In episode 155 Mike and James delve into the tricky area of the evidence around using antipsychotics as either monotherapy or augmentation for depression. We discuss that while there is evidence of benefit, the effect is not dissimilar to that seen with antidepressants. 

Show notes

1) Second-generation antipsychotics for major depressive disorder and dysthymia

Cochrane Library

2) Antipsychotics for depression: An acceptable risk/benefit profile?

Tools for Practice

3) Why Olanzapine Beats Risperidone, Risperidone Beats Quetiapine, and Quetiapine Beats Olanzapine

Am J Psychiatry 2006;163:185–94

In episode 154, Mike and James discuss the whole issue of why we use antibiotics. We discuss patient preferences, the use of delayed antibiotics, diagnostic uncertainty and at the end of the podcast we realise that the whole thing is tricky and so we give tips and tricks for how to deal with all the confusion.
Show notes

In episode 153, James and Mike attempt to breath life into a new agent for COPD called roflumilast. Unfortunately, by the end of the podcast we find out that the effect of this agent doesn’t leave Mike and James breathless but unfortunately it will leave our COPD patients that way. 

Show notes

1)Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease

Cochrane Library CD002309

2) Is roflumilast (Daxas®) beneficial as an add-on therapy in the management of COPD?

Tools for Practice

3) Tiotropium or salmeterol for COPD?

N Engl J Med 2011;364:1093-1103

In episode 152, Mike and James stream to the listeners a synopsis of the literature associated with treatments for overactive bladder and urge incontinence. Despite constant interruptions by James, Mike is able to provide a torrent of useful tips and suggestions for this common problem.

Show notes

1) Diagnosing Incontinence

Ann Intern Med 2006;144:715-723

2) Anticholinergics and pelvic floor exercises

Ann Intern Med 2008; 148; 459-73

3) Overactive bladder, urge incontinence and anticholinergic drugs

Tools for practice

4) Overactive bladder drugs

Cochrane 2006;4:CD00378

Cochrane 2007;4:CD003190

Cochrane 2005;3:CD005429

In episode 151, James and Mike start of the new year with premium information so, by law we had to put it in a PREMIUM podcast. The first study we looked at was AIM-HIGH which showed us that we might need to re-assess how we use niacin and we finally have some reasonable data that helps us figure out how long to stay on a bisphosphonate.

Show notes

1) AIM-HIGH – Niacin added to statins in patients with cardiovascular disease

N Engl J Med 2011; 365:2255-67

2) The idolatry of the surrogate 

BMJ 2011;343:d7995

3) HORIZON-Pivotal Fracture Trial – using zoledronic acid for 3 years or 6 years

J Bone Min Res 2011 DOI:10.1002/jbmr.1494

In episode 150, the last for 2011, Mike and James elicit the help of Laurie Mallery and Paige Moorhouse from Halifax. Laurie and Paige guide us through a step-by step approach to deal with frailty and end of life care. We also discuss their PATH (Palliative and Therapeutic Harmonization) clinic developed for older people in Nova Scotia with chronic health conditions.

Show notes

1) Respecting frailty

J Med Ethics 2010. doi:10.1136/jme.2010.040147

2) PATH – Palliative and Therapeutic Harmonization Clinic

pathclinic.ca

In episode 149, Mike and James finally get to the last of the questions and discuss the use of vinegar for weight loss, surrogate markers and what to do about them, steroids for migraine, niacinamide for acne, statins for women, and what is the meaning of life. We discuss, all of these issues in depth and believe it or not at the end of the podcast we actually figure out the meaning of life but accidentally erase that part. We’ll bring that issue up at a later date in a PREMIUM podcast.

Show notes

1) Vinegar for weight loss

Bioscience, Biotechnology, and Biochemistry 2010:73:1837–43

2) Steroids for acute migraines

Academic Emergency Medicine 2008;15:1223–33
BMJ 2008;336:1359–61

3) Statins in women

Circulation 2010;121:1069-77

In episode 148, Mike and James return to the town of Questionville and attempt to answer riddles from near and far. Despite Mike having a cold, we tackle long acting insulins, exercise, multivitamins and varenecline with near Herculean-like abilities but provide answers that are much more on the mere-mortal side.

Show notes

1) Long acting insulins

CADTH report  Long-Acting Insulin Analogues for the Treatment of Diabetes Mellitus

Diabetes Care 2009;32:32-37

Adv Ther 2009;26:535-51

Tools for Practice – The long and short of long acting insulin analogues (versus NPH)

Tools For Practice – Strategies for initiating insulin in Type 2 Diabetics:  What is the optimal regimen for initiating insulin in type 2 diabetes?

2) Activity

QoL stuff

Arch Intern Med 2009;169:269-278

Pedometers

Can Fam Physician 2010;56:887

Exercise Improves: Sleep, osteoarthritis pain, depression, obesity, glucose, lipids, BP

Cochrane 2002;CD003404

J Gerontol A Biol Sci Med Sci 2008;63:997-1004

J Sports Med Phys Fitness 2007;47:462-7

Cochrane 2008:CD004366

Cochrane 2008:CD004376

Inactivity a bigger risk than weight

J Am Geriatr Soc 2010;58:234–241

Activity and mortality

Arch Intern Med 2007;167:2453-2460

JAMA 2003;289:2379-2386

NEJM 2002;347:716-25

JAMA 1995;273:1093-8

Circulation 2008;117: 614-622

PLOS 2008;5: e12.

More activity, better

Br J Sports Med 2008;42:238–243

NEJM 1999;341:650-8

Eur J Epidemiol 2009;24:181–192

RCT of activity vs angioplasty

Circulation 2004;109:1371-8

3) Multivitamin Evidence

A & E harmful

Can Fam Physician 2005;51:1471-2

Tools for practice #10 

Multivitamins unnecessary(among first to be stopped in polypharmacy)

JAMA 2010;304:1592-1601

Vitamin B increases mortality

BMJ 2010;341:c6273

4) Vitamin D

Vitamin D problems

JAMA 2010;303:1815-1822

Rheumatology 2007;46:1852–1857

Regular dose reduces mortality

Cochrane:CD007470

Reduces falls

BMJ 2009;339:b3692 doi:10.1136/bmj.b3692

Cochrane:CD007146

For fractures (yes with Ca+, unsure otherwise)

Cochrane:CD000227

Re-evaluating the whole reference range

J Clin Endocrinol Metab 2011;96:53–58

5) Calcium evidence

Can Fam Physician 2011;57:798

6) Varenicline for smoking cessation

Cardiovascular events

CMAJ 2011;183:1359-66

Pharmacotherapy for smoking cessation

CFP 2011;57:47

In episode 147, Mike and James cover the issue of humor in teaching, put drugectomies in LTC facilities into perspective, discuss the use of antibiotics in COPD, and finally contextualize bisphophonates and estrogen for fracture reduction. At the end they agree that the 30 minutes of podcast excellence should leave the audience laughing and crying but not for the right reasons.

Show notes

1) Chronic antibiotics in COPD

Am J Respir Crit Care Med 2008;178:1139-47

N Engl J Med 2011;365:689-98

2) Bisphosphonates/zoledronic acid

BMC Musculoskeletal Disorders 2011,12:209

N Engl J Med 2007; 356:1809-1822

3) Lower doses of estrogen

Fertil Steril 2001;75:1065-79

In episode 146, a PREMIUM podcast, Mike and James talk about some timely studies. Mike discusses some interesting results from a study that looked at the simple intervention of taking antihypertensives at bedtime and we find out that this intervention not only has an impact on blood pressure but also produces a further reduction in cardiovascular events. James then discusses the latest atrial fibrillation study which looked at what happens to cardiovascular events when you compare warfarin to apixaban. 

Shownotes

1) Taking antihypertensives at bedtime

Chronobiology International 2010;27:1629–51

2) Apixaban versus warfarin in patients with atrial fibrillation

N Engl J Med 2011;365:981-92