All articles

Dr. Christina Williams
March 16, 2016

Surgery versus IVF in endometriosis infertility

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. read more...

Dr. Hector Baillie
March 2, 2016

When quality trumps quantity: a clinician’s perspective

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. read more...

Drs. Erica Tsang and Iain Mackie
February 17, 2016

Screening for occult cancer in unprovoked venous thromboembolism (VTE)

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. read more...

Dr. Daniel Kim
February 3, 2016

Enhance the valsalva to (actually) terminate SVT

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. read more...

Kishore Mulpuri
January 20, 2016

Screening for developmental dysplasia of the hip: an evidence-based approach to practice

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. read more...

Dr. N. John Bosomworth
January 6, 2016

Weight loss in healthy people

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. read more...

Dr. Steve Wong
December 16, 2015

Letter from the editor

As 2015 comes to a rapid close, I wanted to once again thank all of our authors and readers for their active participation at This Changed My Practice (TCMP). read more...

Sue Barlow, OT and Jennifer Loffree, OT
December 2, 2015

Concussion rehabilitation

The statistics regarding recovery from concussion indicate that the majority of individuals will be symptom-free at 3 months; within 6 months 70-75% will be symptom free; and within a year 10% will have 1 persisting symptom and 5% will have 4 or more persisting symptoms read more...

Dr. Paul Thiessen
November 18, 2015

A simple new technique for collecting urine in infants

What changed my practice was this simple new technique reported in an article from Spain which described a new method to obtain a midstream urine collection in which the infant is held upright and someone rubs over the suprapubic region while gently tapping over the lumbar region of the spine. read more...

Dr. Antoinette van den Brekel
October 28, 2015

Postnatal investigation of antenatally detected hydronephrosis

Health care providers caring for pregnant women and newborns are often faced with a finding of fetal hydronephrosis on routine screening antenatal ultrasound; in fact it is seen in 1 to 2% of fetuses screened. Babies at risk of rapidly progressive renal injury due to urinary tract obstruction need to be evaluated and referred for specialized care urgently, prior to discharge from hospital. read more...

Dr. Ric Arseneau
October 13, 2015

Hope for patients with fatigue, pain, and unexplained symptoms

Fatigue, pain, and unexplained symptoms are commonly seen in physician offices, however they are often experienced as “unsatisfying” for doctors. Our patients need an explanatory model to help them understand their illness. If we don’t provide one, patients will create their own or seek one elsewhere. read more...

Dr. Karen Nordahl
September 30, 2015

Exercise during pregnancy

It has been shown that 55% of pregnant patients reported some form of back pain during their pregnancy when questioned. Studies have demonstrated that if we get pregnant women moving, specifically working their pelvic floor with Kegel exercises and their ‘core’ they may have better pregnancy outcomes. read more...