In episode 350, Mike and James talk about the evidence around sleep restriction. The evidence is fairly solid and the results typically suggest an impact greater than sleeping pills with sleep restriction improving sleep for one in every two to six patients compared to sleep hygiene alone.  At the end of the podcast, James realises that Mike presented the evidence while being fast asleep – showing that the concept of sleep restriction actually works.

Show notes

Tools For Practice

Trouble Sleeping: Spend less time in Bed? 

Simplified Sleep Restriction for Insomnia handout

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

CBC (Confusing Broad Check) for Screening?

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

Clinical Question: What are the risks for asymptomatic patients who present with significantly elevated blood pressure?

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

Handout

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

Handout

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

N Engl J Med 2016;375:730-9

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 

DOI: 10.1056/NEJMoa1615664 

2) mystudies.org

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