In episode 220, James and Mike delve into the scary evidence zone of statistical significance. We discuss p-values, confidence intervals and in a confusing manner explain why many authors are confused about what is actually quite a simple concept. We also show how misinterpretation leads to inappropriate author conclusions. At the end we decide the podcast overall trended towards marginal significance.

Show notes

1) How confidence intervals become confusion intervals

BMC Medical Research Methodology 2013, 13:134  doi:10.1186/1471-2288-13-134

In episode 219, Mike and James final get to the end of the Vitamin D trilogy by reviewing the data for fractures and falls, mortality and cancer. At the end they identify that the best thing one can do when it comes to Vitamin D is to stand in the sun in a speedo bathing suit and eat mackerel – however the authorities intervene before that actually happened.

Show
notes

1) Vitamin D and fractures

Cochrane 2009;2:CD000227

Ann Intern Med 2011;155:827-38

Arch Intern Med 2009;169:551-61

N Engl J Med 2012;367:40-9

2) Vitamin D and falls

Cochrane 2009;2:CD007146

Cochrane 2010;1:CD005465

J Am Geriatr Soc 2010;58:1299-1310

BMJ 2009;339:b3692

Can Geriatric J 2011;14:93-9

Ann Intern Med 2010;153:815-25

J Clin Endocrinol Metab 2011;96:2997-3006

3) Vitamin D and mortality

Cochrane 2011;7:CD007470

Arch Intern Med 2007;167:1730-7

J Clin Endocrinol Metab 2012;97:2670–81

J Clin Endocrinol Metab 2011;96:1931–42

4) Vitamin D and Cancer

Ann Intern Med. 2011;155:827-38

Am J Clin Nut 2007;85:1586-91

5) Diabetes

Age Ageing 2009;38:606-9

Eur J Nutr 2009;48:349–54

Diabet Med 2008;25:320-5

6) Vitamin D and sun

J Clin Endo Metab 2009;94:1092–3

N Engl J Med 2007;357:266-81

7) Harm

Am J Clin Nutr 2007;85:6-18

In episode 218, Mike and James give you more and more Vitamin D love. We look at Vitamin D for MS, depression and upper respiratory tract infections and basically Vitamin D does nothing for these conditions – so go forth and share the love – which means not recommending Vitamin D for these conditions.

Show notes

1) The Calcium and Vitamin “Bible”

Dietary Reference Intakes for Calcium and Vitamin D. Institute of Medicine 2011. 

http://www.ncbi.nlm.nih.gov/books/NBK56070

2) Vitamin D and MS

Neurology 2004;62:60-5

J Neurol Neurosurg Psychiatry 2012;83:565e571

Neurology 2011;77:1611-8

Neurology 2010;74:1852-9

kampmanMult Scler 2012;18:1144-51

Immunol Invest 2011;40:627-39

3) Vitamin D and depression

Brit J Psych 2013; 202:100–7

Nutrition Journal 2004;3:8

J Int Med 2008 264:599–609

PLoS ONE 2011;6: e25966

Brit J Psych 2011;198:357–64

Brit J Psych 2012;201:360–8

Am J Epidemiol 2012;176:1–13

Menopause 2012;19:697–703

J Clin Psychopharmacol 2013;33:378-85

4)Vitamin D and URTI

Epidemiol Infect;2009:137:1396–1404

The Journal of Infectious Diseases 2010; 202:809–14

Rees JR, et al.  Clin Infect Dis. 2013 Sep 6. Pub online

JAMA 2012;308:1333-9

Am J Clin Nutr 2010;91:1255–60

BMJ Open 2012;2:e001663

Age and Ageing 2007;36: 574–92

Trop Med Int Health 2010;15:1148-55

Lancet 2012;379:1419–27

In episode 217, Mike and James level the playing field by talking about the evidence behind recommended Vitamin D levels. We then start to look at the evidence for the use of Vitamin D in a variety of conditions, starting off with rheumatoid arthritis. At the end we realize the recommendations are far stronger than the evidence – surprise, surprise.

Show notes

1) The Calcium and Vitamin “Bible”

Dietary Reference Intakes for Calcium and Vitamin D. Institute of Medicine 2011. 

2) Variability in measurements

J Clin Endocrin Metab 2004;89:3152-7

Ost Int 1999;9:394-7

3) Vitamin D levels and outcomes

Am J Clin Nutr 2006;84:18–28

BMJ 2009;339:b3692

Arch Intern Med 2009;169:551-61

4) Change in level with 800 IU

Scand J Clin Lab Invest 2006;66:227–38

5) Vitamin D and rheumatoid arthritis

Arthritis Rheum 2004;50:72-7

Ann Rheum Dis 2008;67:530–5

Autoimmun Rev 2012; 12:127–36

Semin Arthritis Rheum2011;40:512-31

Rheumatol Int 2012;32:3823–30

Rheumatol Int 2012;32:2129–33

Int J Rheum Dis 2011; 14:332–9

Scand J Rheumatology 1973;2:173-176

In episode 216, Mike and James finally get to the last of the listener questions. We discuss the numbers around the pneumococcal and influenza vaccines, metformin and contraindications, the timing of antihypertensives, and stuff for osteoporosis. Ironically we end with the question “does any of this mean anything in the grand scheme of things?” and we design a metaphorical RCT to answer that question.

Show notes

1) Metformin and harm

Benefits and harms of antidiabetic agents in patients with diabetes and heart failure: systematic review

BMJ 2007;335:497

2) Metformin’s contraindications should be contraindicated

CMAJ 2005;173:502-4

2) MAPEC study

Chronobiol Int 2010;27:1629-51

3) Tools for Practice

Does calcium (Ca+) supplementation contribute to increased risk of myocardial infarction (MI) and other cardiovascular disease (CVD)?

4) CVD risk calculator

http://bestsciencemedicine.com/chd

In episode 213, Mike and James get back to listener questions and we talk about hormones and VTE, gliptins, sulfonlyureas. statins, risk calculators, the elderly and statins and targets. At the end we answer the question “what is the meaning of life” but unfortunately we ran out of tape and this answer wasn’t recorded.

Show notes

1) The ESTHER study

Circulation 2007:115:840-5

2) Gliptins/DPP4s, sulfonlyureas

SAVOR-TIMI 53 – saxagliptin and cardiovascular outcomes

September 2, 2013DOI: 10.1056/NEJMoa1307684 

EXAMINE – alogliptin and cardiovascular outcomes

September 2, 2013DOI: 10.1056/NEJMoa1305889

Sulphonylureas and risk of cardiovascular disease:systematic review and meta-analysis

Diabet Med 2013;30:1160–71

3) Statin intolerance

RxFiles – Statin intolerance – management considerations

4) The greatest CVD risk calculator ever

5) Statins and the elderly

J Am Coll Cardiol 2013;doi:10.1016/j.jacc.2013.07.069

In episode 214, James and Mike notch the discussion up to a PREMIUM level yet again. We discuss the 2 new gliptin studies, SAVOR-TIMI 53 (saxagliptin) and EXAMINE (alogliptin) and we find that low and behold these medications lower glucose and have no impact on cardiovascular disease. At the end we lament this lack of cardiovascular benefit by singing a chorus of “Another One Bites The Dust”.

Show notes

1) SAVOR-TIMI 53 – saxagliptin and cardiovascular outcomes

September 2, 2013DOI: 10.1056/NEJMoa1307684 

2) EXAMINE – alogliptin and cardiovascular outcomes

September 2, 2013DOI: 10.1056/NEJMoa1305889

In episode 213, James and Mike continue on their merry quest of answering the world’s problems. We discuss CRP, ibuprofen for pain, zoster vaccines, thiazides and risk calculators. The questions are answered so well that at the very end Mike and James also solve world hunger and the Middle East crisis.

Show notes 

1) CRP measurements

PLoS Med 7(2):e1000196.doi:10.1371/journal.pmed.1000196

2) Ibuprofen dosing

NEJM 1991;325:87-91

3) 200 vs 400 mg of ibuprofen for headaches

Headache 2001;41:665-79

4) Zoster vaccine

Tools for practice

Zoster vaccine: Zoster loster or imposter coster?

5) Thiazides reduce blood pressure in patients with severe
renal disease

Ann Pharmacother 2012;46:1554-8

6) The greatest CVD risk calculator ever

In episode 212, Mike and James get back into the saddle by jumping into a gamish of listener questions. We perfectly discuss triglycerides, pancreatitis, risk calculators, antibiotics and everything else that is of upmost importance to all health care professionals across the world. At the end James and Mike get counseling for delusions of grandeur.

Show notes 

1) Lipid-modifying therapies and risk of pancreatitis: a meta-analysis

JAMA 2012;308:804-11

2) The “BEST” Risk Calculator ever 🙂

http://bestsciencemedicine.com/chd

Agreement among cardiovascular disease risk calculators

Circulation 2013;127:1948-56

3) Antibiotic stewardship

Aminoglycoside use and monitoring

Clin
Inf Dis 1992;14:320-39

Pharmacotherapy 2000;20:1524-7

Aminoglycoside combinations

BMJ 2004;328:668

Clin Infect Dis. (2013)doi: 10.1093/cid/cit223

4) A prescription for improving antibiotic prescribing in primary care

BMJ 2012;344:d7955

5) Viva La Evidence – a parody of Coldplay’s Viva La Vida – it’s all about evidence-based healthcare – a little bit about the history of evidence and then the key principles.

http://youtu.be/QUW0Q8tXVUc

Hi Everyone – Not really a podcast this week but hope you find it useful/entertaining. Would love feedback. The video can also be found on YouTube at http://youtu.be/QUW0Q8tXVUc . If you like it let people know.