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

Can Fam Physician. 2019 May;65(5):321-330

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

Handout

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

Handout

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

Handout

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

Handout

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