In episode 367, Mike and James talk about the latest cardiovascular medication canakinumab, and a systematic review of corticosteroids for the treatment of a sore throat. And to really make it PREMIUM we throw in a quick discussion about a new study on the T2DM medication exenatide.

Show notes

1) Antiinflammatory therapy with canakinumab for atherosclerotic disease

N Engl J Med 2017;377:1119-31

2) Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials

BMJ 2017 Sep 20;358:j3887. doi: 10.1136/bmj.j3887

3) Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes

N Engl J Med 2017;377:1228-39

In episode 366, Mike, James, and Tony continue to talk about the very important and broad topic of social determinants of health. Interestingly, evidence is fairly clear that social spending may be more useful to health than health spending and we need more focus on community services and primary care.

Show notes

Social determinants of health handout

In episode 364, James, Mike, and primarily Bruce talk about an approach – Focussed Acceptance and Commitment Therapy (FACT) – that clinicians in primary care can use across a broad range of psychological problems. This type of 15-20 minute approach has been evaluated in many RCTs – so have a listen and reach for the behaviour and not the medication.

Show notes

1) Focussed Acceptance and Commitment Therapy Manual

2) An e-learning module on YouTube – Video 8 is the main one

In episode 363, James, Mike, Bruce and Helena continue to talk about depression in primary care. The key messages are that instead of calling it depression we should consider telling people they are “stuck”, negotiate non drug therapies like behavioural activation, do follow-up phone calls and basically NEVER prescribe an antidepressant on the first visit.

Show notes

An Evidence-Based First Consultation for Depression

In episode 362, James and Mike invite Bruce Arroll back to talk about his latest systematic review on antidepressants for treatment of depression in primary care. We quickly come to the realization that primary care is different than specialty care and that we need to talk first and prescribe later and have the clinician be the drug.

Show notes

1) Antidepressants for treatment of depression in primary care: a systematic review and meta-analysis 

J Prim Health Care 2016;8:325–34

2) Effective management of depression in primary care: a review of the literature

BJGP Open 2017; DOI: 10.3399/bjgpopen17X101025

In episode 361, James and Mike pull out the PREMIUM card and we digest two recent publications – a cohort study looking at the relation between percent of macronutrients ingested and CVD and mortality and then a much smaller trial of intensive lifestyle in T2DM. At the end we realize that if nutrition guidelines just stuck to looking at the evidence all would be good in the world – at least around eating.

Show notes

Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study.

Lancet 2017 Aug 28

Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial

JAMA 2017 Aug 15;318:637-46

In episode 360, Mike and James finally get to the end of their agitating three part series on treating agitation in dementia. In this episode we talk about the evidence for the non-drug treatments like group or individual activities, music therapy and sensory interventions. Sadly, there is still real uncertainty if these interventions work reliably.

Show notes

Handout

In episode 359, Mike and James continue to agitate over the evidence for treating agitation in dementia. We talk about the use of benzodiazepines, antidepressants cholinesterase inhibitors for this difficult to treat condition. The evidence ends up just increasing our level of agitation as these agents unfortunately really don’t do a heck of a lot for many people.

Show notes

Handout

In episode 358, Mike and James in an agitated and demented way deal with the evidence around agitation in dementia. We find that the antipsychotics have an effect that might be noticeable in 1 in 10 people but if a person responds it likely had nothing to do with the medication. How agitating is that?

Show notes

Handout