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.

In episode 211, Mike and James bring you brief reports of studies that reinforce previous messages. We go all eclectic from honey to lubricant to steroids to salt to omega-3’s and much more. At the end we cross our fingers and hope our informed luck continues.

Show notes

1) Honey for cough

Pediatrics 2012;130;465;on line

2) Self monitoring blood glucose

BMJ
2012;344:e486

3) Lubricant on a speculum

Obstet Gynecol 2012;119:227–31

4) Tennis elbow

JAMA 2013;309:461-9

5) Omega-3 fatty acids

N Engl J Med 2013;368:1800-8

6) A1c and functional impairment

J Am Geriatr Soc 2012;60:1215–21

7) Pancreatitis and cholesterol drugs

JAMA 2012;308:804-11

8) Chlorthalidone vs HCTZ

Hypertension 2012;59:1110-7

9) Heart failure and salt – retraction

Heart Online First, published on March 12, 2013

In episode 210, the Mikes and James discuss the evidence for probiotics for preventing antibiotic induced C. difficile and antibiotic induced diarrhea. We find that the evidence is solid and consistent and supports their use. At the end of the podcast we all get tired of the bathroom humor and decide to retreat to our individual thrones.

Show notes

1) Tools for Practice

Do probiotics prevent Clostridium difficile associated diarrhea in patients taking antibiotics?

In episode 209, Mike and James finally get back to podcasting after a bit of a break. We briefly discuss what we did in Australia and then we limp around the evidence for the use of viscosupplementation for knee osteoarthritis. We find that as the quality of the trials go up the evidence of benefit goes down. At the end we encapsulate everything we know into a pamphlet.

Show notes

1) The Kim Phuc Foundation

2) Tools for Practice

Do injections of viscosupplementations (hylan or hyaluronic
acid) improve symptoms of knee osteoarthritis?

In this very special episode, Mike and James discuss the whole concept of Minimally Disruptive Medicine with one of its founders, Victor Montori. We discuss the principles of reducing the
burden of treatment, encouraging coordination in clinical practice, acknowledging
comorbidity in clinical evidence, and prioritizing from the patient’s perspective. At the end we all realize we tend to be conservative when ignorant and that is OK.

Show notes

1) Minimally Disruptive Medicine

BMJ 2009;339:b2803

2) Useful shared-decision links

http://shareddecisions.mayoclinic.org

http://statindecisionaid.mayoclinic.org

http://diabetesdecisionaid.mayoclinic.org

http://minimallydisruptivemedicine.org

In episode 208, James and Mike PREMIUM to the max with three interesting studies that could change your practice. We talk about duration of steroids for COPD exacerbations, when to start allopurinol after a gout attack and which NSAIDs are the safest from a cardiovascular perspective. You need to hear all about this!

Show notes

 1) Starting allopurinol right after an acute attack of gout

Amer J Med 2012;125:1126-34

2) COPD steroid treatment for acute exacerbations – 5 days or 14 days

JAMA 2013;309(21):doi:10.1001/jama.2013.5023

3) NSAIDs and cardiovascular risk

PLOS Med 2013;2:1-6

In episode 207, Mike and James keep up the pressure on blood pressure measurements. We talk about the magnitude of the benefit, the variability of all these measurements and get into the whole starting and stopping approach. At the end of the podcast we decide the bottom line is to not panic, sit back, put up your feet and relax and try to get your patients to do the same thing.

Show notes

1) NICE – Clinical management of primary hypertension
in adults

2) Blood pressure variability

Hypertension 2010;56:533-9

Am J Hyper 2008;21:3–4

Br J Gen Pract 2010;60:675–80

BMJ 2009;338:b1492

In episode 206, James and Mike start to tackle the holy gospel of blood pressure measurements and interestingly feel under pressure the entire way due to the trickiness of the evidence. We discuss office measurements, automated measurements, home measurements, 24-ambulatory measurements and at the end realize we have likely raised the blood pressure of our listeners but on principle we refuse to measure it.

 Show notes

1) Screening

Canadian Task Force on Preventive Health Care and the Canadian
Hypertension Education Program

2) Automated blood pressures

BMJ 2011;342:bmj.d286 

3) MAPEC study

Chronobiol Int 2010;27:1629-51

4) Waste and Harm in the Treatment of Mild
Hypertension     

JAMA Intern Med. 2013;():1-2. doi:10.1001/jamainternmed.2013.970.
doi:10:1001/jama.2010.920

5) Mild hypertension – effect of propranolol in mild hypertension

Lancet 1966;2:1148–50

In episode 205, Mike and James continue with their discussion on the use of A1c levels in type-2 diabetes. We discuss the variability in the measurement of A1c and given this, how tricky it is to use the A1c once therapy has been started. We also discuss the magnitude of the vascular benefit of therapies that change A1c and come to the conclusion that with all this confusion “minimally disruptive medicine” seems to make a lot of sense.

Show notes

1) The variability of the A1c test

http://diabetes.niddk.nih.gov/dm/pubs/A1CTest/#11

2) Calculators for converting glucose to A1c and vice versa

Diabetic Med 2006;23:1151–4