In episode 197, James and Mike bring in our good friend and colleague Adil Virani to help us to discuss the issue of ADHD. In this first part we discuss the diagnosis and try to focus on the concept of improving function rather than necessarily improving ADHD symptoms. At the end we all lose focus but realize this is exactly what has happened in the previous 196 episodes.

Show notes

1) Information on Treating ADHD – excellent patient resource on ADHD

2) Influence of relative age on diagnosis and treatment of ADHD

CMAJ 2012;184:755-62

3) The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance

In episode 196, Mike and James squeeze into the literature and look to see if there is a role for drinking cranberry juice in the prevention of urinary tract infections. Given the cost and caloric intake we lean towards prophylactic antibiotics and lean even further towards a 3-day course of antibiotics when symptoms occur.

Show notes

1) Does Cranberry juice or extract prevent recurrent urinary tract infections

Tools For Practice

In this special episode of the podcast, I have a great and lengthy discussion with Ben Goldacre about a variety things from “All Trials”, new drugs, old drugs, guidelines, pragmatic RCTs, to the smartness of the public.

In episode 195, Mike and James go all PREMIUM yet again and discuss the latest Mediterranean diet study for primary prevention. We also review a study that re-looks at niacin for cardiovascular disease prevention. At the end we slather the entire podcast in extra-virgin olive oil and toast its completion with an elegant Merlot.

Show notes

1) Primary Prevention of Cardiovascular Disease with a Mediterranean Diet

N Engl J Med 2013
DOI: 10.1056/NEJMoa1200303

2) Niacin – a combined analysis

Am J Cardiol 2013;111:352-5

In episode 194, Mike and James invite our good friend and colleague David Gardner to layout the evidence for folic acid and Vitamin D for depression. Because there isn’t a lot of definitive evidence we discuss how to make recommendations in the face of limited evidence. We decide that decisions often come down to the chance of harm and what other alternatives are available. At the end, Mike and David decide to take Vitamin D and folic acid just to deal with all the snow they are under. James just goes outside in the sun and gardens.

Show notes

1) Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical Guidelines for the Management of Major Depressive Disorder in Adults

J Aff Disorders 2009;117:S1–S64

2) Enhancement of fluoxetine with folic acid

J Affect Disord 2000;60:121-30 

3) Folic acid with fluoxetine

Neuroimmunomodulation 2008;15:145-52

4) Methylfolate and depression

Lancet 1990;336:392-5

5) L-methylfolate for depression

Am J Psychiatry 2012;169:1267-74

6) Vitamin D as adjunctive therapy to fluoxetine

Aust N Z J Psychiatry 0004867412465022 2012

7) Medication Info Share

8) Effect size illustrator

In episode 193, James and Mike talk about giving iron supplementation to non-anemic women complaining of fatigue. We grow very weak as the podcast gets close to the end and so we try eating an iron dumbbell with mixed success. However, tons of hilarity ensues.

Show notes

1) Tools for Practice

Is iron supplementation a reasonable option in treating non-anemic, menstruating women with unexplainable fatigue? 

2) Very low dose iron

Am J Med 2005;118:1142-7

In episode 192, Mike and James deliver yet more PREMIUM content, in a PREMIUM way to our PREMIUM listeners. We talk about new data on dosing warfarin, using inhaled steroids intermittently, and exercise in patients with heart disease.

Show notes

1) Warfarin dosing

Cochrane CD008685 

2) Intermittent Inhaled corticosteroids

Cochrane CD009611 

3) 10-year study of exercise in CHF

J Am Coll Cardiol 2012;60:1521–8

4) HF-ACTION

JAMA 2009;301:1439-50 

4) Exercise based rehabilitation for heart failure –

Cochrane CD003331

5) Exercise-based cardiac rehabilitation for coronary heart disease

Cochrane CD001800 

In episode 191, Mike and James finally get to the end of the latest listener questions. We try our best to answer issues about niacin, insulin, COPD, hypertension and most importantly sputum color. At the end we also question the questioner’s questions, which leads us to even more questioning.

Show notes

1) Two studies of niacin

AIM-HIGH

N Engl J Med 2011;365:2255-67

HPS2-THRIVE

Forbes

2) Tools for Practice

The long and short of long acting insulin analogues (versus NPH)?

3) Sputum color

Eur Respir J 2012;39:1354–60

4) HYVET

N Engl J Med 2008;358:1887-98

5) Tools for practice

Can Fam Phys 2010;56:1141

5) Chorthalidone versus hydrochlorothiazide

Hypertension 2012;59:1110-7

6) 150 SBP vs 140 SBP

Hypertension 2010;56:196-202

In episode 190, James and Mike answer questions about the zoster vaccine, the flu vaccine, then we shift to estrogen and diabetes and finally discuss something that is not controversial at all, the HPV vaccine.

Show notes

1) Flu vaccine controversy

Center for Infectious Disease Research and Policy 

2) New hormone replacement trial

BMJ 2012;345:e6409. doi: 10.1136/bmj.e6409 

3) Statins and glucose

J Invest Med 2009 57:495-9

In episode 189, James and Mike start off the New Year by briefly discussing the results of the TEC podcast survey. We then delve into some great listener questions. We talk about BMI, diabetes, antibiotic duration, statins etc and provide some great podcast answers. At the end we both drink champagne and get a little giddy – but we doubt anyone will notice.

Show notes

1) Niacin – yet another negative study

HPS2-THRIVE

2) Coenzyme Q10 supplementation for statin-induced myalgias

Am J Cardiol 2012;110:526–9

3) Association of an Intensive Lifestyle Intervention With Remission of Type-2 Diabetes – LookAHEAD

JAMA 2012;308:2489-96. doi:10.1001/jama.2012.67929

4) New BMI study

 JAMA 2013;309:71-82