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» This Changed My Practice » Practice Change

Practice Change

Pharmacotherapy for Tobacco Use Disorder

Pharmacotherapy for Tobacco Use Disorder

By Drs. Clara Lu and Renée Janssen on March 7, 2023

Since the publication of the 2020 ATS Clinical Practice Guideline on pharmacologic treatment in tobacco-dependent adults, I now explain the goals of pharmacotherapy for tobacco use disorder in terms of reducing the compulsion to smoke and increasing readiness to quit, rather than abstinence alone. If patients are open to the conversation, I will discuss and offer all pharmacotherapy options — but emphasize the efficacy and safety of varenicline as my preferred first-line agent.

Read More | 6 Comments

Vaginal progesterone for the prevention of preterm birth

Vaginal progesterone for the prevention of preterm birth

By Drs. Jennifer Kask and Kirsten Duckitt on January 25, 2023

Preterm birth is the leading cause of perinatal morbidity and mortality in British Columbia and worldwide. We now carefully elicit any history of previous preterm birth and offer vaginal progesterone therapy for ANY history of spontaneous preterm birth. We fill in the Special Authority Request and give out the patient handout even before the patient goes to the pharmacy. We also encourage women to continue the medications until 37 weeks of gestational age.

Read More | 3 Comments

Diagnosis and treatment of polycystic ovary syndrome (PCOS) using virtual health

Diagnosis and treatment of polycystic ovary syndrome (PCOS) using virtual health

By Dr. Caitlin Dunne on November 30, 2022

Polycystic ovary syndrome is the most common endocrinopathy in women of reproductive age. It affects 8%–13% of young women and its symptoms are some of the most prevalent concerns that community physicians encounter. In many cases, diagnosis and management can be carried out in a virtual health setting using clinical criteria and judicious use of laboratory investigations.

Read More | 15 Comments

Moving into the treatment phase of the COVID-19 pandemic

Moving into the treatment phase of the COVID-19 pandemic

By Drs. Piszczek, Wright, and Grant on November 16, 2022

My approach now is to have the confidence to reassure patients who are low risk that SARS-CoV2 infection will most likely be mild for them and that no specific therapy is needed. Those who are of intermediate risk will also generally do well, but it is an opportunity to create a plan of what to do if they have flu-like symptoms, including their preferences should they test COVID positive. For those who are at high risk, especially CEV-1, I ensure them that there is a clear testing and treatment plan. Any physician can prescribe Nirmatrelvir/rt. A step-by-step instruction guide for prescribing is available on the BCCDC website.

Read More | 8 Comments

Offering CBT skills by group medical visits

Offering CBT skills by group medical visits

By Drs. Fiona Petigara and Joanna Cheek on September 28, 2022

A large part of physician’s day is spent on mental health and wait times to see specialists can be very long. In 2022 the BC Government created “Group Medical Visit” (GMV) codes to promote physicians to deliver services to groups of patients as “an effective way of leveraging existing resources; simultaneously improving quality of care and health outcomes, increasing patient access to care and reducing costs” (BC Gov, 2022). Physicians can now refer their patients to the Group Cognitive Behavioral Therapy program via cbtskills.ca or through PathwaysBC fillable PDF and they can also train to facilitate group medical visits.

Read More | 8 Comments

Why I no longer prescribe weight loss, calculate BMI, or use the term “obesity”

Why I no longer prescribe weight loss, calculate BMI, or use the term “obesity”

By Dr. Katarina Wind on May 3, 2022

Medical school taught me that “obesity” is a cause of morbidity and mortality, and that weight loss is its cure. I recorded patients’ BMIs and counselled them on weight-loss strategies, believing that I was helping them.

Read More | 35 Comments

Practice tip (for BC practitioners) utilizing PathwaysBC beyond specialist lookups — finding patient handouts, requisitions, point-of-care tools

By Drs. Tracy Monk, Nick Graham, Karin Kausky, Michele Thomasse, and Ryan Gallagher on March 22, 2022

We all used PathwaysBC.ca to help us find specialists for our patients, to look up wait times and what information to include in a referral, but we learned that Pathways could help streamline our clinical work in so many more ways.

Read More | 1 Comment

Tokes in the throat: cannabis smoking-related harm in otolaryngology

Tokes in the throat: cannabis smoking-related harm in otolaryngology

By Brendan McNeely and Dr. Amanda Hu on February 9, 2022

Recent evidence has emerged that shows cannabis smoking is related to significant patient morbidity. Namely, cannabis smoke exposure increased the risk of oropharyngeal cancer in a dose-dependent manner. Cannabis use may also be associated with hearing loss, vestibular dysfunction, tinnitus, and sinusitis.

Read More | 4 Comments

Perioperative anticoagulation management in mechanical heart valves, the PERIOP2 trial

Perioperative anticoagulation management in mechanical heart valves, the PERIOP2 trial

By Drs. Taylor Drury, Poupak Rahmani, and Tony Wan on January 26, 2022

We continue to use full dose therapeutic low molecular weight heparin (LMWH) for bridging in the pre-operative period. However, we now use post-operative prophylactic LMWH as an alternative bridging strategy in patients undergoing high-risk bleeding procedures. In patients at high risk of thromboembolism (including mechanical mitral valve and atrial fibrillation) undergoing a high-risk bleeding procedure, we are now less aggressive in resuming full dose therapeutic anticoagulation, as we feel comfortable using prophylactic LMWH for up to several days post-operatively before resuming therapeutic anticoagulation.

Read More | 3 Comments

Advances in diabetes glucose monitoring

Advances in diabetes glucose monitoring

By Gerri Klein on January 12, 2022

For all my patients who are on hypoglycemic medications, oral or injectable, I suggest using rtCGM or isCGM. Even intermittent use or a short trial of 10 days to two weeks with either of these devices can be enlightening for patients. With the ongoing COVID restrictions, many of my patients have been unable (or unwilling) to obtain an A1C from a lab test. In my practice, I have found it helpful to use glucose TIR to assess glucose control as an adjunct measure to A1C results; when an A1C is not available; and to guide treatment recommendations.

Read More | 23 Comments

Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 3: The Importance of Attachment Theory in Healthcare

Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 3: The Importance of Attachment Theory in Healthcare

By Dr. Linda Uyeda and Dr. Ashley Miller on July 7, 2021

The ingredients needed to create a happy workplace also largely reflect the principles of secure attachment. Across all levels within organizations, if people do not feel “safe, seen, soothed, and secure” they are more likely to make errors, breach safety protocols, and struggle working together as a team.

Read More | 4 Comments

Concussion rehabilitation update and a free self-management concussion tool

Concussion rehabilitation update and a free self-management concussion tool

By Sue Barlow and Carolyn Rondeau on June 3, 2021

Concussions or mild traumatic brain injury are the most common type of traumatic brain injury. It is estimated that every year in British Columbia (BC), there are approximately 14,500 visits to the emergency department and that this number is most likely an underestimate of the “true burden of concussion”.

Read More | 8 Comments

father comforting his crying little son - parenthood concept

Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 2: Parenting During a Pandemic

By Dr. Ashley Miller and Dr. Linda Uyeda on May 12, 2021

As I started to understand that this pandemic would wear on, I had to figure out how to help my patients’ families and my own family navigate our way through this totally new reality. I drew on the science of attachment, resilience and healthy relationships to make a plan. (Please stay tuned for Article #3!)

Read More | 1 Comment

Rate versus Rhythm Control in Patients with Atrial Fibrillation: Time to Change the Paradigm?

Rate versus Rhythm Control in Patients with Atrial Fibrillation: Time to Change the Paradigm?

By Drs. Christopher C. Cheung, Kenneth G. Gin, Jason G. Andrade on February 10, 2021

Patients with persistent AF, less symptomatic and/or older patients, and those with prior anti-arrhythmic failure are best managed with a rate control strategy. The EAST-AFNET 4 study is a practice-changing trial, and strongly supports the role of early rhythm control in patients with newly-diagnosed AF.

Read More | 2 Comments

Psychological PPE during COVID-19

Psychological PPE during COVID-19

By Dr. Jennifer Russel & Françoise Mathieu MEd RP on November 18, 2020

A few weeks into the COVID-19 crisis and as a psychiatrist working in a tertiary care hospital, while homeschooling my two boys, I had a strong awareness that I needed to really work to keep myself healthy in a way that I have never felt before to make sure I was able to survive this crisis. I needed to grab my psychological PPE.

Read More | 10 Comments

Portable ultrasound

Portable ultrasound

By Drs. Philip Lee and Stefanie Falz Mclellan on September 30, 2020

The integration of point of care ultrasound (PoCUS) in the emergency department workflow is not always easy, and these challenges have been amplified in the time of COVID-19. The COVID-19 pandemic has led to an increased interest in the use of handheld ultrasound devices as they simplify infection control procedures and take up little space in emergency rooms crowded with critical care equipment.

Read More | 7 Comments

Heart

Icosapent Ethyl to Reduce Atherosclerotic Events in Patients with Hypertriglyceridemia

By Omid Kiamanesh, MD, FRCPC on August 26, 2020

Despite intensive lowering of LDL-C using lipid-modifying therapy, residual ASCVD risk persists, particularly in those with hypertriglyceridemia. Icosapent ethyl has been shown to reduce residual ASCVD risk and cardiovascular death in select patients with hypertriglyceridemia while on statin therapy.

Read More | 8 Comments

Nash, W. P. (2011). US Marine Corps and Navy combat and operational stress continuum model: A tool for leaders. Combat and operational behavioral health, 107-119.

Stress First Aid as a form of Peer Support

By Dr. Joanna Cheek on August 5, 2020

It’s not easy to train in new skills to support our mental health when the race has already begun. We are all going to cycle out of the green zone many times, regardless of our practice of self-care. We need each other right now to provide peer support to help each of us notice when we’re moving to the right of the stress continuum and pause or pace ourselves so we can complete this marathon together.

Read More | 7 Comments

Serious Illness Conversations in the Time of COVID-19

Serious Illness Conversations in the Time of COVID-19

By Drs. Lawrence Chow and Rose Hatala on May 6, 2020

In the era of the COVID-19 pandemic, our most vulnerable patients (the elderly and those with chronic illnesses) are disproportionately at the highest risk of mortality. In this difficult and chaotic time, it’s more important than ever that we maintain a humanistic approach to care. This involves keeping the patient, and their values and preferences, front and center in our care.

Read More | 4 Comments

Taking care of each other during COVID-19 – peer support for physicians

Taking care of each other during COVID-19 – peer support for physicians

By Tandi Wilkinson MD CCFP-EM on April 1, 2020

I conducted a study examining effective peer support in rural Canadian physicians. (Spoiler alert: those who have had good peer support say it is essential to their career in medicine.) Here is what I am doing now to ensure I, and my team, can manage through this unprecedented time at work.

Read More | 21 Comments

Government Assistance Forms

Government Assistance Forms: Do they leave you bewildered?

By Dr. Janet McKeown on March 11, 2020

Government Assistance: Health Resources and Forms tool has helped me understand assistance with a more organized approach. It has helped me access information quickly and it has helped me be more knowledgeable about billing provincially, federally and privately. It is also an efficient tool to use in a teaching environment to help learners better understand government assistance.

Read More | 15 Comments

Hiding in plain sight: men’s mental health

Hiding in plain sight: men’s mental health

By Dr. Dan Bilsker on January 8, 2020

It is well-known that men die on average 3-4 years before women – but why? We identified three main factors contributing to Years of Life Lost by men compared to women: cardiovascular disease, suicide, and motor vehicle accidents. As a psychologist, I was intrigued by the substantial contribution of suicide.

Read More | 4 Comments

IUD

Use of endometrial aspirators as a uterine sound for IUD insertion

By Dr. Lisa Nakajima on December 4, 2019

One of the risks of IUD insertion includes perforation of the uterus. Although uterine perforation is relatively uncommon and often does not cause long-term harm, it does increase the risk of unplanned pregnancy and often requires surgery. I have chosen to use endometrial aspirators that are commonly used for endometrial biopsy sampling as a sound for IUD insertions, instead of the traditional metal sounds.

Read More | 7 Comments

mental-health

ACEs (Adverse Childhood Experiences): One Family Physician’s Experience

By Dr. Tahmeena Ali on August 21, 2019

I now ask all patients, young and old, new to my practice and established for years, male and female, to complete an ACEs questionnaire in my clinic. I garner a new level of respect for my patients’ resilience and for the ongoing turmoil many of my young patients face. I make finding supports for these young vulnerable patients one of my top priorities—as important as a referral to a specialist or for diagnostic imaging.

Read More | 10 Comments

Tropical

Practice Tip: Cutaneous larva migrans

By Dr. Miguel Imperial on July 30, 2019

Once I diagnose a patient with CLM based on a compatible travel history and characteristic serpiginous rash, I continue to treat the itch and inflammatory symptoms symptomatically if indicated, but I am able to much more readily offer systemic therapy with ivermectin since it no longer requires a Health Canada Special Access application.

Read More | 4 Comments

Facing a College Physician Practice Enhancement Program Assessment? What you need to know in 2019?

Facing a College Physician Practice Enhancement Program Assessment? What you need to know in 2019?

By Dr. Daniel Ngui on June 12, 2019

The Physician Practice Enhancement Program Assessment is highly educational and it helps physicians enhance the quality of their patient care through a peer review. It provides valuable feedback and creates opportunities to guide professional development and lifelong learning.

Read More | 3 Comments

The myth of the “Manipulative Personality Disorder”:  taking the blame out of the illness

The myth of the “Manipulative Personality Disorder”: taking the blame out of the illness

By Dr. Joanna Cheek on May 8, 2019

View personality disorder symptoms as important treatment targets in themselves. Be curious about each patient’s story, validate PD symptoms as coping mechanisms, focus on collaborative problem solving, set proactive regular visits, and also be mindful of your own emotional reactions providing compassion and empathy while setting clear boundaries.

Read More | 7 Comments

Parkinson’s disease: burden of non-motor problems

Parkinson’s disease: burden of non-motor problems

By Dr. Darly Wile on April 3, 2019

What I have found is that while it can sometimes be assumed that motor problems are the patient’s “biggest problem”, this is often not the case; instead, I now make a point of asking the patient, and their family directly: “What is the biggest problem for you right now?”

Read More | 3 Comments

Decreasing pain of osteoarthritic knees

Decreasing pain of osteoarthritic knees

By Dr. Muxin (Max) Sun on March 6, 2019

I have decreased my frequency of giving steroid injections for decreasing pain of osteoarthritic knees. I educate patients on evidence, placebo effects and risks. I recommend less invasive therapies including physiotherapy, exercise (quadriceps and hip abductor strengthening, Tai Chi), hot compress, antiinflammatory creams, weight loss, TENS machine, orthopedic & orthotic devices, etc.

Read More | 10 Comments

HIV pre-exposure prophylaxis (PrEP) for individuals at risk for HIV infection

HIV pre-exposure prophylaxis (PrEP) for individuals at risk for HIV infection

By Mark W. Hull MD MHSc on November 13, 2018

Over the last five years, on an ongoing basis, we have seen new HIV infections occurring in young gay, bisexual and other men who have sex with men (MSM). The majority of these individuals had had a prior negative HIV test within the last year, or were presenting with signs or symptoms supportive of an acute HIV infection, suggesting recent exposure and transmission of HIV infection, highlighting the need for novel HIV prevention strategies.

Read More | 4 Comments

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In 2014 TCMP won the CFPC Continuing Professional Development (CPD) Award. This award recognizes a MAINPRO®-accredited educational program that has provided an exceptional learning experience to practicing or practice-eligible CFPC members.
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      • Help, “hive” got a rash! — Article 1: Practical tips in the assessment of chronic spontaneous urticaria (CSU)
      • Pharmacotherapy for Tobacco Use Disorder
      • Ceiling doses of ketorolac and ibuprofen in acute pain management
      • Vaginal progesterone for the prevention of preterm birth
      • Bugs & Drugs guide to antimicrobial therapy
      • Letter from the editor
      • Diagnosis and treatment of polycystic ovary syndrome (PCOS) using virtual health
      • Moving into the treatment phase of the COVID-19 pandemic
      • Radon: a preventable cause of lung cancer
      • Women with ADHD — Practice Tips
      • Offering CBT skills by group medical visits
      • Why I talk about all Long Term Reversible Contraception (LARC)
      • Duration of antimicrobial therapy for common infections in primary care
      • Hepatitis C birth cohort testing
      • It’s not the ear — how TMD can confound clinicians
      • Mitigating the climate impact of asthma therapy
      • Prevention of recurrent cellulitis
      • Inflammatory back pain: distinguishing it from common mechanical back pain
      • Why I no longer prescribe weight loss, calculate BMI, or use the term “obesity”
      • Identifying Advanced Heart Failure in your patient
      • Practice tips for heart failure with reduced ejection fraction (HFrEF): supporting patients with medications and self-monitoring
      • Practice tip (for BC practitioners) utilizing PathwaysBC beyond specialist lookups — finding patient handouts, requisitions, point-of-care tools
      • Use of non-invasive tests for liver fibrosis
      • Pharmacologic thromboprophylaxis in hospitalized patients with COVID-19
      • Tokes in the throat: cannabis smoking-related harm in otolaryngology
      • Perioperative anticoagulation management in mechanical heart valves, the PERIOP2 trial
      • Advances in diabetes glucose monitoring
      • Letter from the editor
      • Cultivating compassion for people who are unvaccinated
      • PAUSE Trial & Thrombosis Canada Guidelines: practice tip
      • Adult ADHD — Practice Tip
      • Physician well-being during COVID-19 — burnout & moral injury
      • Approach to the patient with flashes and/or floaters
      • Can we identify patients at risk for Opioid Use Disorder when beginning opioid analgesics for pain from new or ongoing non-cancer causes?
      • New treatment option for Primary Biliary Cholangitis (PBC)
      • Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 3: The Importance of Attachment Theory in Healthcare
      • IMPROVE VTE scoring to guide VTE prophylaxis for medical inpatients
      • Concussion rehabilitation update and a free self-management concussion tool
      • Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 2: Parenting During a Pandemic
      • Giant Cell Arteritis Part 2: Treatment
      • A Refresher in Pelvic Pain
      • Clearing up the confusion around pneumococcal vaccines
      • Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 1: Cultivating secure bonds with our children during stressful times
      • Rate versus Rhythm Control in Patients with Atrial Fibrillation: Time to Change the Paradigm?
      • Specialists and Family Practice: Tackling the Pseudo-Penicillin Allergy Epidemic Together
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      • Letter from the editor
      • Alcohol Use Disorder — New Name, New Standard of Care, Dramatically Better Outcomes
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      • Giant Cell Arteritis Part 1: Diagnosis
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      • Interpretation of Syphilis Serology
      • Self-Compassion
      • Nurturing Resilience in Clinical Supervision
      • Healthcare Professional Well-Being
      • Serious Illness Conversations in the Time of COVID-19
      • Evolving in the era of COVID-19
      • Taking care of each other during COVID-19 – peer support for physicians
      • Government Assistance Forms: Do they leave you bewildered?
      • Preparing children for the medically assisted death of a loved one
      • Practice tip: medication-induced stuttering in psychiatric patients
      • Learning from each other: A Peer Coaching Program
      • Appropriate testosterone testing for male hypogonadism
      • Hiding in plain sight: men's mental health
      • Letter from the editor
      • Use of endometrial aspirators as a uterine sound for IUD insertion
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      • New insight into “HFpEF” – cardiac amyloid no longer a zebra diagnosis?
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      • “Girls on the Spectrum”: Autistic Spectrum Disorder in Girls
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      • ACEs (Adverse Childhood Experiences): One Family Physician's Experience
      • Practice Tip: Cutaneous larva migrans
      • Presenteeism
      • Correcting the Myth of Calcium Correction
      • Facing a College Physician Practice Enhancement Program Assessment? What you need to know in 2019?
      • Dry Eye Syndrome
      • The myth of the “Manipulative Personality Disorder”: taking the blame out of the illness
      • Anal cancer: information to get you out of the dark!
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      • Decreasing pain of osteoarthritic knees
      • Help - the steroids are not working - Helping women with refractory vulvar lichen sclerosus
      • Pearls and Pitfalls of Rheumatologic Lab Investigations
      • Dietary and physical activity recommendations for cancer survivors
      • Letter from the editor
      • Postoperative “troponinitis” is not benign: highlighting the importance of surveillance
      • HIV pre-exposure prophylaxis (PrEP) for individuals at risk for HIV infection
      • Driving assessment in older adults
      • New insight into “HFpEF” – cardiac amyloid no longer a zebra diagnosis?
      • Learning to meet my patient where they are at - how letting go changed my practice
      • Fecal incontinence: just ask!
      • Trauma Informed Practice (TIP) makes perfect (or at least it is a good start)
      • Better than sex? Building mind wandering tolerant presentations
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      • Wellness and self-care for professional excellence
      • Hip surveillance in children with cerebral palsy
      • The power of storytelling in clinical encounters
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      • Guidelines for working with formerly incarcerated people
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      • Letter from the editor
      • Managing your passwords
      • Managing opioid use disorder: buprenorphine/naloxone opioid agonist treatment
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      • Backward Course Design
      • Review of the topic of Autism Spectrum Disorder
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      • Seeking collateral information when clinical practice guidelines deliver strong recommendations for drug therapies on the basis of a single clinical trial
      • Long-term benzodiazepine use is associated with increased mortality in people with schizophrenia
      • Elevated Lipoprotein (a) is a common reason for unexplained premature or recurrent coronary heart disease and stroke
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      • First Canadian guideline on perioperative cardiac risk assessment and management for patients undergoing non-cardiac surgery
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      • Geriatric urinary incontinence: just ask!
      • Symptoms attributed to Chronic Lyme Disease
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      • Letter from the editor
      • BC Take Home Naloxone Program - updated article
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      • Best practice: a tip from an employment lawyer
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      • Part 2: Minimizing the pain of the IUD insertion: all effort required
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      • Diagnosis and management of congenital cytomegalovirus infection
      • Non-hormonal treatments for menopausal symptoms
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      • Part 1: Who should be offered an IUD, and selection of the appropriate IUD
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      • Part 2: Treating Gout - Practice Tips and Clinical Pearls
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      • Letter from the editor
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      • This app changed my practice - Read by QxMD
      • Recognizing the Potential Influence of the Interpersonal Gap in Teaching
      • This app changed my practice - Treatable Intellectual Disability Endeavor in B.C. (TIDE) - Treatable ID App www.treatable-id.org
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      • Letter from the editor
      • Fecal biomarkers in the diagnosis and management of inflammatory bowel disease
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      • Tinnitus – The Essentials of Patient Care in BC
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      • Contributed Works Dr. Sylvia Stockler
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      • B.C. Cancer Agency Colon Cancer Program
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      • Pharmacogenetics and pharmacogenomics: practice tips
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      • Barrier repair in atopic dermatitis
      • Care gaps in schizophrenia: male/female differences
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      • Never ignore an elevated eosinophil count - especially in travellers, immigrants and refugees
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      • This app changed my practice: My Fitness Pal
      • The Importance of Words in Clinical Teaching
      • Letter from the editor
      • Direct-to-Consumer genetic testing: What it means for the general practitioner
      • Contributed Works
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      • Undergoing the College’s practice review assessment
      • This app changed my practice: DizzyFix
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      • What's new in dyslipidemia
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      • The whole cell cholera and travellers’ diarrhea vaccine – Looking for evidence in the prevention of travellers’ diarrhea
      • Active video games and child's physical activity
      • Going Experiential
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      • Apps, websites and guidelines for osteoporosis management in primary care in 2012
      • Advance care plan (ACP) for patients with multiple co-morbidities
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      • Something as basic as wax cleaning!
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      • This app changed my practice: CCS lipid guidelines
      • Letter from the editor
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      • Advocating Fallopian Tube removal at the time of hysterectomy to prevent ovarian cancer
      • Weed is not just an herb
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