By Dr. Steve Wong on December 29, 2016
Thanks again to all of our readers, authors, editors and support team. On behalf of all of us at This Changed My Practice, I’d like to wish everyone a safe, happy and healthy holiday season! See you in 2017.
By Dr. Ric Arseneau on November 30, 2016
Chronic Fatigue Syndrome (CFS) – also known as Myalgic Encephalomyelitis (ME) and Systemic Exertion Intolerance Disease (SEID) – is a common clinical condition. Yet, it is under- recognized and diagnosed. An estimated 84–91% of patients with the condition remain undiagnosed.
By Dr. Heather Leitch on November 8, 2016
The MDS Clear Path algorithm is an internet-based interactive tool that was developed to support health care providers in the workup, diagnosis and management of MDS. The Clear Path was developed by a group of 60 Canadian hematologists with an interest in MDS.
By Dr. Paul Mullins on October 26, 2016
Alcoholic hepatitis (AH), perhaps more accurately described as alcohol-related cholestatic liver failure, is a clinical syndrome with high mortality. In severe AH at 28 days: 30-40%. STOPAH is a UK multi-centre, double-blind, randomized trial in severe AH to assess the effect of Prednisolone and/or Pentoxifylline on mortality at 28 days, and mortality or liver transplantation at 90 days and at one year.
By Dr. Joseph Lam on October 25, 2016
Pyogenic granulomas or lobular capillary hemangiomas are common acquired vascular tumors accounting for 0.5% of all skin nodules in children. Although they are benign vascular proliferations, treatment is often sought because of recurrent episodes of bleeding due to a propensity to superficial ulceration and bleeding.
By Dr. Karen Buhler on October 12, 2016
In BC women are receiving maternity care from fewer providers. To assist practitioners Perinatal Services BC created the Primary Maternity Pathway and the Vancouver Division of Family Practice in 2014 developed a 2-page Early Prenatal Care Summary Checklist for Primary Care.
By Dr. Alisa Lipson on September 28, 2016
As a general pediatrician, I see many children whose behaviour and/or development is not emerging as expected. A diagnosis such as autism or learning disability may be the obvious explanation; but frequently it is not so straightforward. Parents come armed with questions about ‘processing disorders’ and and they expect their MD to be knowledgeable.
By Julianne Yeager on September 14, 2016
If you employ people, you should have professionally drafted and implemented employment contracts. The time and cost of having contracts drafted and implemented are minor, in comparison to the time and cost of dealing with a wrongfully dismissed employee and their lawyer.
By Dr. Shelina Babul and Hadley Pearce on August 24, 2016
Concussions are the most common form of brain injury in British Columbia, yet they are often under reported due to lack of awareness and education among the general public. The Concussion Awareness Training Tool (CATT) is a free online resource dedicated to providing resources and training to help increase the recognition, treatment and management of concussions.
By Dr. Jan Hajek on August 3, 2016
For diabetes in particular, observational studies suggest that persons who follow a plant-based diet have a lower risk for diabetes, and an RCT demonstrated reductions in HbA1c in patients with diabetes randomized to a vegan diet compared to the standard American Diabetes Association diet.
By Dr. Roberto Leon on July 12, 2016
Up until recently, pain management with IUDs (intrauterine devices) insertion was not commonly performed, as most users were multiparous women and the insertion was reasonably straightforward. However, because the IUDs provide unsurpassed protection against a pregnancy along with many other advantages, its acceptance is dramatically increasing, especially in nulliparous women and adolescents.
By Drs. Christopher Cheung and Kenneth Gin on June 22, 2016
Hypertension affects over 1 in 5 Canadians and is one of the leading causes of cardiovascular disease, including coronary artery disease and heart failure. Uncontrolled hypertension is a risk factor for stroke (both ischemic and hemorrhagic), retinopathy, chronic kidney disease (CKD), and peripheral vascular disease. Epidemiologic studies show that the risk of cardiovascular disease increases above a blood pressure of 115/75 mmHg.
By Dr. Soren Gantt on June 8, 2016
Approximately 1 out of every 150 live-born infants has congenital CMV infection (cCMV). Of these, most are asymptomatic. However, more than 20% will suffer permanent neurologic sequelae, including hearing loss, intellectual disability, and visual deficits. In fact, cCMV is responsible for 25% of all childhood hearing loss, and is the second most common cause of intellectual disability after Down syndrome.
By Dr. Taryl Felhaber on May 25, 2016
Every woman transitions through menopause, although not all women have bothersome symptoms. Some women’s symptoms may be so disturbing as to lead them to think they are dying, as was the case with a patient in my practice several years ago.
By Dr. Eileen Murray on May 11, 2016
Fungal infections particularly of the feet are a common problem. If only the skin is involved topical treatment with any of the antifungal creams works well. However, often fungal infections are ignored by patients and chronic skin infection can lead to infection of the nails.
By Dr. Roberto Leon on April 27, 2016
Intrauterine devices (IUDs) are a safe, very effective, rapidly reversible and highly acceptable contraception amongst women. Yet it is resisted by many physicians. A recent study in Seattle (1) found that half or fewer of the physicians sampled do not follow the recommended guidelines, advising against using an IUD to nulliparous women, 20 years old or less, or women with a prior history of STI, PID or ectopic pregnancy.
By Dr. Kevin Fairbairn on April 13, 2016
Appendicitis can often present itself in the black box of abdominal pain. Fortunately at times the history and physical can give practitioners a clear window, straight through the fascia, to an unhappy appendix.
By Drs. Neda Amiri and Kam Shojania on March 30, 2016
Despite being one of the most common forms of arthritis afflicting adults, optimal care of patients with gout including treatment of acute attacks as well as long-term management is not always achieved.
By Dr. Christina Williams on March 16, 2016
In my early days as a reproductive physician, I made the diagnosis of “unexplained infertility” when ovulatory, male or tubal factors were absent. I advised the “keep trying” policy as pregnancy rates of 50% were expected in the second year of infertility.
By Dr. Hector Baillie on March 2, 2016
When a very old patient comes to my hospital for a pacemaker, I now spend longer with them. I explain what this device can do, and what it cannot do. Do they understand? Where are your family members, they need to understand too? I take time to get informed consent, when previously obtaining the signature was the most important part of the exercise.
By Drs. Erica Tsang and Iain Mackie on February 17, 2016
An unprovoked venous thromboembolism (VTE), either through a deep venous thrombosis or pulmonary embolism, may be the earliest sign of malignancy. In patients presenting with unprovoked VTE, a limited occult malignancy screening strategy is sufficient, compared to routinely adding CT imaging of the abdomen and pelvis.
By Dr. Daniel Kim on February 3, 2016
Supraventricular tachycardia (SVT) is a dysrhythmia characterized by abrupt onset, regular rate that usually exceeds 150 beats/minute, and lack of identifiable P waves on ECG. SVT is caused by an abnormal circuit that allows a wave of depolarization to repeatedly travel in circular fashion in cardiac tissue via a reentry circuit that may reside in the atrioventricular (AV) node or outside the AV node in an accessory pathway.
By Kishore Mulpuri on January 20, 2016
Developmental Dysplasia of the Hip (DDH) is a spectrum of hip joint abnormalities ranging from mild dysplasia to severe, frank dislocations. Left untreated, DDH can lead to serious complications later in life including osteoarthritis of the hip and total hip replacement.
By Dr. N. John Bosomworth on January 6, 2016
There is no evidence for benefit of weight loss in healthy people. The safest body size trajectory in healthy people is a stable weight. It takes a modest amount of exercise to attain good metabolic benefit. It takes substantial exercise commitment to produce weight loss or to prevent weight regain. Mediterranean diet reduces cardiac risk factors and mortality.
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