Most Recent Tools for Practice
Tools for Practice #251 – But I am not Depressed: Antidepressants for Irritable Bowel Syndrome
Do antidepressant medications improve irritable bowel syndrome (IBS) symptoms?
Bottom Line: Both tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) may improve overall IBS symptoms. About 55% of patients treated with TCAs or SSRIs will benefit compared to ~35% with placebo. Only TCAs improve abdominal pain for ~60% of patients compared to ~30% with placebo. TCA studies reported more side effects (drowsiness and dry mouth) than SSRIs. Read More
Tools for Practice #250 – DPP-4 inhibitor update: Thousands studied but still no evidence of clinical benefits
In type 2 diabetes, do dipeptidyl peptidase-4 (DPP-4) inhibitors improve patient-oriented outcomes like cardiovascular disease (CVD)?
DPP-4 inhibitors have no effect on patient-oriented outcomes like CVD (example myocardial infarction or stroke) or death. They increase the risk of hypoglycemia, pancreatitis and likely heart failure hospitalization. The choice for second line therapy after metformin should focus on drugs that reduce the risk of CVD (ie. SLGT-2 inhibitors or GLP-1 agonists). Read More
Tools for Practice #249 – Helping physicians fatigued by TSH Screening and Subclinical Hypothyroidism
Is there evidence for screening for thyroid function or treating subclinical hypothyroidism?
Bottom Line: There is no randomized controlled trial (RCT) of screening for thyroid function [ordering thyroid stimulating hormone (TSH) in non-pregnant healthy people]. Despite approximately 20 RCTs, there are no patient-oriented benefits (like preventing cardiovascular disease or reduced fatigue or weight) in treating subclinical hypothyroidism. Guidelines recommend against both. Read More
Tools for Practice #248 – Hydrochlorothiazide and Squamous Cell Skin Cancer: Remember when hypertension was easy?
Does hydrochlorothiazide increase the risk of squamous cell carcinoma (SCC) of the skin?
Bottom Line: Observational data suggest an association between hydrochlorothiazide and the risk of SCC. Causation has not been proven. Risk appears to consistently increase with dose and duration (example: 5 years of use increases risk 3-4 times). Baseline incidence of SCC is <0.1% annually. The same risk has not been established with thiazide-like diuretics (like indapamide or chlorthalidone). The benefit of switching from hydrochlorothiazide to another agent should be weighed against the risk of changing medications. Read More
Tools for Practice #247 – Fact or Fad: Intermittent fasting for sustained weight loss
Does intermittent fasting result in greater sustained (>6 month) weight loss than continuous dieting in adults?
Bottom Line: Although inconsistently defined, intermittent fasting (example 500 kcal/day for 2 days/week) and continuous dieting (~25% reduction in caloric intake daily) result in similar weight loss, usually ~5-9kg at 6 months-1 year. Discontinuation rates with both diets is up to ~60%. Read More
When creating primary care education and programs, the PEER team focuses on minimizing bias, patient orientated outcomes, shared decision making, collaboration and most importantly simplicity.
Who is PEER?
Patients, Experience, Evidence and Research (PEER) was formed between a group of primary care providers who shared a common belief that evidence should be made accessible to all primary care providers.