In episode 349, Mike and James talk about the evidence around screening otherwise asymptomatic adults with a complete blood count. While it feels like it should be a good thing to do, the evidence is pretty clear that it doesn’t provide any benefit even though ~ 10% of tests will be abnormal. Basically no one benefits and serious disease is virtually never found.
Show notes
Tools For Practice
In episode 348, Mike and James invite Mike Kolber yet again and he urgently works us through the evidence for treating hypertensive urgency. At the end we realize that asymptomatic patients with BPs >180/110 mmHg can be dealt with addition or initiation of oral agents at presentation with close outpatient follow-up. Even though it is “urgent” we don’t need to panic.
Show notes
Tools For Practice
In episode 347, Mike and James get Mike Kolber to work us through all the evidence around chewing gum after bowel surgery. Believe it or not there are lots of studies and believe it or not there is reasonable benefit. The only tricky part would be to try to get hospitals to implement this protocol.
Show notes
Tools For Practice
Clinical Question: Does chewing gum after surgery improve bowel function?
In episode 346, Mike and James have Adrienne work us through the rest of the evidence for medications used to treat nausea and vomiting around pregnancy. We specifically look at the evidence for diclectin, B6 alone, ginger and ondansetron and then try to figure out what we would use.
Show notes
In episode 345, Mike and James enlist Adrienne Lindblad to help us go through the tricky topic of taking medications in pregnancy. Adrienne covers the topic in general and then discusses some of the evidence around medications for nausea and vomiting around pregnancy.
Show notes
In episode 344, Mike and James discuss the impact of giving fish oil supplementation to reduce the chance of allergic disease in children. The results are consistently inconsistent which leaves us both kind of itching for the truth.
Show notes
Tools for Practice
Preventing Allergies with Omega-3 in Pregnancy: Another fishy idea?
In episode 343, Mike and James talk about a paper they recently published about how we need to think about confidence intervals and how one can think overall about the results of clinical trials. The bottom line is to be more pragmatic and less dogmatic and remember the answers are rarely yes and no.
Show notes
Are potentially clinically meaningful benefits misinterpreted in cardiovascular randomized trials? A systematic examination of statistical significance, clinical significance, and authors’ conclusions.
BMC Med. 2017 Mar 20;15(1):58. doi: 10.1186/s12916-017-0821-9
In episode 342, James and Mike talk about yet another Vitamin D meta-analysis and explain why it really changes nothing when it comes to Vitamin D. But then we talk about a novel RCT on ultrasound treatment for serious hand tremor and it makes us shake all over.
Show notes
1) Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data
BMJ 2017;356:i6583 http://dx.doi.org/10.1136/bmj.i6583
2) A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor
In episode 341, James and Mike talk about the long awaited trial of evolocumab that evaluated the impact it has on cardiovascular outcomes. Certainly not a homerun – maybe a very expensive full swing bunt with an error that leads to a single.
Show notes
1) Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease
2) mystudies.org
In episode 340, Mike and James get all bent out of shape when they discuss the evidence around spinal manipulative therapy and low back pain. The evidence suggests no reliable effect for acute pain but the possibility of an effect for chronic pain. But any recommendations are a stretch because of the poor quality of the evidence.
Show notes
Tools for practice
Manipulating research for spinal manipulative therapy for low back pain
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)
