Post Archives

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...

Dr. Daniel Kim
February 3, 2016

Enhance the valsalva to (actually) terminate SVT

Supraventricular tachycardia (SVT) is a dysrhythmia characterized by abrupt onset, regular rate that usually exceeds 150 beats/minute, and lack of identifiable P waves on ECG. SVT is caused by an abnormal circuit that allows a wave of depolarization to repeatedly travel in circular fashion in cardiac tissue via a reentry circuit that may reside in the atrioventricular (AV) node or outside the AV node in an accessory pathway. read more...

Kishore Mulpuri
January 20, 2016

Screening for developmental dysplasia of the hip: an evidence-based approach to practice

Developmental Dysplasia of the Hip (DDH) is a spectrum of hip joint abnormalities ranging from mild dysplasia to severe, frank dislocations. Left untreated, DDH can lead to serious complications later in life including osteoarthritis of the hip and total hip replacement. read more...

Dr. N. John Bosomworth
January 6, 2016

Weight loss in healthy people

There is no evidence for benefit of weight loss in healthy people. The safest body size trajectory in healthy people is a stable weight. It takes a modest amount of exercise to attain good metabolic benefit. It takes substantial exercise commitment to produce weight loss or to prevent weight regain. Mediterranean diet reduces cardiac risk factors and mortality. read more...

Dr. Steve Wong
December 16, 2015

Letter from the editor

As 2015 comes to a rapid close, I wanted to once again thank all of our authors and readers for their active participation at This Changed My Practice (TCMP). read more...

Sue Barlow, OT and Jennifer Loffree, OT
December 2, 2015

Concussion rehabilitation

The statistics regarding recovery from concussion indicate that the majority of individuals will be symptom-free at 3 months; within 6 months 70-75% will be symptom free; and within a year 10% will have 1 persisting symptom and 5% will have 4 or more persisting symptoms read more...

Dr. Paul Thiessen
November 18, 2015

A simple new technique for collecting urine in infants

What changed my practice was this simple new technique reported in an article from Spain which described a new method to obtain a midstream urine collection in which the infant is held upright and someone rubs over the suprapubic region while gently tapping over the lumbar region of the spine. read more...

Dr. Antoinette van den Brekel
October 28, 2015

Postnatal investigation of antenatally detected hydronephrosis

Health care providers caring for pregnant women and newborns are often faced with a finding of fetal hydronephrosis on routine screening antenatal ultrasound; in fact it is seen in 1 to 2% of fetuses screened. Babies at risk of rapidly progressive renal injury due to urinary tract obstruction need to be evaluated and referred for specialized care urgently, prior to discharge from hospital. read more...

Dr. Ric Arseneau
October 13, 2015

Hope for patients with fatigue, pain, and unexplained symptoms

Fatigue, pain, and unexplained symptoms are commonly seen in physician offices, however they are often experienced as “unsatisfying” for doctors. Our patients need an explanatory model to help them understand their illness. If we don’t provide one, patients will create their own or seek one elsewhere. read more...

Dr. Karen Nordahl
September 30, 2015

Exercise during pregnancy

It has been shown that 55% of pregnant patients reported some form of back pain during their pregnancy when questioned. Studies have demonstrated that if we get pregnant women moving, specifically working their pelvic floor with Kegel exercises and their ‘core’ they may have better pregnancy outcomes. read more...

James McCormack
September 16, 2015

Cardiovascular outcomes and blood pressure, glucose, and cholesterol numbers

Numerous observational studies have consistently shown in many (but not all) patient populations a correlation between people with higher blood pressure, glucose, and cholesterol numbers, and a greater risk of cardiovascular events such as heart attacks, strokes, and other unwanted outcomes. read more...

Dr. Catherine Allaire
September 2, 2015

Management of cyclical pelvic pain

Endometriosis is a very common condition affecting an estimated 10% of women of reproductive age. Severe dysmenorrhea is the most common symptom of endometriosis and the earliest one to occur. read more...

Dr. Anne Antrim
August 19, 2015

This app changed my practice – Read by QxMD

Read by QxMD provides the current research and opinions on topics in your field in a user-friendly manner so that I am not the last person in the province using Ribavarin for RSV infection when everyone else has read about the lack of efficacy. read more...