Post Archives

Drs. Tracy Monk, Nick Graham, Karin Kausky, Michele Thomasse, and Ryan Gallagher
March 22, 2022

Practice tip (for BC practitioners) utilizing PathwaysBC beyond specialist lookups — finding patient handouts, requisitions, point-of-care tools

We all used to help us find specialists for our patients, to look up wait times and what information to include in a referral, but we learned that Pathways could help streamline our clinical work in so many more ways. read more...

Drs. Shirley Jiang and Hin Hin Ko
March 9, 2022

Use of non-invasive tests for liver fibrosis

While liver biopsy is crucial in determining the stage of liver fibrosis in chronic liver disease, it is not the most accessible or appropriate test in most general practice settings. Non-invasive tests (NITs) for liver fibrosis, on the other hand, are more widely available and applicable to different liver conditions. NITs can be a useful tool in general practice to stratify high-risk patients who may require further investigations and referral to specialist care. read more...

Drs. Alejandro Dau, Agnes Lee, and Tony Wan
February 22, 2022

Pharmacologic thromboprophylaxis in hospitalized patients with COVID-19

COVID-19 is associated with an increased risk of venous, arterial, and microvascular thrombosis. Early reports documented high rates of venous thromboembolism (VTE) in hospitalized patients with COVID-19, with pooled incidences of 20-30%, despite standard-dose thromboprophylaxis. Multiple randomized control trials (RCTs) have sought to determine the safety and efficacy of therapeutic anticoagulation in both critically ill and non-critically ill hospitalized patients with COVID-19. read more...

Brendan McNeely and Dr. Amanda Hu
February 9, 2022

Tokes in the throat: cannabis smoking-related harm in otolaryngology

Recent evidence has emerged that shows cannabis smoking is related to significant patient morbidity. Namely, cannabis smoke exposure increased the risk of oropharyngeal cancer in a dose-dependent manner. Cannabis use may also be associated with hearing loss, vestibular dysfunction, tinnitus, and sinusitis. read more...

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...

Sue Barlow and Carolyn Rondeau
June 3, 2021

Concussion rehabilitation update and a free self-management concussion tool

Concussions or mild traumatic brain injury are the most common type of traumatic brain injury. It is estimated that every year in British Columbia (BC), there are approximately 14,500 visits to the emergency department and that this number is most likely an underestimate of the “true burden of concussion”. read more...

Dr. Ashley Miller and Dr. Linda Uyeda
May 12, 2021

Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 2: Parenting During a Pandemic

As I started to understand that this pandemic would wear on, I had to figure out how to help my patients’ families and my own family navigate our way through this totally new reality. I drew on the science of attachment, resilience and healthy relationships to make a plan. (Please stay tuned for Article #3!) read more...