Post Archives

Dr. Duncan Etches
February 21, 2018


In summary, in place of pattern or algorithm driven medicine, clinical experience and ability to determine what is best for our patient lies at the heart of the art of medicine. read more...

Dr. Laura Sauvé
February 7, 2018

Adverse events following immunizations (AEFI)

Vaccines are safe, but sometimes adverse events following immunizations do happen, and can be very concerning to families. If your patient has an AEFI, there is a voluntary reporting system. Public Health Officers in your local Health Authority will be able to answer most questions or concerns. read more...

Ruth Elwood Martin
January 23, 2018

Guidelines for working with formerly incarcerated people

To address the issue of health care discrimination and coordination of care people with incarceration history, the CCPHE has collaboratively developed Guidelines for Family Physicians working with Formerly Incarcerated People. read more...

Doson Chua, PharmD, FCSHP, BCPS(AQ) and Dr. Mustafa Toma
January 10, 2018

Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure with Reduced Ejection Fraction (HFrEF): Sacubiltril/Valsartan and the PARADIGM HF Trial

Sacubitril/valsartan is the first in class of ARNI and has proven its superiority in reducing mortality and morbidity in HFrEF as compared to the use of ACEI. Sacubitril/valsartan should be considered in patients who are symptomatic despite optimal or maximally tolerated guideline-driven HF therapies consisting of a beta blocker, ACEI/ARB and MRA. Monitoring of patients on sacubitril/valsartan is similar to ACEI. read more...

Dr. Steve Wong
December 14, 2017

Letter from the editor

It's hard to believe that this is our 7th year at This Changed My Practice. Thanks for being part of our TCMP family. On behalf of all of us at This Changed My Practice, I wish all of you a happy, healthy holiday season! read more...

Dr. David Topps
November 29, 2017

Managing your passwords

Ever been frustrated by the number of passwords you have to keep track of in your daily life as a professional? At one time, you might have only a few – some simple ones for unimportant sites, some stronger ones and perhaps a really good one for your most important data. read more...

By Dr. Christy Sutherland and Emily Wagner
November 15, 2017

Managing opioid use disorder: buprenorphine/naloxone opioid agonist treatment

I no longer offer rapid methadone tapers to my patients. Buprenorphine/naloxone is now recommended as the first-line opioid agonist treatment for opioid use disorder in British Columbia. This is because of its superior safety profile when compared with methadone as well as an easier transition to take home dosing. read more...

Dr. Roberto Leon
November 1, 2017

Indications and value of self-administered vaginal swabs for STIs and vaginitis

I came across a publication in the British Medical Journal by Sarah A. Schoeman: Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. Participants took a vaginal swab before a routine gynecological exam, and clinicians then took an endocervical swab during examination. read more...

Dr. Jennifer Robinson
October 18, 2017

MOVE an injury not RICE

MOVE an injury: Movement, not rest. Options: offer other options for cross training. Vary rehabilitation with strength, balance and agility drills. Ease back to activity early for emotional strength. read more...

Dr. Eileen Murray
October 3, 2017

Whether or not to use systemic corticosteroids to treat a skin disease

When I started out in dermatology, corticosteroids were the only systemic drug available to treat patients with severe allergic contact dermatitis (ACD), atopic dermatitis (AD), drug reactions and those with bullous diseases. Corticosteroids are potent and excellent immunosuppressive agents. The main problem with systemic use is the high risk of drug interactions, as well as multiple serious acute and long-term side effects. read more...

Dr. Taryl Felhaber
September 20, 2017

The risks of worklessness

Why should physicians encourage early and ultimate return to work whenever they can? In a nutshell, because it is usually in the patient’s best interest to remain in the workforce. read more...

Dr. Jennifer Grant
September 6, 2017

Evaluation of penicillin allergy

Recent data show that up to 90% of patients with a reported penicillin allergy are mislabelled and of those who are allergic, many beta-lactams can still be safely prescribed due to low risk of cross-reactivity. Mislabelling of penicillin allergy is due to many things including misdiagnosis (confusing a viral exanthema for allergy), purer formulations of antibiotics, loss of allergy and differences in side-chain structure. read more...

Drs. Christopher Cheung and Kenneth Gin
August 9, 2017

Management of Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation

Perioperative management of anticoagulation is challenging as physicians must consider the risks of stroke, systemic embolism, and perioperative bleeding. read more...

Michael Lee & Isabeau Iqual
August 8, 2017

Backward Course Design

Like many teachers, I begin to plan my course by creating course-level learning objectives and after that design the course to meet these. read more...

Dr. Anne Antrim
July 18, 2017

Review of the topic of Autism Spectrum Disorder

The current definition of Autism Spectrum Disorder has 2 criteria: “persistent impairment in reciprocal social communication and social interactions” AND “restricted, repetitive patterns of behavior”. The symptoms must be present from early childhood, but may not manifest till the social demands exceed the capacity of the child to respond. read more...

Dr. Roberto Leon
June 20, 2017

Step by step approach to determine the safety of prescribing Hormone Replacement Therapy

One of the most complex decisions that women (and their physicians) occasionally need to take in mid-life is whether to use prescription medications for their menopausal symptoms. Previously known as Hormone Replacement Therapy (HRT), Menopause Hormone Therapy (MHT) is an effective and evidence based treatment for moderate to severe hot flashes and/or night sweats (defined as bothersome enough to interfere with daily activities, impair quality of life and/or interrupt sleep). read more...

Cait O'Sullivan
May 31, 2017

Seeking collateral information when clinical practice guidelines deliver strong recommendations for drug therapies on the basis of a single clinical trial

When I identify strong drug therapy recommendations of particular relevance to my practice scope, I seek collateral information and there are two resources I routinely incorporate into my literature search. I start with the Cochrane Library and then check to see whether a FDA advisory committee has weighed in on key issues. read more...

Dr. Randall White
May 10, 2017

Long-term benzodiazepine use is associated with increased mortality in people with schizophrenia

When psychiatric patients are treated in an emergency department, they are often hypervigilant, manic, or otherwise in an excited, agitated state. The current standard of care to manage acute agitation in adults is using an antipsychotic medication and a benzodiazepine, often loxapine or haloperidol and lorazepam. read more...