Post Archives

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...

Dr. Ric Arseneau
November 30, 2016

Chronic Fatigue Syndrome upgraded to disease

Chronic Fatigue Syndrome (CFS) – also known as Myalgic Encephalomyelitis (ME) and Systemic Exertion Intolerance Disease (SEID) – is a common clinical condition. Yet, it is under- recognized and diagnosed. An estimated 84–91% of patients with the condition remain undiagnosed. read more...

Dr. Heather Leitch
November 8, 2016

Two causes of anemia

The MDS Clear Path algorithm is an internet-based interactive tool that was developed to support health care providers in the workup, diagnosis and management of MDS. The Clear Path was developed by a group of 60 Canadian hematologists with an interest in MDS. read more...

Dr. Paul Mullins
October 26, 2016

Prednisolone or pentoxifylline for alcoholic hepatitis

Alcoholic hepatitis (AH), perhaps more accurately described as alcohol-related cholestatic liver failure, is a clinical syndrome with high mortality. In severe AH at 28 days: 30-40%. STOPAH is a UK multi-centre, double-blind, randomized trial in severe AH to assess the effect of Prednisolone and/or Pentoxifylline on mortality at 28 days, and mortality or liver transplantation at 90 days and at one year. read more...

Dr. Joseph Lam
October 25, 2016

Pyogenic granulomas

Pyogenic granulomas or lobular capillary hemangiomas are common acquired vascular tumors accounting for 0.5% of all skin nodules in children. 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. Karen Buhler
October 12, 2016

But I don’t do maternity care… (yes you do!)

In BC women are receiving maternity care from fewer providers. To assist practitioners Perinatal Services BC created the Primary Maternity Pathway and the Vancouver Division of Family Practice in 2014 developed a 2-page Early Prenatal Care Summary Checklist for Primary Care. read more...

Dr. Alisa Lipson
September 28, 2016

Diagnosing processing disorders

As a general pediatrician, I see many children whose behaviour and/or development is not emerging as expected. A diagnosis such as autism or learning disability may be the obvious explanation; but frequently it is not so straightforward. Parents come armed with questions about ‘processing disorders’ and and they expect their MD to be knowledgeable. read more...

Julianne Yeager
September 14, 2016

Best practice: a tip from an employment lawyer

If you employ people, you should have professionally drafted and implemented employment contracts. The time and cost of having contracts drafted and implemented are minor, in comparison to the time and cost of dealing with a wrongfully dismissed employee and their lawyer. read more...