Practical Talks for Family Docs

In episode 600, James and Mike invite Jamie Falk back to the podcast again and we talk about if exercise helps movement in Parkinson's disease. You might be surprised by the size of the effect so have a listen and get all the evidence and numbers you need. Show Notes Tools For Practice Exercise for Parkinson's Disease: More movement = Better movement? MEME Conference 2025 In Vancouver – May 9/10, 1025

In episode 599, James and Mike invite Roni Kraut to the podcast for the first time to talk about a common problem that has a simple answer. What route and/or duration of antifungals is needed when treating uncomplicated vulvovaginal candidiasis in non-pregnant women. Tune in to find out all the simple details. Show Notes Tools For Practice A single dose for treating yeast infections: Is it really this simple? MEME Conference 2025 Vancouver – May 9/10, 1025

In episode 598, James and Mike continue to talk with David Gardner about the issue of insomnia. We discuss his latest, very cool, Your Answers When Needing Sleep (YAWNS NB) randomized clinical trial. YAWNS was a pragmatic, open-label, minimum-contact, RCT where people with long-term use of benzodiazepines and current or past insomnia were randomly allocated to different mailed behavior change interventions or no intervention. They found that in people who got the intervention more of them stopped or reduced the dose of their benzodiazepines and more improved their sleep. Tune in for the numbers for this simple intervention. Show Notes The YAWNS NB trial Booklets: order booklets via the Resource Centre Sleepwell, a research and knowledge translation program based out of Dalhousie University in Halifax, includes tools, resources, and recommendations for patients, the public, and health care professionals. Some features and resources to explore are: Sleepwell stories (patient and health care professional video and written accounts) Clinicians – short videos on how to use get what you need from the website for patient care, and CBT-I training options Sleepwell recommends – vetted reviews and recommendations for self-help CBT-I programs Sleeping pills – content to motivate and facilitate safely ending long-term use of sedatives Tools – sleep diary, online sleep calculator (with guidance for time-in-bed restriction therapy), behaviour change tools (CBTi vs. Sleeping Pills) Zopiclone's residual effects on actual driving performance in a standardized test: a pooled analysis of age and sex effects in 4 placebo-controlled studies Clin Ther 2014 Jan 1;36(1):141-50. doi: 10.1016/j.clinthera.2013.11.00 Audio Player      

In this episode of In the Clinic, Mike and Jess invite back Dr. Émélie Braschi. The team discusses Mr. Ramakanta, a 75-year-old man who is having trouble sleeping at night and difficulty breathing in the day time.

In episode 597, James and Mike invite David Gardner to talk in depth about the issue of insomnia. We talk about triggers, precipitating factors, acute and chronic insomnia, and chronic use of sleeping pills. We discuss Cognitive Behavioral Therapy for Insomnia (CBT-I) and how his team has developed a comprehensive website, Sleepwell, that provides patients and clinicians with great tools and recommendations for the self-care of chronic insomnia. Mike stays awake for the whole podcast and James only has a brief nap. Show Notes Sleepwell, a research and knowledge translation program based out of Dalhousie University in Halifax, includes tools, resources, and recommendations for patients, the public, and health care professionals. Visit https://mysleepwell.ca/ Some features and resources to explore are: Sleepwell stories (patient and health care professional video and written accounts) Clinicians – short videos on how to use get what you need from the website for patient care, and CBT-I training options Sleepwell recommends – vetted reviews and recommendations for self-help CBT-I programs Sleeping pills – content to motivate and facilitate safely ending long-term use of sedatives Tools – sleep diary, online sleep calculator (with guidance for time-in-bed restriction therapy), behaviour change tools (CBTi vs. Sleeping Pills)

In episode 596, Mike and James talk in a PREMIUM way about three trials that used methotrexate for osteoarthritis and walking for back pain. Nothing miraculous but there seems to be an effect – so have a listen.

In episode 595, Mike and James invite Jennifer Young back to talk about the use of combined oral contraceptives for heavy menstrual bleeding (benign etiology) and see if they improve patient outcomes. They do! Have a listen to get all the numbers and see how they compare to using levonorgestrel-containing intrauterine devices or NSAIDs. Show notes Tools for Practice 1) How to Slow the Flow: Combined oral contraceptives 2) How to Slow the Flow: Tranexamic acid for heavy menstrual bleeding 3) How to Slow the Flow: Levonorgestrel intrauterine systems for heavy menstrual bleeding 4) How to Slow the Flow: NSAIDs for Heavy Menstrual Bleeding

In episode 594, Mike and James invite Samantha Moe back to talk about the use of the RSV vaccine in pregnancy. The only way to have an informed conversation around this vaccine is to know the numbers. If you listen to the whole podcast, you'll get all the numbers available to date. Show notes Tools for Practice 1)Bumpin' Up the Protection? RSV Vaccine in Pregnancy 2) Preventing RSV Infections in Infants 3) Preventing RSV in the elderly

In episode 593, Mike and James invite Samantha Moe back to talk about a newer agent for osteoporosis. So, if you want to know all the evidence for romosozumab, tune in and all will be revealed about the benefits and harms. Show notes 1) Tools for Practice Tony Romo-sozumab: Winning touchdown in osteoporosis or interception for the loss? 2) FRAX site for Canada

In this episode of In the Clinic, Mike and Jess invite back Dr. Émélie Braschi. The team discusses Jay Mal, a 9 year old boy presenting with fatigue and fever.

In this episode of In the Clinic, Mike and Jess invite back Dr. Jennifer Young. The team discusses Brea Salter, a 4-year old girl presenting with wheezing.

In episode 592, Mike and James invite Jennifer Young back to the podcast to review the evidence around the use of antidepressants in the challenging pain condition of fibromyalgia. We find there is an effect but, if you are going to help people make decisions, what you really need to know are the numbers for the benefits and harms around the use of these medications. We give you those, so have a listen. Show notes Tools for Practice Pharm for Fibro: Can antidepressants ease the pain?

In episode 591, Mike and James invite Samantha Moe back to the podcast to review the evidence for using testosterone in older men. We talk about the impact testosterone supplementation has on sexual function, strength, fatigue, cognition, quality of life, and harms. There are 16 systematic reviews so we do have pretty good evidence – have a listen and see what the evidence says about what testosterone supplementation might do or not do. Show notes 1) Tools for Practice Testosterone supplementation for cis-gender men: Let's (andro-)pause for a moment

In this episode of In the Clinic, Mike and Jess invite back Dr. Jennifer Young. The team discusses Sissy Hayes, a 38 year old patient who thinks she has a urinary tract infection. 

In episode 590, Mike and James talk in a PREMIUM way about a new trial that looked at the question, does depression screening provide any benefit in primary care? We also go over a case-finding publication on screening for asthma/COPD. At the end we look at, does implementing guideline care improve outcomes for CKD?

In episode 589, Mike and James invite Jennifer Young back to the podcast again to talk about a topic that Mike absolutely loves – Vitamin D for everyone. Tune in to hear about all the latest, and the older, evidence. Do you agree we should remove the question mark from the podcast title? Show notes 1) Tools for Practice Vitamin D and Fracture Prevention: Not what it's cracked up to be?

In episode 588, Mike and James invite Émélie Braschi back to the podcast to discuss another tricky area – insulin in type 2 diabetes and how to use it. Do we need to give it once a day, twice a day or maybe no times a day? Tune in to hear about all the evidence. Show notes 1) Tools for Practice Strategies for initiating insulin in type 2 diabetes

In this episode of In the Clinic, Mike and Jess are joined by Mike Kolber, family physician from Peace River, Alberta. The team discusses Michelle Reblok - a 25 year old patient who presents with stomach problems - and works through the differential diagnosis.  To claim Mainpro+ credits, click here: https://cfpclearn.ca/podcast/in-the-clinic-episode-29-stomach-problems/ 

Mike, Jess and Jennifer follow up with Farrah Lo, a 27 year old patient, who was diagnosed with iron deficiency anemia in an earlier podcast. Today, the team discusses the management of heavy menstrual bleeding.  Did you miss Farrah's original visit? Tune into episode #13: https://open.spotify.com/episode/366me3xA7wkZYEWS9ANynE?si=5a2b105167214a29 To claim your Mainpro+ credit, click here: https://cfpclearn.ca/podcast/in-the-clinic-episode-28-heavy-menstrual-bleeding/ 

In episode 587, Mike and James invite Adrienne Lindblad back to the podcast to go over all the evidence we have for the oral GLP-1 weight loss medications. You know you are going to get lots of questions about these medications so tune in to find out all the numbers around the benefit and potential harms – and cost. Show notes 1) Tools for Practice Mission Slimpossible Part 2: Oral GLP-1 agonists for weight loss

In episode 585, Mike and James invite Émélie Braschi back to the podcast to talk about the tricky issue of how to deal with a potential penicillin allergy. Believe it or not there are a couple of RCTs looking at this issue. These two trials compared oral challenge alone to skin testing followed (if negative) by oral challenge. The results may allow you to change your practice in a good way. Tune in and find out why. Show notes Tools for Practice It's time to challenge penicillin allergy labels!

In episode 585, Mike and James finally get back to being PREMIUM. We review the REDUCE-AMI trial which tried to answer the question – do you need to use a beta-blocker after an MI if there is preserved ejection fraction? We also review a COPD trial that shows integrating respiratory specialists in primary care improves guideline adherence. However, the interesting finding is what happens to the quality-of-life change and hospitalizations. The results of both of these trials may surprise you. Show notes 1) REDUCE-AMI- Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction N Engl J Med 2024;390:1372-1381 2) Cluster randomised controlled trial of specialist-led integrated COPD care (INTEGR COPD) Thorax 2024;79:209–218

In episode 584, Mike and James invite Tina Korownyk back to the podcast to talk about the evidence for amyloid-targeting monoclonal antibodies in mild cognitive impairment or Alzheimer's dementia. Unfortunately, the evidence shows these medications don't seem to have a clinically important effect and do have some harms. Have a listen as we give you all the numbers so you will be able to properly discuss these medications with your patients. Show notes Tools for Practice Remind me, do medications that target brain amyloid improve my dementia?

Mike, Jess and Émélie follow up with Charlotte McLeod, a 50 year old patient, who originally presented to the clinic with diabetes. Today, the team discusses the management of Charlotte's blood pressure in the context of diabetes. Did you miss Charlotte's original visit? Tune into episode #12: https://open.spotify.com/episode/1F1eZobKKIKTswqYGy9C2c?si=22fa6e6f8a9041e1. To claim your Mainpro+ credit, please click on this link: https://cfpclearn.ca/podcast/in-the-clinic-episode-27-managing-hypertension-in-diabetes/   

Mike, Jess and Émélie discuss Ms. Ottie Stone, a 35 year old patient who presents with dizziness. Today's podcast will discuss the diagnosis and management of benign paroxysmal positional vertigo. To claim your Mainpro+ credit on CFPCLearn, click here: https://cfpclearn.ca/?post_type=podcast&p=13750&preview=true

In episode 583, Mike and James continue to go over the issues associated with using CVD risk calculators. We talk about some of the limitations, how to think about the results and explain the risks and benefits to patients.   Show notes PEER Simplified Cardiovascular Decision Aid Incorporation of Shared Decision-Making in International Cardiovascular Guidelines, 2012-2022 JAMA Network Open. 2023;6(9):e2332793. doi:10.1001/jamanetworkopen.2023.32793 Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines Am Heart J 2009;157:111-7.e2 Agreement among cardiovascular disease risk calculators Circulation. 2013;127:1948–1956

In episode 582, Mike and James go over the issues associated with using CVD risk calculators. We talk about where the numbers come from, what they mean, what their limitations are, how to think about them and how to use them. So have a listen as it may decrease your risk but it will definitely increase your understanding.   Show notes 1) PEER Simplified Cardiovascular Decision Aid https://decisionaid.ca/cvd/ 2) Incorporation of Shared Decision-Making in International Cardiovascular Guidelines, 2012-2022 JAMA Network Open. 2023;6(9):e2332793. doi:10.1001/jamanetworkopen.2023.32793 3) Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines Am Heart J 2009;157:111-7.e2 4) Agreement among cardiovascular disease risk calculators Circulation. 2013;127:1948–1956

In episode 581, Mike and James invite Mike Kolber back to the podcast for the umpteenth time – this time we talk about a topic we haven't discussed before – acute diverticulitis. Historically, if a person has diverticulitis they were given antibiotics BUT do they really do anything? We look at all the evidence and the results may surprise you. Show notes Tools for Practice Antibiotics or no antibiotics for acute diverticulitis, that is the question!

In episode 580, Mike and James invite Jennifer Young to talk about the treatment of pityriasis rosea. Believe it or not there are 2 simple treatments that seem to work really quite well. Tune in to hear what works and how well they work. Show notes Tools for Practice (A)dressing the Christmas Tree? Therapies for pityriasis rosea

In episode 579, Mike and James invite Nicholas Dugré back to the podcast to talk about the evidence around the benefits and harms of a new class of medications for the acute treatment of episodic migraines. Ubrogepant is an oral calcitonin gene-related peptide antagonist. In this case, amazing as it may sound, there are triple the number of systematic reviews than there are RCTs. Nonetheless, we go over all the evidence and at the end of the podcast you'll know what the world knows about these agents. Show notes Tools for Practice Oral Calcitonin Gene-related Peptide Antagonists: A painfully long name for the acute treatment of migraines

In episode 578, Mike, James and Jennifer Potter try to answer the question, in patients with dementia, how safe and effective are stimulants, antidepressants, and antipsychotics for treating apathy? We look at the evidence for methylphenidate, antipsychotics, and antidepressants so tune in to find out if any of these treatments have any sort of effect in this very difficult to treat condition. Show notes Tools for Practice Making a difference in indifference? Medications for apathy in dementia

In episode 577, Mike and James invite Jennifer Young to join us to go over all the evidence around how best to close punch biopsies, lacerations and incisions. We go over all the evidence for sutures (absorbable/nonabsorbable), skin glue, and tape. We look at cosmesis, patient satisfaction, and infection rates so have a listen and find out what we found. Show notes Tools for Practice Looking for Closure: Managing simple excisions or wounds efficiently

n episode 576, James, Mike, and Jamie continue to review the evidence for acne treatments. In this podcast, we examine if antibiotics work and we find they do have an effect. Check out the podcast for all the numbers. Show notes Tools for Practice Facing the Evidence in Acne, Part II: Oral Antibiotics Tools for Practice Is less more with isotretinoin and acne? Alberta Medication Costs

Mike, Jess and Jennifer follow up with Norma Munroe, a 78 year old patient, who originally presented with insomnia. Today's podcast discusses the management of insomnia including sleep restriction and medications.  Did you miss Norma's original visit? Tune into episode #24: https://open.spotify.com/episode/4kwHSsa8Yq3Qs8y4JBGvka?si=d858551f82bf4a1f To claim your Mainpro+ credit, click here: https://cfpclearn.ca/podcast/in-the-clinic-episode-25-insomnia-part-ii/. 

In today's clinic, Mike, Jess and Jennifer introduce Norma Munroe, a 78 year old with complaints of insomnia. This podcast discusses the assessment of insomnia. Be sure to listen to episode #25 also which continues with insomnia managment! To claim a credit for this podcast, click here: https://cfpclearn.ca/podcast/in-the-clinic-episode-24-insomnia-part-i/.  

Mike, Jess and Émélie follow up with Jennifer Aweiree, a 47 year old patient who presented with fatigue in episode #7. Today's follow up involves screening for depression.  Did you miss episode #7? Listen now: https://open.spotify.com/episode/5NWcvn4OO2TeJnVs6Zsj4V?si=fcc8f7d80cd64a8a To claim a credit for episode #23, click here: https://cfpclearn.ca/podcast/in-the-clinic-episode-23-depression/.     

Mike, Jess and Émélie discuss a new patient, Remi Alfred. Remi is a 40 year female patient presenting with joint pain. Join the team as they focus on the differential diagnosis of joint pain and investigations required. To claim your Mainpro+ credit, complete the survey at this link: https://cfpclearn.ca/podcast/in-the-clinic-episode-22-rheumatoid-arthritis/.

Mike, Jessica and Jennifer present the case of Guy Lumbago, a 40 year old man with low back pain. Tune in as the team discusses the diagnosis and management of Guy's symptoms while offering up some great clinical tools that family docs can use in their office.  To claim your Mainpro+ credit for listening to this podcast, click here: https://cfpclearn.ca/podcast/in-the-clinic-episode-21-low-back-pain/ 

Mike, Jess and Jennifer discuss the case of Aira Salter, a 16 month old who is brought to the office with coughing and wheezing.  To claim your Mainpro+ credit for listening to this podcast, click here: https://cfpclearn.ca/podcast/in-the-clinic-episode-20-bronchiolitis/ 

In this episode, Mike, Jess and Émélie discuss Mr. Dion Silenus, a 60 year old man whose concern is that his heart is acting up. Tune in to find out how these symptoms are tied into Dion's alcohol use.  To claim your Mainpro+ credit for listening to this podcast, click here: https://cfpclearn.ca/podcast/in-the-clinic-episode-19-alcohol-use-disorder/

In this episode, Mike, Jess and Émélie discuss Richard Solare, a 70 year old man who presents with red patches on his face.  To claim your Mainpro+ credit for listening to this podcast, click here:  https://cfpclearn.ca/podcast/in-the-clinic-episode-18-actinic-keratosis/ 

Discussing Decision-Making Capacity Assessment is vital because as our population ages, the demand for physicians to be proficient in this area is increasing. Family physicians, being at the forefront of patient care, play a pivotal role not only in diagnosing and managing dementia but also in evaluating decision-making capacity.   Learning objectives:   1.      Discuss the circumstances in which a capacity assessment is necessary.  2.      Identify the appropriate tools and methods to conduct a standardized capacity assessment. 

In episode 575, James and Mike invite Jamie Falk back to the podcast to help us sift through all the evidence for using oral contraceptives and spironolactone to treat acne. We find that they actually do work. We go over all the numbers for the benefits and harms. Have a listen.   Show notes Tools for Practice Facing the Evidence in Acne, Part I: Oral contraceptives and spironolactone in females

In episode 574, James and Mike invite Jennifer Young back to the podcast to help us yet again look at the evidence for cranberries and the prevention of UTI's. Unfortunately, there is a problem with the evidence as there is a high risk-of-bias from potential publication bias, small studies, and unblinding. However, if we look past some of these biases, cranberry products might be worth a try. But have a listen and see what the evidence says.   Show notes 1) Tools for Practice Any berry good solutions to preventing UTIs: Cranberries? 2) MAKING EVIDENCE MATTER for EVERYONE CONFERENCE Vancouver May 24/25, 2024