Post Archives

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...

Dr. Gordon Francis
April 26, 2017

Elevated Lipoprotein (a) is a common reason for unexplained premature or recurrent coronary heart disease and stroke

High Lp(a) is a major CVD risk factor that should be measured and acted upon in patients and families where there is history of premature CV events but lack of clear risk factors, and in patients with known CVD and recurrent events despite treatment to LDL-C target. read more...

Drs. Charlie Chen and Hayden Rubensohn
April 12, 2017

Serious illness conversations and capturing advance care planning

What is the patient willing to consent to as treatment if his/her condition were to seriously deteriorate? The Serious Illness Conversation Guide developed by Ariadne Labs provides a framework for physicians to engage in care planning with patients in a manner acceptable to the patient. read more...

Drs. Terence Yung and Erin Morley
March 22, 2017

First Canadian guideline on perioperative cardiac risk assessment and management for patients undergoing non-cardiac surgery

Physicians who see patients for preoperative assessment often face the dilemma of accurately determining a patients’ cardiac risk. Patients may have limited mobility and thus do not necessarily elicit cardiac symptoms even if there is significant flow-limiting coronary artery disease. read more...

Dr. Dan Bilsker
March 8, 2017

Outcome-focused cognitive behavioral therapy (CBT)

Treatment plan should specifically target psychological problems that are barriers to occupational, relationship or emotional function, rather than broadly defined issues. Being able to return to work is a substantial benefit for the individual: staying at home for an extended time is damaging to the individual’s self-esteem, coping ability and psychological health. Practice “positive psychology”, emphasizing the outcomes that determine the meaning and success of one’s life and focus on individual’s strengths to reach goals. read more...

Heather Buckley and Nawaaz Nathoo
March 1, 2017

Why does my student seem disengaged? A perspective on learner engagement in new environments

I wondered why new learners just transitioning to new clinical experiences sometimes seemed hesitant to participate and thus appeared less engaged in clinics and journal clubs. I found that some learners would jump in and take part in conversations, discussions, and even engaging with patients. read more...

Dr. Martha Spencer
February 22, 2017

Geriatric urinary incontinence: just ask!

Martha Spencer, MD, FRCPC, Providence Health Care, Clinical Instructor, UBC (biography and disclosures) Disclosures: Education grant from Pfizer to help support my incontinence fellowship in Edmonton, Grant from Pfizer ($10 000) to support start-up costs for the Geriatric Continence Clinic at SPH. Mitigating potential bias: Only published trial data is presented and recommendations are consistent […] read more...

Dr. Ric Arseneau
February 8, 2017

Symptoms attributed to Chronic Lyme Disease

The PLEASE trial (Persistent Lyme Empiric Antibiotic Study Europe) was published in the New England Journal of Medicine in March 2016. This randomized, double-blind, placebo-controlled study assessed whether longer-term antibiotic treatment of persistent symptoms attributed to Lyme disease leads to better outcomes than does shorter-term treatment. read more...

Dr. Alissa Wright
January 25, 2017

Outbreak overload: fever in the returning traveller

Canadians travel a lot and are increasingly traveling to more exotic and remote destinations. Unfortunately, travel does carry certain risks with respect to infection. Post-travel assessment of a febrile patient must be comprehensive, but completed in a timely manner so that patients get the care they need. read more...

Dr. Joseph Lam
January 10, 2017

Pyogenic granulomas

Pyogenic granulomas or lobular capillary hemangiomas are common acquired vascular tumors accounting for 0.5% of all skin nodules in children. They occur predominantly on the head and neck. Although they are benign vascular proliferations, treatment is often sought because of recurrent episodes of bleeding due to a propensity to superficial ulceration and bleeding. read more...

Dr. Steve Wong
December 29, 2016

Letter from the editor

Thanks again to all of our readers, authors, editors and support team. On behalf of all of us at This Changed My Practice, I’d like to wish everyone a safe, happy and healthy holiday season! See you in 2017. read more...

Erica Tsang MD, Margot Kuo MPH, Ashraf Amlani MPH, Dr. Caroline Ferris MD CCFP FCFP, Dr. Jane Buxton MBBS MHSc
December 14, 2016

BC Take Home Naloxone Program – updated article

Opioid overdose is a major cause of morbidity and mortality worldwide, and constitutes a serious public health issue. Throughout British Columbia (BC), the landscape of opioid overdose has evolved, first with oxycodone and more recently, illicit fentanyl. read more...