In episode 185, Mike does a stellar job of reviewing the painfully complex literature around the treatment of neuropathic pain – diabetic neuropathy, post-herpetic neuralgia, trigeminal neuralgia. James as usual just adds to the painful nature of the whole process. In this particular episode we discuss the use of antidepressants and at the end we realize we shouldn’t call these agents antidepressants and decide to call them Kevin.

Show notes

1) Antidepressants for neuropathic pain

Cochrane CD005454

2) Duloxetine for neuropathic pain

Cochrane CD007115

In episode 184, James and Mike don their PREMIUM critical appraisal hats yet again to report the results of important recent studies that examine the impact two “new” drugs, aliskiren and dalcetrapib, have on clinically important outcomes. Unfortunately, these well-designed studies show yet again there is no guarantee that if you change cholesterol or blood pressure that clinically important outcomes will decrease.

Show notes

1) Aliskiren

N Engl J Med 2012.
DOI: 10.1056/NEJMoa1208799 

2) Dalcetrapib

N Engl J Med 2012.
DOI: 10.1056/NEJMoa1206797

In episode 183, the Mikes and James shine a bright light on the evidence around the use of proton pump inhibitors. We look at the good and bad outcomes and realize it is all about the numbers and the quality of the evidence. After 45 minutes the bright light and our knowledge starts to dim until we get to the end of the podcast when we shut the light off completely.

Show notes

1) Benefit of PPIs versus H2RA and placebo

Acute 

Cochrane Library CD003244

Chronic http://www.cks.nhs.uk/dyspepsia_proven_gord/evidence/supporting_evidence/no_response_to_initial_therapy/extending_treatment_duration#-330424

2) Prevention of NSAID –induced endoscopic ulcers

Cochrane Library CD002296

3) Stress ulcers

Crit Care Med 2010;38:1-7

4) Rebound

Gastroenterology 2009;137:80-7

5) Withdrawal

Gastroenterology 2001;121:1095–1100

Aliment Pharmacol Ther 2007;25:709–714

6) On demand use

Am J Gastroenterol 2007;102:642–653

7) Esomeprazole

Clin Gastro Hepat 2006;4:1452–8

8) Interactions

BMJ 2012;345:e4388 doi: 10.1136/bmj.e4388

9) Fractures

Drugs 2012;72:437-45

10) Pneumonia

Cleveland Clinic J Med 2011;78:39-49

11) C. difficile

Dig Dis Sci 2011;56:931–50

12) Iron and B12, and cancer

Dig Dis Sci 2011;56:931–50

In episode 182, the Mikes and James talk about the evidence behind the zoster vaccine. We give all the numbers you could possibly want to discuss this with your patients so that they can help you make up your mind what is best for them. As always, the greater the risk the greater the potential benefit. At the end of the podcast the Mikes wrap James in barbwire in an attempt to demonstrate to the listening audience the concept of post-herpetic neuralgia.

Show notes

1. Zoster vaccine evidence

N Engl J Med 2005;352:2271-84

Clinical Infectious Diseases 2012 (in press)

Clinical Infectious Diseases 2012;54:922–8

Ann Intern Med 2010;152:545-54

2. Zoster incidence etc

Can J Infect Dis Med Microbiol 2010;21:45-52 

CMAJ 2010. DOI:10.1503/cmaj.091711

BMJ 2000;321:1–4

Journal of Infectious Diseases 2012;206:190–6

Mayo Clin Proc 2011;86:88-93

National Advisory Committee on Immunization (NACI) 2010; 36: 1-19. Accessed October 15, 2012. http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/10vol36/acs-1/index-eng.php

MMWR 2008; 57(5):1-30. Accessed October 15, 2012. http://www.cdc.gov/MMWR/preview/mmwrhtml/rr5705a1.htm 

In episode 181, James and the two Mikes (Alan and Kolber) discuss two new drugs – one for constipation (prucolapride) and one for gout (feboxustat). We conclude that despite the fact there are studies for both of these drugs published in the New England Journal of Medicine, they really are not ready for primetime.
Show notes
1) Prucolapride

In episode 180, Mike and James invite Mike Kolber back to go over the three major trials that have compared warfarin to the new oral anticoagulants. We try, with limited success, to put all the science into perspective. At the end of the podcast, against all odds, we each have a stroke and a major bleed at the same time which dampens our recommendations.

Show notes

1) Tools for Practice

Novel Oral Anti-coagulants (NOACs): is newer better? 

2) peterloewen.com for stroke risk and benefit calculator 

In episode 179, we again ask Tina Korownyk to join us to help with the topic of screening for lung cancer. We review the most recent study that looked at the risks and benefits of screening high-risk individuals (smoking history of at least 30 pack-years) with low dose CT. At the end we come up with the shocking conclusion that we need to discuss the benefits and risks with patients and that smoking cessation should be a priority.

Show notes

1) RCTs of low dose CT for lung cancer screening

NEJM 2011;365:395-409

ACP Journal Club. 2011;155:JC5-6

Am J Respir Crit Care Med 2009;180:445-453

2) Other useful info

Thorax 2012;67:296-301

Cochrane Database Syst Rev 2004:CD001991

Radiology 2005;235:259-65

Annals of Internal Medicine 2011;155:137-44

JAMA 2012;307:2418-2429

International Journal of Cancer 2007;120:868-74

http://www.lung.org/lung-disease/lung-cancer/lung-cancer-screening-guidelines/lung-cancer-screening.pdf

J Thorac Cardiovasc Surg 2012;144:33-8

JAMA 2005;294:1505-1510

In episode 178, Mike and James invite Tina Korownyk to discuss the evidence around antibiotic choice for respiratory infections. We discuss issues surrounding the choice of treatment for CAP and upper respiratory infections in a very atypical way by suggesting that covering for atypicals may not be necessary. As we typically do we digress at the end and inappropriately recommend amoxicillin for hypertension and erectile dysfunction.

Show notes

1) Systematic review of community acquired pneumonia

BMJ 2005;330:456–60

2) Hospitalized community acquired pneumonia broad versus narrow spectrum

Cochrane Library CD004418

Arch Intern Med 2005;165:1992–2000

3) Choice of antibiotic for CAP

“Currently available evidence from RCTs is insufficient to make evidence-based recommendations for the choice of antibiotic to be used for the treatment of CAP in ambulatory patients”

Cochrane CD002109

4) Duration of treatment for CAP

“The evidence of this review suggests that a short course (three days) of antibiotic therapy is as effective as a longer treatment (five days) for non-severe CAP in children under five years of age. However, there is a need for more well-designed RCTs to support our review findings”

Cochrane CD 005976

5) Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo- controlled study

Lancet 2007;369:482–490

6) 1st-line versus 2nd line antibiotics for acute exacerbation of chronic bronchitis

Chest 2007;132:447-55

7) Amoxicillin versus amoxicillin/clavulanate in AECOPD

Int J Chron Obstruct Pulmon Dis. 2009;4:45-53. 

8) Sinusitis

Pediatrics 1986;77:795–800

Pediatrics 2001;107:619–258. Canadian Bacterial Surveillance Network

http://microbiology.mtsinai.on.ca/research/cbsn/default.asp

In episode 177, Mike and James, both high as a kite on caffeine, discuss the health benefit evidence around coffee ingestion and also discus the evidence or lack thereof of the heath issues around the use of organic foods. At the end we come to the conclusion that ketchup is really the quintessential food and decide that it goes well with everything.

1) Association of Coffee Drinking with Total and Cause-Specific Mortality

Largest cohort N Engl J Med 2012;366:1891-1904

OTHER STUDIES

Ann Intern Med 2008;148:904-914

Eur J Epidemiol 2011 ;26:285-93

J Nutr 2010;140:1007-13

Br J Nutr 2008;99:1354-61

Diabetologia 2006;49:2618–2626

Diabetologia 2009;52:810–817

Arch Intern Med 1978;138:1472-5

Ann Epidemiol 1993;3:375-81

BMC Cancer 2011;11:96

Ann Oncol 2011;22:536-44

BJU Int 2010;106:762-9

Ann Oncol 2012;23:311-8 

J Natl Cancer Inst 2010;102:771–783 

J Epidemiol Community Health 2011;65:230-40

Am J Epidemiol 2011;174:993–1001 

Arch Intern Med 2000;160:3393-3400 

Arch Intern Med 2009;169:2053-2063

Arch Intern Med 2011;171:1571-1578

BMJ 2003 Feb 22;326:420

2) Are Organic Foods Safer or Healthier Than Conventional Alternatives?

Ann Intern Med 2012;157:348-66

3) TEC podcast survey link – PLEASE GIVE IT A GO

https://www.surveymonkey.com/s/MF7GRGM

In episode 176, we get back to a non-PREMIUM podcast and discuss the evidence around the venous thromboembolism risk associated with different types of hormonal contraception. In our ongoing desire to provide our podcast listeners with solid information both Mike and James started taking oral contraceptives a few years ago and they are glad to report that neither have developed any side effects (at least that they are willing to discuss) and, believe it or not, neither of them have become pregnant.

Show notes

1) What are the Venous Thromboembolism risks with varying Hormonal Contraception?

Tools for Practice