In the Clinic Episode 43: Urinary Incontinence

In episode 602, James and Mike Kolber go over the best available evidence for the benefits and the harms for one of the most commonly used classes of medications – proton pump inhibitors. We find out the benefit numbers are much larger than the harm numbers. Check out the podcast to get all the numbers you need to help people make decisions. Show Notes 1) Tools For Practice Side effects of long-term PPI use: Leaving a bad taste in your mouth? Proton Pump Inhibitors (PPIs): Is Perpetual Prescribing Inevitable? 2) PEIP Conference Edmonton October 17-18, 2025 3) SPARCTool 4) RX files PPI Stopping your Proton Pump Inhibitor or “PPI”

In episode 601, James and Mike invite Jennifer Young back to the podcast to go over all the evidence we have for pregabalin and gabapentin in patients with fibromyalgia. During the discussion we find out how many people actually get a ≥30% reduction in pain compared to placebo. We even look at some information about different doses. All the numbers are revealed by the end of the podcast – and we give tips and suggestions throughout. Check it out. Show Notes 1) Tools For Practice Pharm for Fibro, Round 2: Can gabapentinoids ease the pain? 2) MEME Conference 2025 in Vancouver – May 9/10, 2025

In this episode of In the Clinic, Mike and Jess invite back Dr. Jennifer Young.  The team discusses Benazir Pervez, a 17-year-old female coming in for acne.  

In this episode of In the Clinic, Mike and Jess invite back Dr. Émélie Braschi.  The team discusses Micti Colate, a 70-year-old female coming in for urinary incontinence.

In this episode of In the Clinic, Mike and Jess invite back Dr. Jennifer Young.  The team discusses Annie Ploidy, a 36-year-old female coming in for prenatal screening.

Over 60% of Canadian trans adults rate their mental health as fair-to-poor and are twice as likely to avoid seeking primary care. Avoidance isn’t random – it’s the predictable outcome of everyday micro-aggressions, systemic barriers, and what psychologists call minority stress. This podcast will name those forces of avoidance and offer trauma-informed counter-moves family physicians can use on the front line to support their 2SLGBTQ+ patients.    Learning objectives:    By the end of this episode, listeners will be able to: 1. Explain the minority‑stress model and its relevance to everyday family practice. 2. Recognise three common clinic‑level micro‑aggressions that fuel avoidance behaviour. 3. Apply trauma‑informed communication skills that transform micro‑aggressions into micro‑affirmations.

Un nouvel épisode du Pharmascope est disponible… Et on s’attaque encore au trouble d’usage d’alcool! Dans cette deuxième partie, Nicolas, Isabelle et une invitée discutent des traitements de maintien du trouble d’usage d’alcool. Les objectifs pour cet épisode sont: Discuter des interventions comportementales dans le traitement de maintien du trouble d’usage d’alcool Discuter de la prise en charge pharmacologique du trouble d’usage d’alcool Comparer les avantages et les inconvénients de chaque classe médicamenteuse en trouble d’usage d’alcool   Ressources pertinentes en lien avec l’épisode Wood E, Bright J, Hsu K, et coll. Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder. CMAJ. 2023 Oct 16;195(40):E1364-E1379. Repères canadiens sur l’alcool et la santé : rapport final. Centre canadien sur les dépendances et l’usage de substances. 2023 Répertoire des ressources en dépendances du MSSS INESSS. Sevrage d’alcool et prévention des rechutes. 2021. Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database Syst Rev. 2020 Mar 11;3(3):CD012880. McPheeters M, O’Connor EA, Riley S, et coll. Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis. JAMA. 2023 Nov 7;330(17):1653-1665. Rösner S, Hackl-Herrwerth A, Leucht S, et coll. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD001867 Rösner S, Hackl-Herrwerth A, Leucht S, et coll. Acamprosate for alcohol dependence. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD004332. Cheng YC, Huang YC, Huang WL. Gabapentinoids for treatment of alcohol use disorder: A systematic review and meta-analysis. Hum Psychopharmacol. 2020 Nov;35(6):1-11. Anton RF, Latham P, Voronin K, et coll. Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal Symptoms: A Randomized Clinical Trial. JAMA Intern Med. 2020 May 1;180(5):728-736. Blodgett JC, Del Re AC, Maisel NC, Finney JW. A meta-analysis of topiramate’s effects for individuals with alcohol use disorders. Alcohol Clin Exp Res. 2014 Jun;38(6):1481-8. Agabio R, Saulle R, Rösner S, Minozzi S. Baclofen for alcohol use disorder. Cochrane Database Syst Rev. 2023 Jan 13;1(1):CD012557.

Un nouvel épisode du Pharmascope est disponible et on s’attaque cette fois au trouble d’usage d’alcool. Dans cette première partie, Nicolas, Isabelle et une nouvelle invitée discutent du dépistage et de l’évaluation de cette maladie sous diagnostiquée, en plus de réviser la prise en charge du sevrage alcoolique. Les objectifs pour cet épisode sont: Procéder au dépistage du trouble d’usage d’alcool Diagnostiquer un trouble d’usage d’alcool Discuter des bénéfices et des désavantages associés aux principaux traitements pharmacologiques du sevrage alcoolique   Ressources pertinentes en lien avec l’épisode Lignes directrices canadiennes récentes en trouble d’usage d’alcool Wood E, Bright J, Hsu K, et coll. Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder. CMAJ. 2023 Oct 16;195(40):E1364-E1379. Repères canadiens sur l’alcool et la santé : rapport final. Centre canadien sur les dépendances et l’usage de substances. 2023 Guide canadien sur les risques associés à l’usage d’alcool Coalition canadienne pour la santé mentale des personnes pagées. Lignes directrices sur le trouble lié à l’utilisation de l’alcool chez les personnes âgées. 2023. Guide de l’INESSS sur la prise en charge du trouble d’utilisation d’alcool INESSS. Sevrage d’alcool et prévention des rechutes. 2021. US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, et coll. Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018 Nov 13;320(18):1899-1909. Mitchell AJ, Bird V, Rizzo M, et coll. Accuracy of one or two simple questions to identify alcohol-use disorder in primary care: a meta-analysis. Br J Gen Pract. 2014 Jul;64(624):e408-18. Bush K, Kivlahan DR, McDonell MB, et coll. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998 Sep 14;158(16):1789-95. Maldonado JR, Sher Y, Das S, et coll. Prospective Validation Study of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) in Medically Ill Inpatients: A New Scale for the Prediction of Complicated Alcohol Withdrawal Syndrome. Alcohol Alcohol. 2015 Sep;50(5):509-18. Kaner EF, Beyer FR, Muirhead C, et coll. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2018 Feb 24;2(2):CD004148. Amato L, Minozzi S, Vecchi S, Davoli M. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD005063. Daeppen JB, Gache P, Landry U, et coll. Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: a randomized treatment trial. Arch Intern Med. 2002 May 27;162(10):1117-21. Elholm B, Larsen K, Hornnes N, Zierau F, Becker U. Alcohol withdrawal syndrome: symptom-triggered versus fixed-schedule treatment in an outpatient setting. Alcohol Alcohol. 2011 May-Jun;46(3):318-23. Minozzi S, Amato L, Vecchi S, Davoli M. Anticonvulsants for alcohol withdrawal. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD005064. Airagnes G, Valter R, Ducoutumany G, Vansteene C, Trabut JB, Gorwood P, Dubertret C, Matta J, Charles-Nelson A, Limosin F. Magnesium in the treatment of alcohol withdrawal syndrome: a multicenter randomized controlled trial. Alcohol Alcohol. 2023 May 9;58(3):329-335.

Un nouvel épisode du Pharmascope est maintenant disponible! Dans de ce 138ème épisode, Nicolas, Isabelle et Olivier discutent d’un problème pas reposant : le syndrome des jambes sans repos. Les objectifs pour cet épisode sont : Expliquer la présentation clinique, les critères diagnostics et les facteurs de risque du syndrome des jambes sans repos Conseiller des mesures non-pharmacologiques pour aider les personnes avec un syndrome des jambes sans repos Discuter des bénéfices et des désavantages associés aux principaux traitements pharmacologiques du syndrome des jambes sans repos   Ressources pertinentes en lien avec l’épisode Manconi M, Garcia-Borreguero D, Schormair B, Videnovic A, Berger K, Ferri R, Dauvilliers Y. Restless legs syndrome. Nat Rev Dis Primers. 2021 Nov 3;7(1):80. Trotti LM, Becker LA. Iron for the treatment of restless legs syndrome. Cochrane Database Syst Rev. 2019 Jan 4;1(1):CD007834. Earley CJ, García-Borreguero D, Falone M, Winkelman JW. Clinical Efficacy and Safety of Intravenous Ferric Carboxymaltose for Treatment of Restless Legs Syndrome: A Multicenter, Randomized, Placebo-controlled Clinical Trial. Sleep. 2024 Apr 16:zsae095. Short V, Allen R, Earley CJ, Bahrain H, Rineer S, Kashi K, Gerb J, Auerbach M. A randomized double-blind pilot study to evaluate the efficacy, safety, and tolerability of intravenous iron versus oral iron for the treatment of restless legs syndrome in patients with iron deficiency anemia. Am J Hematol. 2024 Jun;99(6):1077-1083. Wilt TJ, MacDonald R, Ouellette J, Khawaja IS, Rutks I, Butler M, Fink HA. Pharmacologic therapy for primary restless legs syndrome: a systematic review and meta-analysis. JAMA Intern Med. 2013 Apr 8;173(7):496-505. Allen RP, Chen C, Garcia-Borreguero D, Polo O, DuBrava S, Miceli J, Knapp L, Winkelman JW. Comparison of pregabalin with pramipexole for restless legs syndrome. N Engl J Med. 2014 Feb 13;370(7):621-31. Trenkwalder C, Benes H, Grote L, Happe S, Högl B, Mathis J, Saletu-Zyhlarz GM, Kohnen R; CALDIR Study Group. Cabergoline compared to levodopa in the treatment of patients with severe restless legs syndrome: results from a multi-center, randomized, active controlled trial. Mov Disord. 2007 Apr 15;22(5):696-703. Trenkwalder C, Beneš H, Grote L, García-Borreguero D, Högl B, Hopp M, Bosse B, Oksche A, Reimer K, Winkelmann J, Allen RP, Kohnen R; RELOXYN Study Group. Prolonged release oxycodone-naloxone for treatment of severe restless legs syndrome after failure of previous treatment: a double-blind, randomised, placebo-controlled trial with an open-label extension. Lancet Neurol. 2013 Dec;12(12):1141-50. Carlos K, Prado GF, Teixeira CD, Conti C, de Oliveira MM, Prado LB, Carvalho LB. Benzodiazepines for restless legs syndrome. Cochrane Database Syst Rev. 2017 Mar 20;3(3):CD006939. Jadidi A, Rezaei Ashtiani A, Khanmohamadi Hezaveh A, Aghaepour SM. Therapeutic effects of magnesium and vitamin B6 in alleviating the symptoms of restless legs syndrome: a randomized controlled clinical trial. BMC Complement Med Ther. 2022 Dec 31;23(1):1. Wali SO, Abaalkhail B, Alhejaili F, Pandi-Perumal SR. Efficacy of vitamin D replacement therapy in restless legs syndrome: a randomized control trial. Sleep Breath. 2019 Jun;23(2):595-601.