Drs. Tracy Monk, Nick Graham, Karin Kausky, Michele Thomasse, and Ryan Gallagher
Mar 22, 2022
Practice tip (for BC practitioners) utilizing PathwaysBC beyond specialist lookups — finding patient handouts, requisitions, point-of-care tools
We all used PathwaysBC.ca 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
Mar 09, 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
Feb 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
Feb 09, 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
Jan 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
Jan 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
Dec 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
Dec 07, 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
Nov 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
Oct 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
Oct 05, 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
Sep 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...
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