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June 24, 2020
In episode 451, Mike and James invite Adrienne to talk about how we put all the osteoarthritis evidence into a simplified decision guide. We talk about how we produce these decision guides and also give tips and suggestions around how to use the evidence with patients. Show notes
June 11, 2020
In episode 450 Mike and James continue, with Danielle and Joey, going over our osteoarthritis systematic review. We talk in detail about all the evidence around oral NSAIDs, glucosamine, topical NSAIDs, chondroitin, viscosupplementation, oral opioids, acetaminophen. And now you know all the numbers. Show notes
June 5, 2020
In episode 449, Mike and James invite Danielle Perry and Joey Ton to go over our osteoarthritis systematic review. We talk about all the evidence around exercise, steroid injections, SNRIs, oral NSAIDs, glucosamine, topical NSAIDs, chondroitin, viscosupplementation, oral opioids, acetaminophen.
May 5, 2020
In episode 448, Mike and James go over all the evidence around masks for preventing viral respiratory infections in healthcare workers. We find that surgical masks and N95 masks provide similar protection against viral infections. Unfortunately we have no evidence for COVID-19. Show notes  Tools for Practice
April 16, 2020
In episode 447, Mike and James invite Tina and Mike to talk about a really important topic – is there asymptomatic transmission of COVID-19? The simple answer is yes. Have a listen and hear about all the data and the numbers. Show notes  Tools for Practice
April 16, 2020
In episode 446, Mike and James invite Mike and Tina to talk about all things COVID. In this podcast we look at what are the presenting symptoms, the clinical course and the risk factors for mortality.   Show notes  Tools for Practice
April 9, 2020
In episode 445, Mike and James wade into the evidence-free zone (pretty much) around assessing dyspnea over a telephone/video conference. We talk about the Roth score, respiratory rate, fever, and patient self-rating of dyspnea. Have a listen and see what we found. Show notes The BMJ
March 31, 2020
In episode 444, James and Mike wade into the evidence quagmire around hydroxychloroquine and COVID-19.  The bottom line is the evidence will likely be different around the time you listen to the podcast. So listen quickly. Show notes 1)Tools for Practice
March 26, 2020
In episode 443, James and Mike continue with Mike Kolber and we discuss the evidence around electronic cigarettes and their use for smoking cessation. Overall, the podcast ends up being smoking hot in so many ways. Show notes Tools for Practice
March 17, 2020
In episode 442, James and Mike welcome back Mike Kolber to discuss all the evidence around biosimilars. The issue is exactly the same one we have had for decades with the question around brand name versus generic medications. Tune in and find out the answer. Show notes Tools for Practice
March 9, 2020
In episode 441, James and Mike revisit the problem with guidelines. We talk about recent writings on the issues around guidelines. We discuss the main problems and believe it or not we give advice and suggestions for how to make them better. Show notes 1) Health Affair
February 28, 2020
In episode 440, Mike and James yet again invite Adrienne to go over all the evidence for treating toenail onychomycosis.  We find that ~ 40% more people get better on oral treatments than on placebo. For topicals the number is closer to 10%. Topicals should likely only be used if there is
February 10, 2020
In episode 439, Mike and James invite Adrienne to take us through the impressively large amount of evidence for the PDE5 inhibitors for erectile dysfunction. We find that the NNTs are 2-3 for the not clearly defined endpoint of successful intercourse. There is a 20% absolute increase in adverse effects but almost no one stops using these medications because of these effects. Go figure.
January 22, 2020
In episode 437, Mike and James invite Joey Ton to help us work through all the evidence around Platelet-Rich Plasma (PRP) injections for tendinopathies. The best evidence for Achilles tendinopathy, lateral epicondylitis, and rotator cuff tendinopathy shows no difference in pain, function or return to sport when PRP is compared to dry needling or saline. Show notes
January 16, 2020
In episode 436, Mike and James invite Samantha Moe to help us work through the recent evidence suggesting that hydrocholorothiazide is associated with squamous cell skin cancer. We go over all the numbers and talk about how we use cohort data to figure out if an association needs to influence our clinical practice. As always it is tricky. Show notes
December 31, 2019
In episode 435, Mike and James unravel the evidence around thyroid testing. We talk about an approach to deal with the lack of research and the variation in the measurement of TSH and many other things. At the end we both complain of fatigue, dry skin, puffy eyes, anxiety and depression – and immediately get a TSH test. Show notes 1) Tools for Practice
December 9, 2019
In episode 433, Mike and James get all sweet on the latest diabetic trials from 2019. We provide the results, the critique and the context and we do it all with our usual level of charm and wit – which is by all accounts at a level similar to the size of the effect that many diabetes medications have on CVD events.  Show notes
November 22, 2019
In episode 432, James and Mike finish their review of the evidence around medications for systolic heart failure. In this episode our goal was to try to make sense of the process by adding as much art as possible to the evidence and also use a modicum of common sense. Let us know if we achieved our goal. Show notes
November 7, 2019
In episode 431, James and Mike continue their review of the evidence around medications for systolic heart failure. In this episode we discuss betablockers, ACEIs, ARBs, MRAs and a few other key trials of somewhat newer agents.  Show notes Podcast handout
October 30, 2019
In episode 430, James and Mike do a review of all the best available evidence around medications for systolic heart failure. In this episode we start off by framing the risk associated with heart failure (mortality and hospitalizations for heart failure) and what the evidence is for exercise, salt, diuretics, digoxin and ISDN/hydralazine. Show notes
October 21, 2019
In episode 429, Mike and James continue their discussion with Barb Farrell around deprescribing. We talk in generalities, with occasional brilliant specificity, about the PPI/benzos/antipsychotics/glucose lowering medication deprescribing guidelines. In the end we come up with the astounding idea that maybe some people are on too many medications.
October 15, 2019
In episode 428, Mike and James invite Barb Farrell to discuss all the great work being done by the people at deprescribing.org.  We discuss the general approach to deprescribing and why it is so important to keep this concept front and center of health discussions. Show notes
September 23, 2019
In episode 427, James and Mike invite Mark McConnell back to the podcast to discuss the philosophy around how not to do what didn’t need to be done. You start with a differential diagnosis then think about what are the possible causes of this presentation?
August 30, 2019
In episode 425, James and Mike invite Samantha back again to talk about the evidence around the incidence of opioid use disorder that we cause by prescribing opioids. The key issue seems to be whether or not your patient has a history of substance abuse.  Show notes Tools For Practice
August 14, 2019
In episode 424, James and Mike continue chatting with Samantha Moe about a number of useful studies in primary care. We talk about blood pressures in the elderly, negative urine cultures, melatonin and migraine, dementia and driving, and complementary health products for the common cold. Show notes
August 6, 2019
In episode 423, James and Mike welcome Samantha Moe, a pharmacist and clinical evidence expert with the College of Family Physicians, to the podcast. We discuss studies on cannabis and risk of schizophrenia, the harms of PPIs, H pylori infections and duration of treatment, and blood pressure measurements over clothes or a bare arm. Show notes
July 17, 2019
In episode 421, Mike and James discuss the best available evidence around the newer and typically more expensive iron formulations used for iron deficiency anemia. We find the newer iron formulations are inferior to older ferrous salts when it comes to treating anemia and the evidence that newer formulations have less adverse effects is at best inconsistent.
July 10, 2019
In episode 420, James and Mike welcome back Bruce Arroll to talk about approaches to how we should talk about, discuss, chart and treat mental health issues. We discuss avoiding psychiatric labels, consider giving transdiagnostic labels, and doing functional assessments around work, love, and play. Show notes
June 28, 2019
In episode 419, Tina, Mike and James finish talking about managing opioid use disorder in primary care.  We find that positive reinforcement and brief counseling can be of some value but not the opposite – we realize we should treat this in a similar way to a chronic condition.
June 17, 2019
In episode 418, Tina, Mike and James continue to talk about managing opioid use disorder in primary care. We talk about tools used for case finding and decide the POMI tool is the most useful. We also discuss whether or not tapering is useful and look at the naltrexone data. Show notes
June 7, 2019
In episode 417, Mike and James invite Tina Korownyk to talk about all the work our PEER group did in developing a simplified guideline for managing opioid use disorder in primary care.
May 21, 2019
In episode 415, Mike and James continue with an overview of the evidence around depression. In this episode we talk about the use of antipsychotics for depression or augmentation of antidepressants, stopping antidepressants and the chances of withdrawal, and non-medication treatments. Show notes
May 12, 2019
In episode 414, Mike and James continue with an overview of the evidence around depression. In this episode we talk about antidepressant management nuances from lower doses, to dose escalation, switching, and the time to response. Show notes Handout
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