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.

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?