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

BMJ 2011;342:d2040

2) Probiotics for acute infectious diarrhea

Cochrane review

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?

Lancet 2011;377:650-7

2) Calcium – yet another study showing maybe it isn’t all it was cracked up to be

BMJ 2011; 342:d2040 

3) Tiotropium or salmeterol for COPD?

N Engl J Med 2011;364:1093-1103

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 

Cochrane Library

3) Low fat, low carb vs Mediterranean

N Engl J Med 2008;359:229-41

4) 4 different diets (varying concentrations of carbohydrate, protein and fat)

N Engl J Med 2009;360:859-73

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

Obesity 2006;14:1283-93

Obesity 2008;16:2456–61

7) Mediterranean diet evidence

Lancet 1994;343:1454-59

Ann Intern Med 2009;151:306-14

Lancet 2002;360:1455–61

BMJ 2008;337:a1344

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.

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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.

In Episode 120, Mike and James, in an attempt to truly make this a PREMIUM podcast, elicit Tina Korownyk to yet again help us unravel the mysteries of medicines. In this podcast, we report on two new studies that look at two old therapies for cough and cold symptoms (Vapor Rub and Zinc). We learn that despite coughs and colds being a very common condition, effective therapies are definitely not common.

Show notes

1) Vapor Rub for children with nocturnal cough and cold symptoms

Pediatrics 2010;126:1092-9 

2) Zinc systematic review

Cochrane Library

HI Everyone – sorry for the hit and miss approach to podcasts over the last month or so. Over the last few weeks we had some technological challenges and Mike and I have also needed to spend time getting ready for our Annual Drug Therapy Course here in Vancouver – April 1 and 2. We have had a great response and a couple of weeks we had to put a stop to registration because we can’t fit any more people in the ballroom at the hotel – a great problem to have. Nonetheless, their should be a premium podcast posted either Wednesday or Thursday this week (and what a perfect time to become a Premium Subscriber) but we may need to take another week or so off after the course. I also have not had time to personally respond to a number of questions and comments that have been left on the website but we will get to the questions in a future podcast. For those of you who are coming to Vancouver, I very much looking forward to meeting you and while we will be busy, please try to catch up with us and say hello. THANKS.

In episode 119, Mike and James tackle a few final issues of atrial fibrillation – rate vs rhythm control, anticoagulation in the elderly, what do with high INR numbers, and short-term warfarin interruption. They outline the details in such a clear and succint manner that they decide all you have to do is follow their guidelines but as they really don’t like guidelines it really is unclear what you should do.

Show notes

1) Rate vs rhythm meta-analyses

Arch Intern Med. 2005;165:258-62

European Heart Journal 2005;26:2000–6

Br J Clin Pham 2005;60:347-54

2) Strict versus lenient rate control

N Engl J Med 2010;362:1363-73

3) Other info on atrial fibrillation

N Engl J Med 2008;358:2667-77

Circulation 2006;114;e257-e354

4) Anticoagulation of the elderly

Circulation 2007;115:2689-96

Lancet 2007;370:493–503

5) High INR and Vitamin K

Ann Intern Med. 2009;150:293-300

Chest 2008;133:160–98S

6) Short-term warfarin interruption

Arch Intern Med 2008;168:63-69

Circulation 2006;114;e257-e354

Chest 2008;133;299S-339S