Post Archives

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...

Dr. Shelina Babul and Hadley Pearce
August 24, 2016

Gaps in recognizing, treating and managing concussions

Concussions are the most common form of brain injury in British Columbia, yet they are often under reported due to lack of awareness and education among the general public. The Concussion Awareness Training Tool (CATT) is a free online resource dedicated to providing resources and training to help increase the recognition, treatment and management of concussions. read more...

Dr. Jan Hajek
August 3, 2016

Recommending a plant-based diet

For diabetes in particular, observational studies suggest that persons who follow a plant-based diet have a lower risk for diabetes, and an RCT demonstrated reductions in HbA1c in patients with diabetes randomized to a vegan diet compared to the standard American Diabetes Association diet. read more...

Dr. Roberto Leon
July 12, 2016

Part 2: Minimizing the pain of the IUD insertion: all effort required

Up until recently, pain management with IUDs (intrauterine devices) insertion was not commonly performed, as most users were multiparous women and the insertion was reasonably straightforward. However, because the IUDs provide unsurpassed protection against a pregnancy along with many other advantages, its acceptance is dramatically increasing, especially in nulliparous women and adolescents. read more...

Drs. Christopher Cheung and Kenneth Gin
June 22, 2016

Comparing intensive versus standard blood-pressure control: The SPRINT Trial

Hypertension affects over 1 in 5 Canadians and is one of the leading causes of cardiovascular disease, including coronary artery disease and heart failure. Uncontrolled hypertension is a risk factor for stroke (both ischemic and hemorrhagic), retinopathy, chronic kidney disease (CKD), and peripheral vascular disease. Epidemiologic studies show that the risk of cardiovascular disease increases above a blood pressure of 115/75 mmHg. read more...

Dr. Soren Gantt
June 8, 2016

Diagnosis and management of congenital cytomegalovirus infection

Approximately 1 out of every 150 live-born infants has congenital CMV infection (cCMV). Of these, most are asymptomatic. However, more than 20% will suffer permanent neurologic sequelae, including hearing loss, intellectual disability, and visual deficits. In fact, cCMV is responsible for 25% of all childhood hearing loss, and is the second most common cause of intellectual disability after Down syndrome. read more...

Dr. Taryl Felhaber
May 25, 2016

Non-hormonal treatments for menopausal symptoms

Every woman transitions through menopause, although not all women have bothersome symptoms. Some women’s symptoms may be so disturbing as to lead them to think they are dying, as was the case with a patient in my practice several years ago. read more...

Dr. Eileen Murray
May 11, 2016

Nail fungus

Fungal infections particularly of the feet are a common problem. If only the skin is involved topical treatment with any of the antifungal creams works well. However, often fungal infections are ignored by patients and chronic skin infection can lead to infection of the nails. read more...

Dr. Roberto Leon
April 27, 2016

Part 1: Who should be offered an IUD, and selection of the appropriate IUD

Intrauterine devices (IUDs) are a safe, very effective, rapidly reversible and highly acceptable contraception amongst women. Yet it is resisted by many physicians. A recent study in Seattle (1) found that half or fewer of the physicians sampled do not follow the recommended guidelines, advising against using an IUD to nulliparous women, 20 years old or less, or women with a prior history of STI, PID or ectopic pregnancy. read more...

Dr. Kevin Fairbairn
April 13, 2016

The Alvarado Score in Acute Appendicitis

Appendicitis can often present itself in the black box of abdominal pain. Fortunately at times the history and physical can give practitioners a clear window, straight through the fascia, to an unhappy appendix. read more...

Drs. Neda Amiri and Kam Shojania
March 30, 2016

Part 2: Treating Gout – Practice Tips and Clinical Pearls

Despite being one of the most common forms of arthritis afflicting adults, optimal care of patients with gout including treatment of acute attacks as well as long-term management is not always achieved. read more...

Dr. Christina Williams
March 16, 2016

Surgery versus IVF in endometriosis infertility

In my early days as a reproductive physician, I made the diagnosis of “unexplained infertility” when ovulatory, male or tubal factors were absent. I advised the “keep trying” policy as pregnancy rates of 50% were expected in the second year of infertility. read more...

Dr. Hector Baillie
March 2, 2016

When quality trumps quantity: a clinician’s perspective

When a very old patient comes to my hospital for a pacemaker, I now spend longer with them. I explain what this device can do, and what it cannot do. Do they understand? Where are your family members, they need to understand too? I take time to get informed consent, when previously obtaining the signature was the most important part of the exercise. read more...

Drs. Erica Tsang and Iain Mackie
February 17, 2016

Screening for occult cancer in unprovoked venous thromboembolism (VTE)

An unprovoked venous thromboembolism (VTE), either through a deep venous thrombosis or pulmonary embolism, may be the earliest sign of malignancy. In patients presenting with unprovoked VTE, a limited occult malignancy screening strategy is sufficient, compared to routinely adding CT imaging of the abdomen and pelvis. read more...