In episode 303, James and Mike finally get back into PREMIUM mode. We discuss two new hypertension meta-analyses that help clarify (at least somewhat) what we can be discussing with patients. In addition, we discuss a great new study on acute back pain and whether or not we should add a narcotic or a muscle relaxant and one study on what to use for chlamydia. You can’t get any more PREMIUM than that.

Show notes

1) Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses

BMJ 2016;352:i717

2) Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels – updated overview and meta-analyses of randomized trials

Journal of Hypertension 2016, 34:000–000 

3) Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain

JAMA 2015;314:1572-80

4) Azithromycin versus Doxycycline for Urogenital Chlamydia trachomatis Infection 

N Engl J Med 2015;373:2512-21

In episode 302, James, Mike, Tina and Mike talk about the drugs that didn’t make their top 20 list of post-apocalyptic medications. You might be surprised. At the end of this we would love your feedback to see if you think we got the list right.

In episode 301, James, Mike, Tina and Mike continue on their merry way after surviving Armageddon and discuss the last 10 (actually 11) medications in their top 20 essential medications list.

In episode 300, James, Mike, Tina and Mike have survived an apocalyptic event and they have been left with clean water, a proper sewer system, lots of good food but NO MEDICATIONS. Their task is to choose only 20 medications they can use for the foreseeable future.  Tune in to find out what they are – you may be shocked, amazed and astounded.

In episode 299, James and Mike get back to the podcast business with the scintillating topic of nasal saline irrigation for rhinosinusitis. We find that for acute symptoms, the evidence doesn’t support a benefit but there may be some value for chronic rhinosinusitis. At the end of the podcast Mike takes the evidence to heart goes home and sticks his head in his pool and breaths in deeply. 

Show notes

Coming soon

In episode 298, Mike, James and Tina discuss the evidence and use of Anti-CCP as a test for adult rheumatoid arthritis. We find that this test may be more useful than rheumatoid factor when it comes to figuring out if a patient has rheumatoid arthritis.

Show notes

1) Tools for Practice

Anti-CCP: A truly helpful Rheumatoid Arthritis lab test? 

2) Likelihood values and what do they mean – Diagnosis in primary care: probabilistic reasoning

J Prim Health Care 2012;4:166-73

In episode 297, Mike, James and Tina chat about a treatment that takes 2-5 minutes and has an NNT of 2-3 – it doesn’t get much better than that. While there isn’t a lot of evidence around the Epley maneuver for benign paroxysmal vertigo, what there is is fairly impressive – in fact it made our heads spin.

Show notes

Evaluating the Epley maneuver

Can Fam Phy 2015;61:779

In episode 296, Mike and James invite Alan Cassels to help us discuss a deprescribing resource we created called MedStopper which you can find at medstopper.com. We talk about where the idea came from and how we created the database for MedStopper. We would love it if you would check out the site and let us know what you think.

Show notes

1) The MedStopper Site

medstopper.com

2) The Med Stopper SONG – a parody of the Beatles song Day Tripper

3) Alan’s website – where media and medicine meet

In episode 295, Mike and James discuss the latest blood pressure target trial in an impressive PREMIUM way. We also discuss the most recent meta-analysis that looked at all of the studies (except SPRINT) that have evaluated intensive blood pressure lowering. At the end we put the entire process into a perfect perspective that some have called earth shattering; and you can only find out what we think by becoming a PREMIUM member.

Show notes

1) The SPRINT trial

N Engl J Med 2015; 373:2103-16

2) Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis 

November 6, 2015 http://dx.doi.org/10.1016/ S0140-6736(15)00805-3 

In episode 294, Mike and James put the nail in the coffin on the evidence around inhalers for COPD. We discuss the evidence and studies around combination inhalers and the treatment of acute exacerbations of COPD. The bottom line is never, ever, ever, smoke.

Show notes

FOR COPD

See episode #292