All articles

Drs. Jill Norris and Jessica Otte
Sep 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...

Drs. Domnick Manhas and Tony Wan
Aug 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...

Dr. Sander Veldhuyzen van Zanten
Aug 09, 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...

Vinicio Delgado and Dr. Wayne Lai
Jul 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...

Hans Haag and Dr. Ricky Turgeon
Jul 05, 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...

Jamison Falk, PharmD
Jun 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...

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...

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...

Drs. Kerstin Gustafson and Colleen Dy
May 02, 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...

Dr. Mark Adrian
Apr 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...

Dr. Emma Coffey
Apr 03, 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...

Drs. Kevin Lee and Persia Pourshahnazari
Mar 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...