Drs. Taylor Drury, Poupak Rahmani, and Tony Wan
January 26, 2022
Perioperative anticoagulation management in mechanical heart valves, the PERIOP2 trial
We continue to use full dose therapeutic low molecular weight heparin (LMWH) for bridging in the pre-operative period. However, we now use post-operative prophylactic LMWH as an alternative bridging strategy in patients undergoing high-risk bleeding procedures. In patients at high risk of thromboembolism (including mechanical mitral valve and atrial fibrillation) undergoing a high-risk bleeding procedure, we are now less aggressive in resuming full dose therapeutic anticoagulation, as we feel comfortable using prophylactic LMWH for up to several days post-operatively before resuming therapeutic anticoagulation. read more...
Gerri Klein
January 12, 2022
Advances in diabetes glucose monitoring
For all my patients who are on hypoglycemic medications, oral or injectable, I suggest using rtCGM or isCGM. Even intermittent use or a short trial of 10 days to two weeks with either of these devices can be enlightening for patients. With the ongoing COVID restrictions, many of my patients have been unable (or unwilling) to obtain an A1C from a lab test. In my practice, I have found it helpful to use glucose TIR to assess glucose control as an adjunct measure to A1C results; when an A1C is not available; and to guide treatment recommendations. read more...
Dr. Steve Wong
December 21, 2021
Letter from the editor
Who would have thought 2021 could bring with it even more dreadful events than the year before? In this past year, we all became familiar with words that were previously obscure — terms like heat dome, atmospheric river, and now Omicron. Yet, there are words that I'm glad we're hearing more often these days, too. Words like representation, reconciliation, and the focus of our last article this year: compassion. read more...
Drs. Tandi Wilkinson and Shireen Mansouri
December 7, 2021
Cultivating compassion for people who are unvaccinated
We are hearing from many of our medical colleagues about their distress in this time of COVID-19. Many are troubled by the fact that most of the people admitted to hospitals and intensive care units are not vaccinated. Faced with yet another variant and uncertainty, we hear that our colleagues are exhausted, frustrated, and angry. Both authors, being interested in supporting physicians to thrive in their work, have been studying compassion and its role in practitioner well-being for the last few years. As looking at this issue (and other challenges of the pandemic) through the lens of compassion has been personally helpful to both of us, we wanted to share our learnings with you. read more...
Drs. Elina Liu, Erin Morley, and Anna Rahmani
November 15, 2021
PAUSE Trial & Thrombosis Canada Guidelines: practice tip
Each year, 1 in 6 patients with atrial fibrillation, or an estimated 6 million patients worldwide, will require perioperative anticoagulant management. An increasing number of atrial fibrillation patients are using direct oral anticoagulants (DOACs) in place of warfarin for stroke prevention. However, there has been uncertainty regarding perioperative management of DOACs, with significant variability noted in clinical practice. This can lead to potential harm with an increased risk of thrombosis if a DOAC is held for too long versus increased risk of post-operative bleeding if interruption intervals are too short. read more...
Dr. Elisabeth Baerg Hall
October 27, 2021
Adult ADHD — Practice Tip
October is ADHD Awareness Month. Patients may be increasingly aware of ADHD, having heard about the associated functional impairment and identifying with these stories. Treatment for adults with ADHD is effective. For best results, treatment includes both medications and Executive Function Skills support. read more...
Beata Chami
October 5, 2021
Physician well-being during COVID-19 — burnout & moral injury
It has been eighteen months since COVID-19 emerged in Canada. The trajectory of the pandemic has placed a strain on our citizens’ mental health, particularly our frontline workers. While physician well-being has been a longstanding concern, the global pandemic has magnified the daily challenges that clinicians so bravely navigate to safeguard the health of their patients. read more...
Drs. Lauren Hughes and Heather L. O'Donnell
September 15, 2021
Approach to the patient with flashes and/or floaters
Acute onset of monocular flashes and/or floaters is a common presentation to primary care providers. Most often, this represents a posterior vitreous detachment (PVD), an age-related condition with a prevalence that increases from 24% in adults aged 50 to 59 to 87% among those aged 80 to 89 years. read more...
Jan Klimas, PhD; Michee-Ana Hamilton, MSc; Malcolm Maclure, ScD; Rita McCracken, MD, CCFP, PhD
August 24, 2021
Can we identify patients at risk for Opioid Use Disorder when beginning opioid analgesics for pain from new or ongoing non-cancer causes?
There is growing recognition that opioid prescribing can lead to prescription opioid use disorder (OUD). It is estimated that nearly 115,000 British Columbians have become addicted to opioids. There is a need to safely reduce the volume of new opioid prescriptions for opioid naïve patients. read more...
Shirley Jiang, Edward Tam, and Hin Hin Ko
August 4, 2021
New treatment option for Primary Biliary Cholangitis (PBC)
Primary biliary cholangitis (PBC) is the most common autoimmune liver disease with an incidence of 1 in 1000 in women over age 40. For decades, the only evidence-based treatment was ursodeoxycholic acid. Unfortunately, the rate of inadequate response to UDCA is up to 40%. In 2017, Health Canada approved the use of obeticholic acid (OCA) for the treatment of PBC. UDCA remains first-line therapy for PBC with a long record of use and generic preparations but in non-responders, OCA treatment should be considered. read more...
Dr. Linda Uyeda and Dr. Ashley Miller
July 7, 2021
Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 3: The Importance of Attachment Theory in Healthcare
The ingredients needed to create a happy workplace also largely reflect the principles of secure attachment. Across all levels within organizations, if people do not feel “safe, seen, soothed, and secure” they are more likely to make errors, breach safety protocols, and struggle working together as a team. read more...
Drs. Charles Au, Tristen Gilchrist, and Agnes Lee
June 16, 2021
IMPROVE VTE scoring to guide VTE prophylaxis for medical inpatients
The IMPROVE VTE score is an externally validated tool that can be used to identify low-risk medical patients who do not warrant VTE prophylaxis. read more...
