In episode 128, James and Mike finally get to the last of the listener questions We discuss codeine and cough, Vapor Rub; we talk about the PREMIUM podcast, otitis media and antibiotics, atrial fibrillation and low dose statins. We then both collapse from exhaustion yet promise to get back to making premium podcasts as soon as possible.
Show notes
Codeine and cough
In episode 127, Mike and James attempt to answer questions about topical NSAIDs, bleeds on NSAIDs and SSRIs, Strep throat, statins in the UK, and NSAIDs and CVD risk. They smish and smash all the available data into partly coherent answers, yet give definitive and dogmatic answers with the conviction of a dog with a bone or a cardiologist with a statin.
Show notes
1) SSRIs and bleeds
Alimentary Pharmacology & Therapeutics 2008;27:31-40
Arch Intern Med 2003;163:59-64
2) Dipstick urinalysis
In women with dysuria, frequency, and no vaginal discharge the probability of UTI is 96%
In episode 126, James and Mike discuss how to do a drugectomy and why one needs to consider evidence, efficacy, side effects, cost, patient preference and that as clinicians we need to do many “n of 1” trials. We then discuss the concerns around dabigatran and what to do about bleeding on this agent and why the FDA made the 150 mg dose the chosen one. We also provide commentary on how long we need to give antibiotics and if you really need to take them until they are “all gone”. At the end we advise listeners to only listen to the podcasts until they feel better and then stop before they get any side effects like annoyance or frustration.
Show notes
1) Dabigatran and the FDA – why 150 mg?
In episode 125, Mike and James get back to the listener questions and discuss calcium, probiotics, and clopidogrel. By the end of the podcast Mike threatens to jump out of a 17 story building unless he gets a high fat meal with some caffeine. Out of respect for Mike’s surrogate markers James steals Mike’s Egg McMuffin and coffee and eats it himself.
Show notes
1) Calcium and MI
2) Probiotics for acute infectious diarrhea
2) Clopidogrel
N Engl J Med 2010;362:1374-82
N Engl J Med 2010;362:1441-3
Ann Pharmacother 2008;42:550-7
Arch Intern Med 2007;167:1593-9
N Engl J Med 2007;357:2001-15
3) Clopidogrel Guidelines
NHS 2007 Northwest London Cardiac Network:
Bare Metal: 1 month
Drug Eluting Stent: 12 month
American College of Chest Physicians (2008)
No stent: 12 months
Bare-metal: 12 months
DES: 12 months (or more with no contraindications)
Veterans Affairs (August 2009)
Bare Metal: 1 month minimum, up to 12 months
DES: 12 months – or longer duration if
No bleeding risk and “complex anatomy”
Stent thrombosis indefinite unless bleed risk
4) Prasugrel
N Engl J Med 2007;357:2001-15
5) High fat followed by caffeine
No comment!!!!
In episode, 124 James and Mike go all PREMIUM on the podcast and provide our wonderful PREMIUM subscribers with information that will make them much better health care practitioners than those listeners who are not PREMIUM podcast subscribers. They discuss definitive studies on childhood asthma, COPD and calcium yet at the end they still do not come up with definitive answers and question the PREMIUM nature of this podcast.
Show notes
1) In children with asthma – can you stop inhaled corticosteroids?
2) Calcium – yet another study showing maybe it isn’t all it was cracked up to be
3) Tiotropium or salmeterol for COPD?
In episode 123, Mike and James chew on and regurgitate all the diet data that’s fit for consumption. They figure out that all diets have similar average effects on weight but that only the Mediterranean diet has any evidence of benefit in reducing cardiovascular outcomes. To celebrate this new found knowledge we both celebrate by eating 4 pounds of bacon (tofu bacon for James) dipped in olive oil.
1) Tools for Practice
Is any diet better for weight loss or preventing negative health outcomes?
2) Low glycaemic index or low glycaemic load diets for overweight and obesity
3) Low fat, low carb vs Mediterranean
4) 4 different diets (varying concentrations of carbohydrate, protein and fat)
5) Cohort data – increased mortality with low carb diets especially if protein and fat from animal sources
Eur J Clin Nutr 2007;61:575-81
Ann Intern Med 2010;153:289-98
6) Very low calorie diets
7) Mediterranean diet evidence
Hi Everyone: Well we tried to get back the “lost” recordings but the cost of doing so would have offset the debt of a small country. Mike and I will be back in the luxurious TEC studies next Monday so we should be able to put out a new podcast sometime next week. Thanks for you patience.
Hi Everyone. Mike and I recorded a couple of podcasts 4-5 days ago and 2 hours after recording them the computer we used had a major hard drive failure. So far we have been unable to recover the recordings. We have a few more tricks up our sleeve to recover the files but we can’t do anything until after the Easter holidays. Hopefully we’ll get the next latest and greatest (at least in our minds) podcasts posted next week sometime. If we can’t recover the data, we’ll have to re-record them and so it may take a little longer. Thanks and both of us hope you have a good time with family and friends over this long weekend and as always thanks for listening.
PLAY/DOWNLOAD THIS EPISODE FOR FREE
In episode 122, James and Mike welcome to the podcast a good friend and colleague Mark McConnell, an internist from Lacrosse, Wisconsin. We discuss how Mark became interested in evidence and how his practice has evolved, for the better, by incorporating the concepts of evidence and shared-informed decision making. At the end we get a very special message from Reverend Lovejoy’s identical twin who really provides us with the most insightful comment of the whole podcast.
In episode 121, Mike, James and Tina tackle the issue of who needs a bone density measurement and describe a simple tool that will help you with that decision.
However, at the end, Mike threatens to jump out of his building and James and Tina talk him down by promising not to measure his BMD more than once.
Show notes
1) Tools for Practice
Screening for Osteoporosis – Who Should Receive Bone Mineral Density Testing?
2) Osteoporosis Self Assessment Tool (OST)
Simple application of OST:
Age – Weight (kg)
If greater than minus 5, increased risk of osteoporosis and BMD is warranted
A cut-off of greater than positive 5 should be used for Asian patients.
THE NUTRITION PROPOSITION BOOK
Check it out at nutritionproposition.com and think about picking up a copy on Amazon. All the evidence you ever wanted about nutrition and the only nutrition book that won’t tell you what to eat.
This pragmatic trial is now recruiting in BC. Make a difference and get involved with pragmatic trials (www.pragmatictrials.ca)
