidepressants in the elderly. We find 40% to 80% of elderly patients will recover with antidepressants, but a number of studies show no difference from placebo response rates. In addition, approximately 20% will stop due to adverse effects. 

Show notes

Tools for Practice

The depressing evidence for antidepressants in the elderly

In episode 409, Mike and James yet again welcome Adrienne from Red Deer to talk about whether or not we need to give antibiotics for drained abscesses. We find out that relatively, the benefit of increased cure is similar to the chance of side effects.

Show notes

Tools for Practice

There’s Pus About, So Are Antibiotics In or Out? Adding antibiotics for abscess management

In episode 408, Mike and James talk about a couple of recent survey publications. One, which examined patient satisfaction around patient requests and denials of those requests. The other examined how often and why patients are not always honest about disclosing medically relevant information. At the end we decide there is a little liar in all of us and we just need to accept it.

Show notes

1) Association of clinician denial of patient requests with patient satisfaction

JAMA Intern Med 2018;178:85-91

2) Prevalence of and factors associated with patient nondisclosure of medically relevant information to clinicians

JAMA Network Open. 2018;1(7):e185293. doi:10.1001/jamanetworkopen.2018.5293

3) Register for the Best Science Medicine Course – May3/4, 2019 in Vancouver

In episode 407, Mike and James go PREMIUM and talk about three potentially practice changing trials. Water for recurrent UTIs, e-cigarettes for smoking cessation, and acetaminophen for febrile seizures. It doesn’t get more PREMIUM than that.

Show notes

1) Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections

JAMA Intern Med. doi:10.1001/online October 1, 2018

2) A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy

January 30, 2019 DOI: 10.1056/NEJMoa1808779

3) Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode

Pediatrics. 2018;142:e20181009

In episode 406, Mike, James, and Tina go over the evidence for treating opioid use disorder in primary care and the evidence is clear that it can be done in primary care but specialized opioid treatment programs are also obviously needed.

Show notes

1) Tools for Practice

Location, Location, Location: Treating patients with opioid use disorder in primary care

2) CFPC webinar – 12:00PM EST Feb 12, 2019

Top 10 take-home points for advance care planning in primary care

YouTube link: www.youtube.com/watch?v=-mWsMA39YOw

In episode 405, Mike and James, with yet again the very smart and helpful Tina Korownyk, go over the evidence for buprenorphine-naloxone for pharmaceutical opioid use disorder. While the evidence is at moderate to high risk of bias the results are fairly impressive with NNTs of 3-5.

Show notes

Tools for Practice

Is buprenorphine (with or without naloxone) effective as maintenance therapy in pharmaceutical opioid use disorder?

In episode 404, Mike and James, with the very capable Tina Korownyk, go over the approach to what tools to use to help determine if a patient has an opioid use disorder (OUD). We talk about a simple tool called the Prescription Opioid Misuse Index (POMI), a 6-point questionnaire with strong predictive ability for OUD which seems to be a reasonable case-finding tool. 

Show notes

Tools for Practice

Does this patient taking prescription opioids have opioid use disorder?

In episode 403, Mike and James finally finish up their clear demonstration as to why they aren’t therapeutic nihilists.  We focus on system/ecological issues and specifically primary care – the bottom line is things aren’t as bad as they sometimes seem, but things could always be better – you heard it here first.

Show notes

Handout

CFPC National Webinar – Learn about the top 2018 research studies  – Jan 9, 2019 – 12:00 EST Web link

In episode 402, Mike and James continue to try to demonstrate beyond a shadow of a doubt that they aren’t therapeutic nihilists. We talk about treatments that really work for symptoms – antibiotics, corticosteroids, antidepressants, proton pump inhibitors, and ED medications.

Show notes

1) Handout

2) Effectiveness of Antidepressants

BMJ 2018;360:k1073

3) Pain Calculator