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    Implementing Prescribing Portraits — Therapeutics Initiative

    Primary care clinicians face an overwhelming volume of information to process and tasks to complete. There are new and sometimes conflicting guidelines and practice standards, forms to fill out, emails about meetings, and an inbox full of labs, documents to review, and messages to respond to. Now that I get Portraits in my email inbox from time to time, I schedule time to look at them, and focus on the listed recommendations and whether my pattern of practice is close to where it should be according to the evidence, and if not, why not. Read More

  • Family Medicine
  • Practice

Drs. Jill Norris and Jessica Otte
September 12, 2023

Implementing Prescribing Portraits — Therapeutics Initiative

Primary care clinicians face an overwhelming volume of information to process and tasks to complete. There are new and sometimes conflicting guidelines and practice standards, forms to fill out, emails about meetings, and an inbox full of labs, documents to review, and messages to respond to. Now that I get Portraits in my email inbox from time to time, I schedule time to look at them, and focus on the listed recommendations and whether my pattern of practice is close to where it should be according to the evidence, and if not, why not. read more...

  • Family Medicine
  • Internal Medicine

Drs. Domnick Manhas and Tony Wan
August 23, 2023

Thromboprophylaxis in ambulatory cancer patients

It is estimated that 15% of all cancer patients will develop VTE, resulting in significant morbidity and mortality. The cost of cancer-associated thrombosis is substantial to the healthcare system. Currently, routine thromboprophylaxis is not recommended given the fear of increased risk of bleeding, modest absolute risk reduction in VTE, and inconvenience. However, a selected group of cancer patients with very high VTE risk will benefit from thromboprophylaxis. read more...

  • Family Medicine
  • Gastroenterology

Dr. Sander Veldhuyzen van Zanten
August 9, 2023

Management of Helicobacter pylori in 2023: who should be tested, treated, and how

Helicobacter pylori (H. pylori) continues to be an important pathogen, associated with peptic ulcer disease, dyspepsia, and gastric cancer. The conventional triple combination of a PPI, clarithromycin, and either amoxicillin or metronidazole is no longer recommended because its success rates have decreased to less than 60%. The recommended first-line therapy is concomitant therapy (PPI, clarithromycin, amoxicillin, and metronidazole) and second-line therapy is bismuth-based therapy (PPI, bismuth, metronidazole, and tetracycline). read more...

  • Family Medicine
  • Neurology
  • Psychiatry

Vinicio Delgado and Dr. Wayne Lai
July 19, 2023

Offering Brief Behavioral Therapy for insomnia (BBTi) in primary care settings

Insomnia is one of the most commonly reported sleep disorders at our sleep clinic. Despite its prevalence, treating it can be challenging due to its complex and multifactorial nature. A comprehensive and personalized approach to treatment is, therefore, necessary for effective management. However, providing this level of support requires significant time and resources. Offering a self-help intervention as a complement to care can help reach patients who might not otherwise receive CBTi or refuse onsite treatment. read more...

  • Cardiology
  • Internal Medicine

Hans Haag and Dr. Ricky Turgeon
July 5, 2023

Identifying and treating iron deficiency in patients hospitalized for heart failure

Heart failure is the third leading cause of hospitalization in Canada and leads to readmission in 1 in 5 patients within 30 days after discharge. Iron deficiency (with or without anemia) is an important comorbidity in patients with HF and is associated with worse outcomes. Assess iron deficiency for all patients with HFrEF and HFmrEF admitted for acute HF. read more...

  • Endocrinology

Jamison Falk, PharmD
June 19, 2023

SGLT2i in patients with diabetes: translating an evolving body of evidence to the nuances of practice

While I’ve been hard on newer medications like SGLT2i for their relatively small benefit in lower-risk patients, recent systematic reviews show that our traditional interventions are no better, and may be worse, at reducing risks of outcomes. I now discuss the option of adding an SGLT2i with patients with diabetes and pre-existing cardiovascular or renal disease or with symptomatic hyperglycemia where blood glucose reduction would be expected to reduce day-to-day symptoms. I reduce or discontinue doses of other antihyperglycemic medications if possible when starting an SGLT2i and I educate patients about potential adverse events. read more...

  • Allergy/ Immunology
  • Family Medicine

Drs. Kevin Lee and Persia Pourshahnazari
May 31, 2023

Help, “hive” got a rash! – Article 2: Practical tips in the management of chronic spontaneous urticaria (CSU)

While not a fundamentally dangerous condition, CSU can have a significant impact on a patient’s quality of life and can be challenging to manage. Symptoms can be prolonged and can recur even after a long symptom-free period. Escalate and taper non-sedating H1-antihistamines, encourage daily antihistamine use, and add corticosteroids or refer to an allergist if needed. read more...

  • Family Medicine
  • Infectious Disease

Drs. Rohit Vijh and Jason Wong
May 17, 2023

Managing syphilis during pregnancy — practice tip

Pregnant persons should be screened for syphilis during the first trimester (or first prenatal visit), and at delivery (or any time after week 35 for those planning home births). read more...

  • Obstetrics and Gynaecology

Drs. Kerstin Gustafson and Colleen Dy
May 2, 2023

Genitourinary syndrome of menopause (GSM) — a refresher

Women should be proactively educated at routine visits on menopause and the changes in the genital tract and anyone with vulvar and vaginal complaints should be offered a clinical exam to rule out secondary causes. GSM often continues to worsen with time if untreated. Daily use of vulvar and vaginal moisturizers and barrier creams to protect the skin from irritants may be helpful. Use of lubricants for intercourse should be recommended routinely. Many women will require pharmacotherapy in addition to non-hormonal treatments. read more...

  • Physical Medicine and Rehabilitation

Dr. Mark Adrian
April 19, 2023

Spinal stenosis — practice tips

Degenerative lumbar spinal stenosis refers to the narrowing of the spinal canal that can result in numbness, pain, and weakness of the lower extremities. Atypical presentations are common as are competing diagnoses. Top practice tips: distinguish the source of the symptoms, rule out competing disorders, send for imaging, encourage exercises that place the patient in a flexed position, and consider gabapentin, epidural steroid injections, and a referral for a surgical opinion. read more...

  • Family Medicine
  • Obstetrics and Gynaecology

Dr. Emma Coffey
April 3, 2023

LNG-IUS (Mirena) IUD for emergency contraception

Many patients don’t know that an IUD is a highly effective option for emergency contraception. We can offer patients either the 52mg LNG-IUS (up to 5 days) or the copper IUD (up to 7 days) for EC. Both options are highly effective at preventing pregnancy (>99%). read more...

  • Allergy/ Immunology
  • Family Medicine

Drs. Kevin Lee and Persia Pourshahnazari
March 21, 2023

Help, “hive” got a rash! — Article 1: Practical tips in the assessment of chronic spontaneous urticaria (CSU)

Despite being a fairly common problem, with an estimated prevalence of 0.5–5%, chronic spontaneous urticaria (CSU) is often a challenging condition for health-care providers to diagnose and for patients to accept as a diagnosis. A diagnosis of CSU does not equate to a diagnosis of a systemic autoimmune disease. We do not routinely recommend dietary modification for CSU. We advise patients with CSU to limit alcohol intake and to take a higher dose of antihistamines prior to receiving vaccinations. read more...

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      • Implementing Prescribing Portraits — Therapeutics Initiative
      • Thromboprophylaxis in ambulatory cancer patients
      • Management of Helicobacter pylori in 2023: who should be tested, treated, and how
      • Offering Brief Behavioral Therapy for insomnia (BBTi) in primary care settings
      • Identifying and treating iron deficiency in patients hospitalized for heart failure
      • SGLT2i in patients with diabetes: translating an evolving body of evidence to the nuances of practice
      • Help, “hive” got a rash! – Article 2: Practical tips in the management of chronic spontaneous urticaria (CSU)
      • Managing syphilis during pregnancy — practice tip
      • Genitourinary syndrome of menopause (GSM) — a refresher
      • Spinal stenosis — practice tips
      • LNG-IUS (Mirena) IUD for emergency contraception
      • Help, “hive” got a rash! — Article 1: Practical tips in the assessment of chronic spontaneous urticaria (CSU)
      • Pharmacotherapy for Tobacco Use Disorder
      • Ceiling doses of ketorolac and ibuprofen in acute pain management
      • Vaginal progesterone for the prevention of preterm birth
      • Bugs & Drugs guide to antimicrobial therapy
      • Letter from the editor
      • Diagnosis and treatment of polycystic ovary syndrome (PCOS) using virtual health
      • Moving into the treatment phase of the COVID-19 pandemic
      • Radon: a preventable cause of lung cancer
      • Women with ADHD — Practice Tips
      • Offering CBT skills by group medical visits
      • Why I talk about all Long Term Reversible Contraception (LARC)
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      • Mitigating the climate impact of asthma therapy
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      • Inflammatory back pain: distinguishing it from common mechanical back pain
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      • Identifying Advanced Heart Failure in your patient
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      • Practice tip (for BC practitioners) utilizing PathwaysBC beyond specialist lookups — finding patient handouts, requisitions, point-of-care tools
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      • Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 3: The Importance of Attachment Theory in Healthcare
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      • Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 2: Parenting During a Pandemic
      • Giant Cell Arteritis Part 2: Treatment
      • A Refresher in Pelvic Pain
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      • Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 1: Cultivating secure bonds with our children during stressful times
      • Rate versus Rhythm Control in Patients with Atrial Fibrillation: Time to Change the Paradigm?
      • Specialists and Family Practice: Tackling the Pseudo-Penicillin Allergy Epidemic Together
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      • Hiding in plain sight: men's mental health
      • Letter from the editor
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      • You too can help eliminate Hepatitis C by 2030
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      • ACEs (Adverse Childhood Experiences): One Family Physician's Experience
      • Practice Tip: Cutaneous larva migrans
      • Presenteeism
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      • Facing a College Physician Practice Enhancement Program Assessment? What you need to know in 2019?
      • Dry Eye Syndrome
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      • Anal cancer: information to get you out of the dark!
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      • Help - the steroids are not working - Helping women with refractory vulvar lichen sclerosus
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      • Letter from the editor
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      • New insight into “HFpEF” – cardiac amyloid no longer a zebra diagnosis?
      • Learning to meet my patient where they are at - how letting go changed my practice
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      • Wellness and self-care for professional excellence
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      • The power of storytelling in clinical encounters
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      • Trauma as a determinant of health
      • Practice Tip: “SAIL" through a vulvovaginal examination
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      • Guidelines for working with formerly incarcerated people
      • Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure with Reduced Ejection Fraction (HFrEF): Sacubiltril/Valsartan and the PARADIGM HF Trial
      • Letter from the editor
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      • Backward Course Design
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      • Seeking collateral information when clinical practice guidelines deliver strong recommendations for drug therapies on the basis of a single clinical trial
      • Long-term benzodiazepine use is associated with increased mortality in people with schizophrenia
      • Elevated Lipoprotein (a) is a common reason for unexplained premature or recurrent coronary heart disease and stroke
      • Serious illness conversations and capturing advance care planning
      • First Canadian guideline on perioperative cardiac risk assessment and management for patients undergoing non-cardiac surgery
      • Outcome-focused cognitive behavioral therapy (CBT)
      • Why does my student seem disengaged? A perspective on learner engagement in new environments
      • Geriatric urinary incontinence: just ask!
      • Symptoms attributed to Chronic Lyme Disease
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      • Pyogenic granulomas
      • Letter from the editor
      • BC Take Home Naloxone Program - updated article
      • Chronic Fatigue Syndrome upgraded to disease
      • Two causes of anemia
      • Prednisolone or pentoxifylline for alcoholic hepatitis
      • Pyogenic granulomas
      • But I don’t do maternity care… (yes you do!)
      • Diagnosing processing disorders
      • Best practice: a tip from an employment lawyer
      • Gaps in recognizing, treating and managing concussions
      • Recommending a plant-based diet
      • Part 2: Minimizing the pain of the IUD insertion: all effort required
      • Comparing intensive versus standard blood-pressure control: The SPRINT Trial
      • Diagnosis and management of congenital cytomegalovirus infection
      • Non-hormonal treatments for menopausal symptoms
      • Nail fungus
      • Part 1: Who should be offered an IUD, and selection of the appropriate IUD
      • The Alvarado Score in Acute Appendicitis
      • Part 2: Treating Gout - Practice Tips and Clinical Pearls
      • Surgery versus IVF in endometriosis infertility
      • When quality trumps quantity: a clinician’s perspective
      • Screening for occult cancer in unprovoked venous thromboembolism (VTE)
      • Enhance the valsalva to (actually) terminate SVT
      • Screening for developmental dysplasia of the hip: an evidence-based approach to practice
      • Weight loss in healthy people
      • Letter from the editor
      • Concussion rehabilitation
      • A simple new technique for collecting urine in infants
      • Postnatal investigation of antenatally detected hydronephrosis
      • Hope for patients with fatigue, pain, and unexplained symptoms
      • Exercise during pregnancy
      • Cardiovascular outcomes and blood pressure, glucose, and cholesterol numbers
      • Management of cyclical pelvic pain
      • This app changed my practice - Read by QxMD
      • Recognizing the Potential Influence of the Interpersonal Gap in Teaching
      • This app changed my practice - Treatable Intellectual Disability Endeavor in B.C. (TIDE) - Treatable ID App www.treatable-id.org
      • Measurement of depressive symptoms improves outcomes in primary care
      • Open book exams - something to consider?
      • BC Take Home Naloxone Program
      • Role of imaging in management of undescended testis (UDT)
      • Mineralocorticoid Receptor Antagonists in Heart Failure with Preserved Ejection Fraction: The TOPCAT and ALDO-DHF trials
      • Evolving use of multi parametric MRI in prostate cancer detection
      • The unvoiced questions of children experiencing an illness, dying, or death in their family
      • Meningococcal Serogroup B Vaccine
      • Why Am I Talking?
      • Part 1: Diagnosing Gout in Primary Care Settings: Do we have to tap?
      • This app changed my practice: Mindshift App
      • Does my patient have a food allergy?
      • Incretin Safety: What is the Evidence?
      • Age-Related Macular Degeneration: New treatments that changed my practice
      • Knee arthroscopy for conditions of the degenerative knee
      • Non-suicidal self-injury
      • Letter from the editor
      • Fecal biomarkers in the diagnosis and management of inflammatory bowel disease
      • Can my patient safely drive on long-term daily opioid medication?
      • Ovarian cancer and hereditary predisposition
      • Tinnitus – The Essentials of Patient Care in BC
      • Diuretic strategies in patients with acute decompensated heart failure
      • Early diagnosis of autism
      • What blood pressure should I target in my patients with chronic kidney disease?
      • Routine neonatal oximetry screening for critical congenital heart defects in British Columbia: It's time!
      • Meniscectomy
      • Contributed Works Dr. Sylvia Stockler
      • DrugCocktails.ca resource
      • Managing opioid withdrawal
      • Minimal evidence of benefit from medications to increase sexual desire
      • Myocardial infarction in women without obstructive coronary artery disease
      • Compassion Fatigue What you don't know will hurt you
      • Update on the guidelines for Subacute Bacterial Endocarditis (SBE) prophylaxis
      • Using domperidone to enhance lactation
      • Midshaft Clavicle Fractures
      • Five clinical points on Rheumatoid Arthritis in Family Practice
      • Lateral Epicondyle Tendinopathy (Tennis Elbow) Toolkit
      • Letter from the editor
      • When vulvovaginal atrophy involves loss of genital sexual sensitivity: local (vaginal) dehydroepiandrosterone (DHEA) shows promise
      • Swaddling and developmental dysplasia of the hips
      • B.C. Cancer Agency Colon Cancer Program
      • Choosing Wisely - A resource to help reduce unnecessary or harmful tests and interventions
      • HIV in Family Practice: testing & diagnosis
      • Effects of glucocorticoids on cardiovascular risks in patients with rheumatoid arthritis
      • Managing the complicated somatoform disorder patient
      • Evaluation of familial cancer risk: it starts at www.screeningbc.ca
      • Reduce falls by improving cognitive function
      • Traveller’s diarrhea
      • Use exams to guide, not drive, learning; the importance of intrinsic motivation
      • RACE Hotline
      • Provoked vestibulodynia (PVD) needs holistic management and a chronic pain approach
      • Pharmacogenetics and pharmacogenomics: practice tips
      • How a family physician can help patients with chronic pain: a guide to navigating patient internet resources in BC
      • Clostridium difficile infection (CDI)
      • Aldosterone antagonists for the treatment of systolic heart failure
      • Barrier repair in atopic dermatitis
      • Care gaps in schizophrenia: male/female differences
      • Appropriate use of sedation in palliative care
      • Never ignore an elevated eosinophil count - especially in travellers, immigrants and refugees
      • Thyroid Nodules: Get more information from your ultrasound
      • Acute limping in children
      • Stuck in Transmission: Time to Change Gears
      • This app changed my practice: My Fitness Pal
      • The Importance of Words in Clinical Teaching
      • Letter from the editor
      • Direct-to-Consumer genetic testing: What it means for the general practitioner
      • Contributed Works
      • Rivaroxaban for treatment of symptomatic pulmonary embolism: exploring new territories
      • Rotavirus vaccine
      • "Bleach baths" and atopic dermatitis - help from under the kitchen sink
      • Undergoing the College’s practice review assessment
      • This app changed my practice: DizzyFix
      • Depression in the elderly
      • What's new in dyslipidemia
      • May I add an HIV test to your bloodwork today?
      • The whole cell cholera and travellers’ diarrhea vaccine – Looking for evidence in the prevention of travellers’ diarrhea
      • Active video games and child's physical activity
      • Going Experiential
      • This app changed my practice: Dropbox
      • Diabetes and exercise
      • Role of inhaled steroids in acute asthma exacerbations
      • Screening for depression in pregnancy using the Edinburgh Depression Scale
      • Apps, websites and guidelines for osteoporosis management in primary care in 2012
      • Advance care plan (ACP) for patients with multiple co-morbidities
      • Paradigm shift in treatment of hemangiomas
      • Understanding breast cancer responsiveness
      • Something as basic as wax cleaning!
      • Tailoring therapy for type 2 diabetes: the role of incretins
      • This app changed my practice: CCS lipid guidelines
      • Letter from the editor
      • What is the correct dosing for Vitamin D?
      • Vapor rub for treatment of nocturnal cough and cold symptoms in children
      • Non-suicidal self-injury: reducing future risk
      • The most important question never asked about sleep
      • Improving end-of-life care for patients with advanced cancer
      • It’s just a runny nose!
      • Spreading pain with neuropathic features may be induced by opioid medications
      • Community acquired pneumonia
      • Don’t request testosterone levels for women’s low sexual desire
      • This app changed my practice: Pocket A1C
      • Treating Hepatitis C - the future is now!
      • Proton pump inhibitors and Clostridium difficile infection
      • New targets for Diabetes (A1C): Why we are aiming at 'only' 7 percent
      • Advocating Fallopian Tube removal at the time of hysterectomy to prevent ovarian cancer
      • Weed is not just an herb
      • Prostate Specific Antigen – Does the new data support its utility for prostate cancer screening?
      • Acute Ischemic Stroke: Thombolysis is an Effective Therapy
      • Self-management of mood problems
      • New therapies and new end points in the treatment of Crohn’s Disease
      • Management of maternal thyroid disease in pregnancy
      • Chronic ulcers and biofilms
      • The outcomes of prematurity
      • Monitoring of cardiovascular disease risk in people with chronic mental illness
      • Smoking Cessation
      • Transient Ischemic Attacks: High Risk and Treatable
      • Use of HAART as a strategy to stop HIV and AIDS
      • Early prenatal screening
      • Leaving warfarin for the rats? A new option in anticoagulation for atrial fibrillation
      • Minimizing radiation exposure – decision to order imaging?
      • An Update: BPH Management for Family Physicians
      • The Intra-Uterine Device
      • Pediatric allergy
      • The natural history of severe dementia
      • Understanding eGFR in the clinical context: who does and does not need referral?
      • Probiotic therapy has changed my approach to treating patients with irritable bowel syndrome
      • New fee codes and treatment options have improved my care of patients with mental health problems
      • Evidence shows that chemotherapy holidays may not be in the best interest for patients with metastatic colorectal carcinoma
      • New study on the use of erythropoietin stimulating agents in chronic kidney disease has made us evaluate the risk-benefit of ESA’s in CKD patients not on dialysis.
      • Choosing antihypertensive combos: does it matter how you do it?
      • MRSA skin and soft tissue infections
      • What are the CV risks of TZDs: have the safety questions been answered?

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