Resource TitlePublication DateFile TypeResource TypeKeywords
CERVICAL CANCER SCREENING - Clinical Practice Guideline2016-5-1PDFToward Optimized Practice (TOP)Carcinogenic Type | Intimate Sexual Contact | Overscreening | Human Papillomavirus (HPV) | Cervical Cancer | InfectionOBJECTIVE Alberta clinicians will understand the recent evidence^ offer age and risk-appropriate cervical cancer screening^ and follow up on abnormal screen results. TARGET POPULATION Consider all women 21-69 years of age who are or have ever been sexually active. Include transgender people with a cervix. EXCLUSIONS Women who have never been sexually active Women with symptoms such as vaginal spotting or bleeding need investigation but not screening *** Original Documents can be found and downloaded using the link provided below ***
TFP 066 - The Best Puffer for Initial Therapy in COPD 2012-4-30PDFAlberta College of Family Physicians (ACFP)Copd | PufferClinical Question: Which puffer has the greatest impact on clinical outcomes as the first-line long- acting inhaled treatment for COPD? Bottom-line: The available evidence indicates that tiotropium is likely the best initial long-acting therapy for COPD^ followed by a LABA (like salmeterol). *** Original Documents can be found and downloaded using the link provided below ***
TFP 124 - Vitamin D and Respiratory Tract Infections: Does the sun's vitamin chase the cold? 2014-10-27PDFAlberta College of Family Physicians (ACFP)Deficiency | Supplementation | Respiratory Tract Infections | Vitamin DClinical Question: Can regular vitamin D supplementation reduce the frequency^ duration^ or severity of respiratory tract infection (RTI)? Bottom-line: Regular use of vitamin D does not reduce the frequency^ duration^ or severity of RTI in western populations. Infrequent benefits seen in a few studies are at high risk of bias and/or involved children with profound deficiency (example 17.5 nmol/L) in developing countries. *** Original Documents can be found and downloaded using the link provided below ***
TFP 145 - Exercise and Cardiovascular Disease: Getting to the heart of the matter 2015-8-31PDFAlberta College of Family Physicians (ACFP)PCI | Cardiovascular Disease (CVD) | ExerciseClinical Question: How effective is exercise in reducing cardiovascular disease? Bottom Line: In patients with cardiovascular disease (CVD)^ exercise may reduce the risk of dying from CVD for one in 32 people at 48 months and heart failure admissions for one in 14 heart failure patients at 27 months. It is cost effective and improves quality of life. *** Original Documents can be found and downloaded using the link provided below ***
Summary of the Laboratory Guidelines for Serological testing for Suspected Viral Hepatitis2006-1-1PDFToward Optimized Practice (TOP)Alanine Aminotransferase (ALT) | Serum Enzymes | Suspected Viral Hepatitis | Viral Hepatitis: A, B, C, D, And E | Viral HepatitisSummary Alberta clinicians are assisted to identify patients with suspected viral hepatitis and optimize laboratory tests for the investigation TARGET POPULATION Children and adults with suspected viral hepatitis EXCLUSIONS Where an infectious etiology is not a consideration Outbreak investigations Pregnant women undergoing routine prenatal screening for viral hepatitis *** Original Documents can be found and downloaded using the link provided below ***
Urinalysis – OSCE Guide MovieVideosUrinalysis | Osce GuideExcellent; high-quality video demonstrates how to perform urinalysis; text instructions are embedded throughout; little audio Length: 2:20 Target Audience: Medical students and health professionals Author: Geeky Medics (UK)
TFP 049 - Can ondansetron help children vomiting due to gastroenteritis? 2015-4-21PDFAlberta College of Family Physicians (ACFP)Ondansetron | Gastroenteritis | ChildrenClinical Question: In children presenting with vomiting associated with gastroenteritis^ what are the benefits and harms of ondansetron? Bottom-line: While most cases of paediatric gastroenteritis are self-limiting^ a single dose of oral ondansetron can help reduce vomiting^ the need for IV fluids and likely admission. *** Original Documents can be found and downloaded using the link provided below ***
TFP 044 - Screening for Osteoporosis 2015-4-13PDFAlberta College of Family Physicians (ACFP)Mineral Density Testing | OsteoporosisClinical Question: What is the most efficient way to determine which patients are at high risk of osteoporosis and require further testing (Bone Mineral Density (BMD))? Bottom-line: The OST is simple^ quick and predicts osteoporosis as reliably as other more complicated instruments. It is a reasonable screening tool to identify those who would benefit from bone mineral density testing. *** Original Documents can be found and downloaded using the link provided below ***
TFP 024 - Pediatric Cough: Do OTC cough suppressants or honey help? 2013-10-22PDFAlberta College of Family Physicians (ACFP)Otc Cough Suppressants | Honey | Upper Respiratory Tract Infection (URTI)Clinical Question: Do Over-The-Counter (OTC) cough suppressants or honey improve cough due to Upper Respiratory Tract Infection (URTI) in children? Bottom-line: OTC cough suppressants should not be used in children under six and are likely ineffective in older children. The evidence supporting honey is positive for a small effect but the evidence is at high risk of bias. *** Original Documents can be found and downloaded using the link provided below ***
CLERKSHIP STUDENT HANDBOOK - Class of 20172016-2-23PDFStudents & LearnersMedical StudentsHandbook for all Cumming School of Medicine students in their clerkship year
LABORATORY ENDOCRINE TESTING GONADAL DISORDERS: HIRSUTISM Clinical Practice Guideline 2014-5-1PDFToward Optimized Practice (TOP)Hair | HirsutismOBJECTIVE Alberta clinicians optimize laboratory testing for investigation of suspected hirsutism TARGET POPULATION Women with moderate^ severe or rapidly developing hirsutism EXCLUSIONS None RECOMMENDATIONS X NO laboratory investigation is required for mild hirsutism - Refer to endocrinologist for severe or rapidly developing hirsutism - Consider testing for total testosterone^ DHEAS and androstenedione (drawn after 10 a.m.) X DO NOT test for LH^ FSH^ estradiol^ progesterone^ DHEA to diagnose hirsutism in absence of menstrual disorders *** Original Documents can be found and downloaded using the link provided below ***
Lymph node exam - Stanford Medical 252016-1-15WebsiteTeachingphysical exam | lymph nodesPalpation of the lymph nodes provides information about the possible presence of a malignant or inflammatory process and the localization or generalization of that process. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
LABORATORY ENDOCRINE TESTING: PHEOCHROMOCYTOMA Clinical Practice Guideline2014-5-1PDFToward Optimized Practice (TOP)Adrenal | HypertensionOBJECTIVE Alberta clinicians optimize laboratory testing for investigation of suspected pheochromocytoma and refer to an endocrinologist as soon as possible TARGET POPULATION Patients with typical symptoms^ hypertension refractory to multiple drug regimens^ accelerated hypertension^ known familial syndromes^ paradoxic hypertensive responses to antihypertensives^ hypertensive episodes during surgical procedures^ incidental findings of an adrenal tumor EXCLUSIONS None *** Original Documents can be found and downloaded using the link provided below ***
Teaching on the run tips 13: being a good supervisor — preventing problems2008-10-10PDFTeachingJMO | StressSetting You bump into a junior medical officer you know. She looks tired and harassed. She has been working long hours and spent much of the previous evening sorting out a sick patient without getting help from anyone. She felt she had made some mistakes. You wonder whether the JMO in your unit has ever been in the same situation. Fiona R Lake and Gerard Ryan *** Original Documents can be found and downloaded using the link provided below ***
Colorectal Cancer Screening Clinical Practice Guidelines - Summary2013-11-1PDFToward Optimized Practice (TOP)FIT | Colonoscopy | Fecal Immunochemical Test | Colorectal CancerSummary of the Colorectal Cancer Screening Clinical Practice Guidelines *** Original Documents can be found and downloaded using the link provided below ***
Guideline for the Diagnosis and Management of Croup 2008-1-1PDFToward Optimized Practice (TOP)Epiglottitis | Bacterial Tracheitis | CroupThis guideline assists in the diagnosis of croup through history taking^ examination and investigation. It also provides recommendations for emergency management including pharmacotherapy^ instructions for admissions^ discharge^ and supportive care and follow-up. Target Population: Children with mild^ moderate or severe croup - primarily six months to three years old but may include all from three months to 18 years Exclusions: None specified Minor Revision 2015
TFP 090 - Statin-Induced Diabetes: Too Sweet a Deal? 2013-5-27PDFAlberta College of Family Physicians (ACFP)Diabetic Threshold | Statin-Induced DiabetesClinical Question: Do statins increase the risk of diabetes^ and does this worsen outcomes? Bottom-line: Statins modestly increase blood glucose^ which leads to 1 in 250 or so patients crossing the “diabetic threshold” over 5 years. Pre-existing elevated sugars^ other diabetes risk factors or higher doses may slightly increase the risk. This should not change statin prescribing as they reduce cardiovascular events and all-cause mortality in appropriate patients. *** Original Documents can be found and downloaded using the link provided below ***
TFP 030 - Iron Deficiency Anemia in the Elderly: How much iron is enough? 2013-11-21PDFAlberta College of Family Physicians (ACFP)Iron | Hemoglobin | AnemiaClinical Question: In elderly adults with iron deficiency anemia (IDA)^ what is the appropriate dose of iron? Bottom-line: In elderly patients with iron deficiency anemia^ low doses of iron raise hemoglobin similar to higher doses with considerably less adverse events in most patients. Options for dosing include 1⁄2 of a 300mg ferrous gluconate per day or 2.5mL of Fer-In-Sol syrup a day. Clinicians should work-up the cause of anemia as appropriate. *** Original Documents can be found and downloaded using the link provided below ***
TFP 166 - Not So Free testing for cell free fetal DNA – Is it worth the cost? 2016-7-4PDFAlberta College of Family Physicians (ACFP)Down SyndromeClinical Question: Can cell free DNA (CF-DNA) be recommended to women to screen for trisomies? Bottom Line: Best evidence suggests that CF-DNA testing at 10-14 weeks is more sensitive (100 percent) and specific (99.9 percent) than current screening for Trisomy 21 and approaches accuracy of amniocentesis. Implementation of CF-DNA may be limited by cost and provincial coverage. *** Original Documents can be found and downloaded using the link provided below ***
Toenail Removal for Ingrown Toenail2012-1-1MovieVideosIngrown | ToenailExcellent; high-quality video discusses indications^ procedural technique^ dressing and follow-up. Length: 3:43 Target Audience: General Public Author: Dr. Donald Pelto
DOCTORS OPPOSING VIOLENCE EVERYWHERE (DOVE) Clinical Practice Guidelines2015-1-1PDFToward Optimized Practice (TOP)Abuse | Violence | Physically Or Sexually AbusedOBJECTIVE Increase Alberta physician awareness of issues relating to violence Provide resources for the identification and management of suspected violence TARGET POPULATION All Albertans EXCLUSIONS None *** Original Documents can be found and downloaded using the link provided below ***
LABORATORY ENDOCRINE TESTING: CUSHING’S SYNDROME Clinical Practice Guideline 2014-5-1PDFToward Optimized Practice (TOP)Cushing | Cortisol | AdrenalOBJECTIVE Clinicians in Alberta investigate for suspected Cushing’s syndrome including selecting optimal laboratory tests and timely referral to an endocrinologist. TARGET POPULATION Adults and children exhibiting clinical features of Cushing’s syndrome EXCLUSIONS None RECOMMENDATIONS - Refer to endocrinologist as soon as Cushing’s syndrome is suspected - Order a 24 hour urine collection for cortisol - Order a urine creatinine to ensure a complete 24 hour urine collection - Consider repeating tests if results are borderline values - X DO NOT order serum cortisol levels. They have low predictive value and are not recommended
TFP 087 - Daily multivitamins to reduce mortality^ cardiovascular disease and cancer2013-4-15PDFAlberta College of Family Physicians (ACFP)Multivitamins | Cardiovascular Disease (CVD) | CVD | CancerClinical Question: Does daily multivitamin supplementation reduce mortality^ cardiovascular disease (CVD) and/or cancer? Bottom-line: Present evidence does not support the routine use of multivitamins to reduce mortality^ cardiovascular disease or cancer for people in developed countries. *** Original Documents can be found and downloaded using the link provided below ***
Examination of the Liver - Stanford Medicine 252012-12-5WebsiteTeachinghepatomegaly | percussion | palpation | hepatic | liver | physical examThe liver is enlarged in a number of important clinical diagnoses. Palpation and percussion of the liver are important techniques for identifying hepatomegaly. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
Laboratory Endocrine Testing Guidelines: ACROMEGALY2014-5-1PDFToward Optimized Practice (TOP)Endocrine Investigation | Radiologic Examinations | Serum Igf-1 | Pituitary Adenoma | Chronic Debilitating Condition | AcromegalyOBJECTIVE Clinicians in Alberta select optimal laboratory tests for investigation of suspected acromegaly TARGET POPULATION Any person with signs or symptoms of acromegaly EXCLUSIONS None *** Original Documents can be found and downloaded using the link provided below ***
TFP 144 - Evaluating the Epley Maneuver: When one good turn deserves another 2015-8-4PDFAlberta College of Family Physicians (ACFP)Negative Dix-Hallpike | Benign Paroxysmal Positional Vertigo (BPPV) | Epley ManeuverClinical Question: How effective are Epley maneuvers in the treatment of Benign Paroxysmal Positional Vertigo (BPPV)? Bottom-line: Epley maneuvers will lead to the complete resolution of symptoms in every 2-3 patients treated. Post-Epley movement restriction does not improve symptom resolution but might promote a negative Dix-Hallpike for one in every 10 patients treated. *** Original Documents can be found and downloaded using the link provided below ***
TFP 096 - Calcitonin withdrawal: Now what for acute vertebral fractures? 2013-9-23PDFAlberta College of Family Physicians (ACFP)Calcitonin Withdrawal | Acute Vertebral Fractures | Traditional Analgesia | Bone Pain | Calcitonin | Cancer Risks | Bisphosphonates | Secondary Fracture PreventionClinical Question: Is there any medication (other than traditional analgesia) that works for bone pain resulting from osteoporotic vertebral compression fractures (OVCF)? Bottom-line: Calcitonin had weak evidence of moderate effectiveness for acute OVCF pain but was withdrawn over cancer risks. Although the evidence is very poor^ bisphosphonates appear to have similar effect on acute pain reduction and are useful in secondary fracture prevention. *** Original Documents can be found and downloaded using the link provided below ***
Fundoscopic / Ophthalmoscopic Exam - Stanford Medicine 252016-3-24WebsiteTeachingphysical exam | Eye | fundoscopy | ophthalmoscopyThe retina is the only portion of the central nervous system visible from the exterior. Likewise the fundus is the only location where vasculature can be visualized. So much of what we see in internal medicine is vascular related and so viewing the fundus is a great way to get a sense for the patient’s overall vasculature. But the fundoscopic exam can discover pathological process otherwise invisible. Examples are plentiful^ and include recognizing endocarditis^ disseminated candidemia^ CMV in an HIV infected patient^ and being able to stage both diabetes and hypertension. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 125 - HPV Vaccine: Shot of Cancer (and Wart) Prevention 2014-11-10PDFAlberta College of Family Physicians (ACFP)Condyloma | Genital Warts (condyloma) | Cervical Lesions | Hpv Vaccine:Clinical Question: How effective is the Human Papillomavirus (HPV) vaccine in preventing cervical lesions or genital warts (condyloma)? Bottom-line: HPV vaccine is effective in preventing advanced cervical lesions (CIN≥2) in one in 60-125 women and condyloma in one in 40- 50 men and women over 3-4 years. *** Original Documents can be found and downloaded using the link provided below ***
DIAGNOSIS AND MANAGEMENT OF URINARY TRACT INFECTION IN LONG TERM CARESummary of the Clinical Practice Guideline2015-1-1PDFToward Optimized Practice (TOP)Clinical Pathway | Urinary Tract Infection (UTI)Summary Alberta clinicians caring for residents in long term care facilities (LTCF)* will: Increase the accuracy of clinical diagnosis of urinary tract infections (UTI) Reduce inappropriate prescribing of antibiotics for asymptomatic bacteriuria Optimize antibiotic therapy for treatment of UTI while minimizing short and long term risks associated with antibiotic use Optimize testing and use of laboratory services for UTI TARGET POPULATION Older adults living in LTCF *LTCF is any congregate living environment for older or disabled persons who have high personal and professional care needs *** Original Documents can be found and downloaded using the link provided below ***
TFP 050 - CT scans and other forms of low-dose ionizing radiation – What is the risk of cancer? 2015-4-30PDFAlberta College of Family Physicians (ACFP)Ct Scans | Ionizing RadiationClinical Question: Is there an increased incidence of cancer in patients who undergo CT scans? Bottom-line: Individual risk estimates related to CT use are real but small^ and depend on a number of factors including CT type^ age^ sex and number of CT scans. Alternative imaging methods with lower or no radiation dose should be used when possible^ particularly in children and young adults. *** Original Documents can be found and downloaded using the link provided below ***
ThoracentesisMovieVideosThoracentesisExcellent; high-quality video is accompanied by clear audio instructions; indications, contraindications, equipment, preparation, fluid aspirate, fluid analysis and complications are discussed. Length: 8:51 Target Audience: Medical students and health professionals Author: New England Journal of Medicine
Headache Diary2012-7-1WebsiteToward Optimized Practice (TOP)Handout | Headache DiaryHeadache Diary *** Original Documents can be found and downloaded using the link provided below ***
Removal of foreign body – eye: Eye Foreign Body Removal (full procedure) 2013-1-1MovieVideosEye | Foreign Body Good; patient’s history^ full procedure and follow-up are demonstrated in the video; see Root Atlas.com video for close-up of the procedure Length: 3:12 Target Audience: Medical students^ health professionals^ general public Author: Dr. Larry Mellick^ Professor of Pediatrics and Emergency Medicine^ Medical College of Georgia
Sleep Diary2015-12-1PDFToward Optimized Practice (TOP)Handout | Sleep Logs | Primary Insomnia | Chronic Insomnia | Adult InsomniaSleep Diary patient handout *** Original Documents can be found and downloaded using the link provided below ***
What You Should Know About Your Chronic Low Back Pain2015-1-1PDFToward Optimized Practice (TOP)Lumbar | Handout | Low Back PainPatient handout about Chronic Low Back Pain *** Original Documents can be found and downloaded using the link provided below ***
TFP 137 - Benzodiazepines in Generalized Anxiety Disorder: Calm Your Nerves? 2015-4-27PDFAlberta College of Family Physicians (ACFP)Generalized Anxiety Disorder (GAD) | Antidepressants | Benzodiazepines | PlaceboClinical Question: Are benzodiazepines effective in generalized anxiety disorder (GAD)? Bottom-Line: In GAD^ benzodiazepines are more effective than placebo and similar to antidepressants. They cause more withdrawals for adverse effects than placebo but less than antidepressants. They are recommended second-line generally due to concerns of dependence. The evidence quality is generally poor^ trials are short-term^ and none used benzodiazepines as adjunctive therapy. *** Original Documents can be found and downloaded using the link provided below ***
Primary Care Guide to Evaluation and Referral for Prostate Cancer (PROCAP)2010-1-1PDFToward Optimized Practice (TOP)Procap | Abnormal Digital Rectal Examination (DRE) | Prostate Specific Antigen (PSA) testing | Prostate Cancer Refer to the Canadian Task Force Prostate Cancer Screening Guideline: canadiantaskforce.ca/guidelines/published-guidelines/prostate-cancer/
Laboratory Endocrine Testing Guidelines: ADRENAL INSUFFICIENCY (ADDISON’S DISEASE)2014-5-1PDFToward Optimized Practice (TOP)Hypotension | Adrenocorticol Insuf Ciency Symptoms | Type 1 Diabetes Mellitus | Autoimmune Endocrinopathies | Endocrine Disorder | Addison’s Disease | Adrenal InsufficiencyOBJECTIVE Clinicians in Alberta provide urgent referral to an endocrinologist and optimize laboratory tests for investigation of adrenal insufficiency (Addison’s disease) TARGET POPULATION Children and adults with signs or symptoms of primary or secondary adrenal insufficiency (Addison’s disease) EXCLUSIONS None *** Original Documents can be found and downloaded using the link provided below ***
TFP 069 - Omega-3 Fatty Acids (Fish Oil) for Patients with Cardiovascular Disease (CVD)2012-7-3PDFAlberta College of Family Physicians (ACFP)Cardiovascular | Omega-3 Fatty AcidsClinical Question: Do omega-3 fatty acid supplements reduce the risk of recurrent cardiovascular events in patients with existing cardiovascular disease (CVD)? Bottom-line: Although guidelines recommend increased dietary omega-3 consumption^ evidence does not support using omega-3 fatty acid supplements to prevent recurrent CVD events in patients with cardiovascular disease. *** Original Documents can be found and downloaded using the link provided below ***
DETERMINATION OF GESTATIONAL AGE BY ULTRASOUND - SUMMARY of the Clinical Practice Guideline2014-9-1PDFToward Optimized Practice (TOP)Ultrasound | Prenatal Ultrasound | Fetus (baby) | obstetrics | gynecologyOBJECTIVE Alberta clinicians assign gestational age based on ultrasound biometry TARGET POPULATION All pregnant women KEY MESSAGE Ultrasound is consistently more accurate than relying on patient recall for menstrual dating Routine ultrasound in the first or second trimester reduces inductions for post term pregnancies A woman’s self-knowledge and awareness of her internal functions^ including ovulation^ can be very accurate. However^ given the physiologic changes that can occur in any one menstrual cycle^ the exact time of ovulation^ fertilization and implantation cannot be precisely known. *** Original Documents can be found and downloaded using the link provided below ***
TFP 020 - Strategies for Initiating Insulin in Type 2 Diabetics 2013-9-16PDFAlberta College of Family Physicians (ACFP)Type 2 Diabetes | Initiating InsulinClinical Question: What is the optimal regimen for initiating insulin in Type 2 diabetes? Bottom-line: In Type 2 diabetes poorly controlled with oral agents^ initiating basal insulin results in similar HbA1c reductions compared to starting with prandial or biphasic insulin and may cause less weight gain and hypoglycemia. *** Original Documents can be found and downloaded using the link provided below ***
Gait Abnormalities - Stanford Medicine 252014-3-16WebsiteTeachingataxia | gait | physical examGait Abnormalities There are eight basic pathological gaits that can be attributed to neurological conditions: hemiplegic^ spastic diplegic^ neuropathic^ myopathic^ Parkinsonian^ choreiform^ ataxic (cerebellar) and sensory. Observation of these gait are an important aspect of diagnosis that may provide information about several musculoskeletal and neurological conditions. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 039 - Dabigatran versus Warfarin in Atrial Fibrillation 2015-2-9PDFAlberta College of Family Physicians (ACFP)Dabigatran | Warfarin | Thrombin Inhibitor | Atrial FibrillationClinical Question: What are the benefits and risks of dabigatran (Pradax) (a direct thrombin inhibitor)^ compared to warfarin^ in patients with atrial fibrillation? Bottom-line: Dabigatran offers some advantages over warfarin (example -0.6 percent/year fewer strokes)^ but benefits decline as warfarin time in INR range improves. If using Dabigatran 150mg bid is generally recommended. *** Original Documents can be found and downloaded using the link provided below ***
Flipped Classroom1980-1-1MovieTeachingLectureExcellent podcast by Dr. Kelly Burak^ Cumming School of Medicine^ University of Calgary Duration: 11:28
TFP 113 - Acetaminophen in pregnancy and future risk of ADHD for the unborn2014-5-12PDFAlberta College of Family Physicians (ACFP)Hyperactive Disorder (ADHD) | AcetaminophenClinical Question: Does acetaminophen in pregnancy increase the future risk of Attention Deficit Hyperactive Disorder (ADHD) for the unborn? Bottom-Line: Two well-done cohort studies suggest an association between acetaminophen use in pregnancy and an increased risk of ADHD or similar behaviours in children. While cohort studies cannot prove causation and we need further confirmation^ there may be a possible small risk of prolonged use of acetaminophen – especially late in pregnancy. Study limitations prevent specifics. *** Original Documents can be found and downloaded using the link provided below ***
TFP 181 - Manipulating Research for Spinal Manipulative Therapy for Low Back Pain2017-2-21PDFAlberta College of Family Physicians (ACFP)Acute Low Back Pain | LBP | Low Back Pain | SMT | Spinal manipulative therapyClinical Question: Is spinal manipulative therapy (SMT) effective for low back pain (LBP)? Bottom Line: Research around SMT is poor^ consistently inconsistent^ and almost impossible to interpret. Likely no reliable effects in acute LBP^ but possible small effects in chronic LBP^ at best improved pain (≤0.9 points out of 10) and recovery (for one in ~11 patients at one month) but two thirds of comparisons found no effect.
DIAGNOSIS AND TREATMENT OF HELICOBACTER pylori INFECTION IN ADULTS Summary of the Clinical Practice Guideline2016-6-1PDFToward Optimized Practice (TOP)H. Pylori | Peptic Ulcer Disease (PUD) | Dyspepsia | Helicobacter PyloriSummary algorithm... Exclusion - This guideline does not apply to pregnant or lactating women or patients <18 years of age Etiology *** Original Documents can be found and downloaded using the link provided below ***
TFP 079 - Iron Supplementation in Non-Anemic Women with Unexplainable Fatigue: Another Tired Theory?2012-12-10PDFAlberta College of Family Physicians (ACFP)Iron Supplementation | Non-Anemic Women | Unexplainable FatigueClinical Question: Is iron supplementation a reasonable option in treating non-anemic^ menstruating women with unexplainable fatigue? Bottom-line: In female non-anemic patients with low ferritin (<50 μg/L) who have unexplained fatigue there is some weak evidence (at high risk of bias) of small benefit from iron supplementation. If real^ at best 1 in 4 (to 1 in 10) may have slight improvement in fatigue^ with 1 in 7 having adverse events. *** Original Documents can be found and downloaded using the link provided below ***
A ReThink of the Way we Drink2015-2-9MovieVideosAlcoholism | Addiction | Patient Education | Alcohol ConsumptionExcellent patient education video regarding the use of alcohol and our health Length: 9:54 Author Dr. Mike Evans
Cognitive Impairment - Part 1: Symptoms to Diagnosis Clinical Practice Guideline2017-2-1PDFToward Optimized Practice (TOP)Cognitive Impairment | Older Adults (65+) | Cognitive Decline | Forgetful | MemoryOBJECTIVE Alberta primary care physicians and their interdisciplinary teams will be able to assess patients presenting with cognitive concerns and manage the majority of these patients and support their caregivers. TARGET POPULATION Older adults (65 years of age and greater) EXCLUSIONS - Children - Younger adults (less than 65 years of age) with early onset dementia Includes Key Messages^ Early Warning Signs And Five-Step Approach For Symptoms To Diagnosis And Pharmacological And Non-Pharmacolgical Therapy With Clinical Care Algorithm.
Failing Kidneys and Different Treatment Options 2014-3-13MovieVideosHemodialysis | Patient Education | Chronic Renal Failure | DialysisExcellent patient education video regarding the treatment of chronic renal failure Length: 10:32 Author Dr. Mike Evans
TFP 006 - PPIs and clopidogrel: Never the twain shall meet? Are there risks in giving a Proton Pump Inhibitor (PPI) with clopidogrel? 2013-10-7PDFAlberta College of Family Physicians (ACFP)Proton Pump Inhibitors | Clopidogrel | CardiovascularClinical Question: Do proton pump inhibitors (PPIs) interact with clopidogrel to reduce its cardiovascular (CV) benefit? Bottom-line: Studies are inconsistent about the impact of PPIs on clopidogrel effectiveness^ though most higher-quality studies show no interaction. The association with CV risk seen with PPI use is likely due to underlying comorbidities rather than a true drug interaction. *** Original Documents can be found and downloaded using the link provided below ***
TFP 011 - Atrial Fibrillation Patients Needing Brief Interruptions in Warfarin: Bridge or Not? 2013-10-28PDFAlberta College of Family Physicians (ACFP)Fibrillation | Warfarin | ThromboembolismClinical Question: If non-valvular atrial fibrillation (AF) patients on warfarin require an interruption of warfarin^ should we offer bridging with a heparin product? Bottom-line: According to present evidence^ non-valvular AF patients on warfarin at lower risk of thromboembolism do not require bridging for brief interruptions ≤7 days (preferably ≤5 days). Bridging is still recommended in higher-risk (e.g. recent stroke/TIA^ mechanical valves^ rheumatic valve disease^ or CHADS2 score ≥3) and interruptions >7 days. See 2010 Canadian AF guidelines for specific recommendations on bridging. *** Original Documents can be found and downloaded using the link provided below ***
IV line start up - PocketSnipsMovieVideosPocketsnipsYouTube requires Age Validation through Signin for this video Excellent; accompanied by clear audio instructions Length: 2:28 Target Audience: Medical students and health professionals Author: Dr. David Topps
Chronic Kidney Disease (CKD) Clinical PathwayWebsitePathwaysClinical Pathway | Kidney Disease | Chronic Renal FailureThe Chronic Kidney Disease (CKD) Clinical Pathway is a resource for primary care providers to aid in the diagnosis, medical management, and referral of adults with CKD.
Family Physicians: Licensing and Practice Readiness2017-1-1PDFAlberta Health ServicesLicensing | AppointmentsThe licensing and practice readiness information sheet provides contact information^ timelines and links for family physicians to be ready for practice in Calgary.
TFP 001 - CRP = CV? Should we React to C-Reactive Protein? 2009-5-15PDFAlberta College of Family Physicians (ACFP)Cardiovascular | Prevention | Statin | JUPITER | hs-CRP | LDL | high sensitivity | CRP | rosuvastatin | Crestor | Diabetes | MI | cardiac deathClinical Question: Is high-sensitivity C-reactive protein (hs-CRP) useful in guiding the management cardiovascular (CV) disease primary prevention? Bottom-line: hs-CRP is not useful at identifying patients at risk of a CV event or those who may benefit from primary prevention interventions.
Guideline for Primary Care Management of Headache in Adults^ 2nd ed2012-7-1PDFToward Optimized Practice (TOP)Secondary Headaches | Primary Headaches | Headache DisordersTarget Population: Adult patients 18 years or older in primary care settings. Exclusions: • This guideline does not provide recommendations for the management of patients with headache in the emergency department or inpatient setting beyond a discussion of “red flags” and some comments on the initial patient assessment. It is intended for primary care providers rather than for headache specialists. • Although some advice is provided with regard to the diagnosis and investigation of secondary headache disorders^ and the management of cervicogenic headache and temporomandibular disorder are discussed briefly^ the guideline does not provide advice on the management of other secondary headache disorders. • This guideline does not provide advice on the diagnosis and management of headache in children and adolescents. *** Original Documents can be found and downloaded using the link provided below ***
Identification and Symptom Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - SUMMARY of the Clinical Practice Guideline2016-1-1PDFToward Optimized Practice (TOP)CFS | FatigueObjective: Alberta clinicians will have the information and tools necessary to detect key symptoms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and manage these symptoms over the long term. Target population: Adults and children Exclusions: None *** Original Documents can be found and downloaded using the link provided below ***
TFP 151 - Rotavirus Vaccine: A shot to get off the pot(ty) 2015-11-23PDFAlberta College of Family Physicians (ACFP)Rotavirus | Vaccine | DiarrheaClinical Question: What are the benefits and risks of the rotavirus vaccine? Bottom-line: In developed countries^ rotavirus vaccine prevents serious diarrhea for one in 22 and reduces hospitalizations for one in 100. There does not appear to be an increase in intussusception rates. *** Original Documents can be found and downloaded using the link provided below ***
TFP 115 - Statins and cognitive impairment: Don't forget the evidence? 2014-6-9PDFAlberta College of Family Physicians (ACFP)Idiosyncratic | Cognitive Function | Dementia | StatinsClinical Question: Do statins have any effect on cognitive function or dementia? Bottom-line: Available evidence indicates that statins do not prevent^ treat^ or cause cognitive impairment or dementia. The FDA warning seems to be based primarily on case reports that may reflect idiosyncratic short-term “fuzzy” thinking. Decisions to prescribe statins should not be altered. *** Original Documents can be found and downloaded using the link provided below ***
TFP 009 - Home in the Range – Home Blood Pressure Monitoring2013-10-7PDFAlberta College of Family Physicians (ACFP)Hypertension | Blood Pressure | MonitoringClinical Question: Is home blood pressure monitoring (HBPM) helpful in the management of adult hypertension? Bottom-line: HBPM appears to provide some advantages over office BP assessment and may be a helpful addition for willing patients. *** Original Documents can be found and downloaded using the link provided below ***
TFP 003 - Glucose Self-Monitoring in Type 2 Diabetics Not Using Insulin: Is It Bitter Sweet? 2009-6-15PDFAlberta College of Family Physicians (ACFP)Self-Monitoring | Type 2 Diabetes | Glucose | Diabetes | Hba1c | Insulin | Quality Of Life | Randomized-Control Trial | RCT | Systematic ReviewClinical Question: What are the pros and cons of self- monitoring blood glucose for Type 2 Diabetics not using insulin? Bottom-line: Routine self-monitoring of blood glucose in Type 2 Diabetics who do not use insulin has no clinical benefits^ is not cost- effective^ and may reduce quality of life. *** Original Documents can be found and downloaded using the link provided below ***
TFP 170 - Back to activity: When is exercise effective for back pain?2016-9-12PDFAlberta College of Family Physicians (ACFP)Opioids | Nsaids | Physiotherapy | strength | function | chronic back pain | Acute Back Pain | non-specific low back pain | Back Pain | Exercise | LumbarClinical Question: Is exercise effective for non- specific lower back pain and^ if so^ when and which exercises? Bottom-line: For acute back pain^ exercise does not improve pain^ but giving advice to stay active (versus rest) will improve function slightly and reduce sick days (by -3 days). For chronic back pain^ exercise is effective^ reducing pain 10-13 points (out of 100)^ and preventing pain recurrence for one in four patients/year. Exercise (probably strength and stability with physiotherapy) is likely better than medicines and should be recommended to all patients.
The Prostate Specific Antigen (PSA) Test2014-7-21MovieVideosProstate Cancer | Prostate Specific Antigen (PSA) testing | Patient EducationExcellent patient education video regarding the pros and cons of PSA testing Length: 8:48 Author Dr. Mike Evans
Vitamin D Testing and Supplementation 2014-8-1PDFToward Optimized Practice (TOP)Osteomalacia | Supplementation | Osteoporosis | Vitamin DClinical Practice Guideline OBJECTIVE Appropriate vitamin D testing and supplementation is understood and practiced in Alberta. Specifically that: TARGET POPULATION Adults^ children and pregnant/lactating women who may be at risk for low vitamin D levels as a result of low dietary intake or seasonal (sunlight) exposure do not require vitamin D testing EXCLUSIONS Patients with malabsorption syndromes^ renal failure^ unexplained bone pain^ unusual fractures^ and other evidence of metabolic bone disorders may require vitamin D testing determined by specialists managing these conditions *** Original Documents can be found and downloaded using the link provided below ***
TFP 149 - Burning Issues and Aching Questions: Tramadol for osteoarthritic and neuropathic pain 2015-10-26PDFAlberta College of Family Physicians (ACFP)Pain | Neuropathic Pain | OsteoarthritisClinical question: Is tramadol effective for neuropathic or osteoarthritic pain? Bottom Line: Compared to placebo^ tramadol reduces neuropathic and osteoarthritic pain by ≥50 percent for one in five people with one in 8- 12 stopping for adverse effects. Although comparisons are limited^ pain control with tramadol appears to be similar to gabapentin (neuropathic pain) and maybe similar or better than opioids or diclofenac (osteoarthritis). *** Original Documents can be found and downloaded using the link provided below ***
TFP 077 - Zoster vaccine: Zoster loster or imposter coster? 2012-11-12PDFAlberta College of Family Physicians (ACFP)Zoster VaccineClinical Question: What are the benefits of the zoster vaccine to our patients? Bottom-line: Over 3 years^ zoster vaccine will prevent one herpes zoster for every 60-70 patients vaccinated^ and one postherpetic neuralgia in 350. Long-term benefits and effectiveness in specific patient populations (immunocompromised^ previous HZ) are unclear. *** Original Documents can be found and downloaded using the link provided below ***
Concussions 101^ a Primer for Kids and Parents2011-12-16MovieVideosConcussion | Patient EducationExcellent patient education video regarding the treatment of concussion Length: 5:51 Author Dr. Mike Evans
Ascites & Venous Patterns - Stanford Medicine 252012-12-5WebsiteTeachingphysical exam | liver | hepatic | hepatomegaly | ascites | abdomenWhen liver disease is severe enough to cause cirrhosis^ the increase in portal hypertension can lead to backup of flow through the liver. This may lead to fluid in the abdomen (ascites) and unique venous patterns on the abdomen that can vary depending on the diagnosis. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 018 - Is there more to medical management of renal stones than analgesia?2013-9-5PDFAlberta College of Family Physicians (ACFP)Medical Expulsion Therapy (MET) | Renal Stones | AnalgesiaClinical Question: In patients with renal stones eligible for observation^ does medical expulsion therapy (MET) improve passage of stones? Bottom-line: The current evidence indicates that patients with renal stones <10mm^ who are eligible for observation^ can be offered alpha-blockers or nifedipine to increase the chance of stone expulsion^ decrease pain and decrease the time to stone expulsion. *** Original Documents can be found and downloaded using the link provided below ***
Approach to the Hip Region Exam - Stanford Medicine 252016-10-17WebsiteTeachingphysical exam | hip | OsteoarthritisHip pain is really common. Sometimes the pain is coming from the hip joint. Other times^ pain may be coming from other surrounding causes. Here^ we'll review all causes of pain in the hip region and show you the exam to diagnose each one. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
LABORATORY ENDOCRINE TESTING: GALACTORRHEA Clinical Practice Guideline2014-5-1PDFToward Optimized Practice (TOP)Milk | Lactation | BreastOBJECTIVE Alberta clinicians optimize laboratory testing for investigation of suspected galactorrhea TARGET POPULATION Patients with non-puerperal secretions of milk EXCLUSIONS None RECOMMENDATIONS Evaluate secretions during breast examination Repeat testing if equivocal prolactin results Measure prolactin level at least one hour after a breast examination as breast trauma or manipulation can affect prolactin levels Refer to algorithm for diagnostic options *** Original Documents can be found and downloaded using the link provided below ***
Drainage of subungual hematomaMovieVideosDrainage | Subungual Hematoma | NailPoor; does explain indications or preparation; uses electric cautery to penetrate the nail Length: 1:02 Target Audience: General public (for interest) Author: Dr. John Gilmore, Cypress Lakewood Clinic, Texas
TFP 130 - Working out depression: Is exercise effective for depression? 2015-1-19PDFAlberta College of Family Physicians (ACFP)Depression | ExerciseClinical Question: Can exercise improve mild to moderate depression? Bottom-Line: Exercise shows benefit in treating mild to moderate depression but the evidence is at a high risk of bias with smaller benefit in higher quality studies. In high quality studies showing benefit^ approximately one in 8-12 patients with mild-moderate depression will attain remission due to exercise. *** Original Documents can be found and downloaded using the link provided below ***
TFP 051 - Antidepressants for preventing headaches: Which work and how well? 2015-4-30PDFAlberta College of Family Physicians (ACFP)Prophylaxis | Antidepressant | MigrainesClinical Question: In the prevention or prophylaxis of headaches (including migraines)^ which antidepressants work and how effective are they? Bottom-line: Daily tricyclic antidepressants^ particularly amitriptyline^ effectively reduce headache severity and frequency. They are effective regardless of headache type and the benefit improves with time. *** Original Documents can be found and downloaded using the link provided below ***
TFP 184 - Preventing Allergies with Omega-3 in Pregnancy: Another fishy idea?2017-4-3PDFAlberta College of Family Physicians (ACFP)Fish oil | Omega 3 | Pregnancy | Allergy | eczema | Asthma | Rhinitis | olive oil | long chain poly-unsaturated fatty acids | eicosapentaenoic acid | docosahexaenoic acidClinical Question: Can fish oil supplementation during pregnancy prevent allergic disease in children? Bottom-line: Fish oil in pregnancy is likely ineffective at preventing allergic disease in offspring as decreases in either eczema^ food allergies^ or asthma in one study are generally not found in others and any positive effects seem to wane over time. Enthusiastic mothers could try fish oil supplements from ~20th week of gestation to delivery to prevent allergic disease in^ at best^ one in ~20 children.
TFP 157 - Flibanserin: Feeling frisky or falling over? 2016-2-29PDFAlberta College of Family Physicians (ACFP)Sexual Activity | SexualClinical Question: Does flibanserin improve sexual desire and the number of satisfying sexual episodes for women? Bottom-line: Flibanserin results in -7 percent improvement in desire and 0.4-1 additional “satisfying” sexual event per month. However^ it is also associated with adverse events like dizziness or somnolence for one in 10-15 women. Concerns regarding hypotension^ syncope^ and interactions with commonly used drugs (particularly alcohol) are worrisome and require further research. *** Original Documents can be found and downloaded using the link provided below ***
TFP 022 - Treating Hypertension in the Very Elderly: What we know so far?2013-10-17PDFAlberta College of Family Physicians (ACFP)Elderly Patients | HypertensionClinical Question: In patients over age 80^ what are the risks and benefits of treating hypertension? Bottom-line: Treating hypertension in healthy elderly patients age ≥80 is effective. Exact targets are uncertain but the primary trial used 150/80 as a target. The benefit of treating the frail elderly or those with orthostasis and/or a standing systolic pressure of <140 remains uncertain. *** Original Documents can be found and downloaded using the link provided below ***
TFP 143 - Acute Back Pain: Is Cyclobenzaprine a reasonable option?2015-7-20PDFAlberta College of Family Physicians (ACFP)Diazepam | Cyclobenzaprine | Acute Back Pain | PlaceboClinical Question: What is the effectiveness of cyclobenzaprine for acute back pain? Bottom-line: Cyclobenzaprine provides reduced pain and increased global improvement over placebo for one in every 3-9 patients in the first week. Cyclobenzaprine is as good or better than diazepam. Cyclobenzaprine 5 mg TID (half-pill) is as effective as 10 mg TID with less somnolence. *** Original Documents can be found and downloaded using the link provided below ***
TFP 100 - Effectiveness of seasonal influenza vaccine for healthy^ working age adults 2013-11-12PDFAlberta College of Family Physicians (ACFP)Circulating Influenza Strains | Flu Shot | Seasonal Influenza Vaccine | Trivalent Influenza VaccineClinical Question: Does the trivalent influenza vaccine (flu shot) prevent influenza or its complications in healthy working age adults? Bottom-line: For healthy adults^ the flu shot reduces influenza when vaccine is well matched to circulating influenza strains (Numbers Needed to Treat (NNT)=12-37). When vaccine is poorly matched^ effectiveness diminishes and may be similar to placebo. The flu shot has not been shown to affect hospitalizations and observational evidence that influenza vaccine decreases mortality is likely biased. *** Original Documents can be found and downloaded using the link provided below ***
TFP 037 - SPRINT don’t walk to Evidence for Specific BP Targets?2016-3-25PDFAlberta College of Family Physicians (ACFP)BP | Blood PressureClinical Question: What is the evidence for blood pressure (BP) targets lower than 140/90? Bottom-line: Evidence supports BP targets of <140/90 for general hypertension and diabetic/renal subgroups. However^ in patients with cardiovascular disease (CVD) risk ≥20 percent over 10 years^ targets -120 can be (carefully) considered. This does not include diabetics or post-stroke and standing BP should be monitored. *** Original Documents can be found and downloaded using the link provided below ***
TFP 061 - Is HCTZ the best thiazide diuretic for hypertension?2012-2-6PDFAlberta College of Family Physicians (ACFP)Hydrochlorothiazide | Hypertension | Thiazide DiureticClinical Question: When choosing a thiazide diuretic for hypertension^ is hydrochlorothiazide (HCTZ) the best choice? Bottom-line: The available data suggest that chlorthalidone is at least equal to and very likely superior to HCTZ in reducing BP and improving clinical outcomes. Consider prescribing chlorthalidone (12.5mg increasing to 25mg daily) when initiating thiazide diuretic therapy for hypertension. *** Original Documents can be found and downloaded using the link provided below ***
TFP 032 - Bone Mineral Density – Too much of a good thing? 2013-11-26PDFAlberta College of Family Physicians (ACFP)Osteoporosis | Bisphosphonates | Bmd Measurement | Bmd TestingClinical Question: Once we have initiated bisphosphonate therapy^ how frequently should we check bone mineral density (BMD)? Bottom-line: Repeating BMD in the first three years after starting treatment with a bisphosphonate is unnecessary and potentially confusing.1 The vast majority of patients taking a bisphosphonate will get an adequate increase in BMD after three years and have a reduced fracture risk regardless of BMD changes. *** Original Documents can be found and downloaded using the link provided below ***
Summary for the Diagnosis and Management of COPD COPD2010-2-1WebsiteToward Optimized Practice (TOP)Copd**UNDER REVIEW**
The General Dermatology Exam: Learning the Language - Stanford Medicine 252016-1-22WebsiteTeachingmorphology | skin | dermatology | physical examThe diagnosis of any skin lesion starts with an accurate description of it. To do that^ you need to know how to describe a lesion with the associated language. This language^ reviewed here^ can be used to describe any skin finding. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
Liver Disease^ Head to Foot - Stanford Medicine 252012-12-5WebsiteTeachingphysical exam | liver | hepatic | hepatomegalyThe signs of liver disease are for the most part to be found OUTSIDE the abdomen. The goal of this Stanford Medicine 25 session is for you to be able to list these signs from head to foot. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
Skin staplingMovieVideosSkin StaplingExcellent; high-quality video discusses indications, equipment, and various approaches to stapling along with the procedure Length: 5:20 Target Audience: Medical students and health professionals Author:Dr. Carlo Oller, Emergency Physician, EmCare (Medical Director of CMC Emergency Room)
TFP 180 - GLP-1 Analogues in Diabetes: As sweet as can be?2017-2-6PDFAlberta College of Family Physicians (ACFP)Hypoglycemia | A1c | CVD | Cardiovascular Disease (CVD) | lixisenatide | liraglutide | Semaglutide | Diabetes | Type 2 Diabetes | GLP-1 | Glucagon-like peptide 1 analogues | EndocrinologyClinical Question: Do glucagon-like peptide 1 analogues (GLP-1) improve patient-oriented outcomes in type 2 diabetes? Bottom Line: Compared to placebo^ semaglutide and liraglutide^ but not lixisenatide^ reduce cardiovascular disease (CVD) for ~1 in 50 diabetics with existing CVD over 2-4 years^ irrespective of specific A1c targets (attaining ~7.5%). These drugs reduce weight 0.7-4.3 kg^ but around one in 25 more than placebo will stop due to gastrointestinal effects. Some uncertainty around neoplasm risk remains.
TFP 028 - Are acetaminophen and ibuprofen equivalent in the treatment of pediatric fever? 2013-10-24PDFAlberta College of Family Physicians (ACFP)Fever | Pediatric | Tylenol | Advil | MotrinClinical Question: If we provide a recommendation regarding the treatment of pediatric fever^ is acetaminophen or ibuprofen superior? Bottom-line: Treatment of pediatric fever is debated and should be discussed with parents/patients. If clinicians are going to recommend a treatment^ ibuprofen offers superior fever reduction with no increase in adverse events. *** Original Documents can be found and downloaded using the link provided below ***
TFP 064 - Opioids and Osteoarthritis: weighing benefits and risks 2012-3-19PDFAlberta College of Family Physicians (ACFP)Osteoarthritis | OpioidsClinical Question: What is the evidence for opioids as a treatment for osteoarthritis (OA)? Bottom-line: In osteoarthritis^ research demonstrating long-term improvements in pain or function with opioids is lacking. In elderly patients with OA^ the risk of opioids may be even greater than the risk of NSAIDs. Opioids should not be routinely used in osteoarthritis^ but if necessary^ they should be used for short- courses in carefully selected patients. *** Original Documents can be found and downloaded using the link provided below ***
TFP 134 - Getting patients to drink less—Are words mightier than drink?2015-3-16PDFAlberta College of Family Physicians (ACFP)Morbidity | Alcohol ConsumptionClinical Question: Is brief intervention (BI) in primary care effective in reducing alcohol consumption in adults with excessive alcohol intake? Bottom-Line: Brief intervention reduces drinking to lower risk levels over 12 months for one in 10 adults with excessive alcohol intake. There is no evidence of corresponding improvement in alcohol related morbidity and mortality. This could take up to -40 hours per year for the average-sized practice. *** Original Documents can be found and downloaded using the link provided below ***
Shoulder Exam - Stanford Medicine 252014-3-16WebsiteTeachingphysical exam | Shoulder | rotator cuffShoulder complaints are common and the shoulder exam is the most important way to address these complaints by finding the cause of shoulder pain and figuring out what treatment is needed. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 085 - Vitamins for age-related macular degeneration (AMD) demonstrates minimal differences 2013-3-18PDFAlberta College of Family Physicians (ACFP)Age-Related Macular Degeneration (AMD) | Vitamins | Ocular Vitamins | Anti-Oxidants | Zinc | Retinal FindingsClinical Question: Does taking ocular vitamins (including anti-oxidants and zinc) decrease the progression of age related macular degeneration (AMD)? Bottom-line: Only in AMD patients with intermediate or greater retinal findings do ocular vitamins slow visual loss NNT 13. The risk of advanced AMD is rare in patients with minimal AMD^ and ocular vitamins do not prevent AMD in those without AMD. Components of ocular vitamins are potentially harmful and should be used only in selective patients. *** Original Documents can be found and downloaded using the link provided below ***
Active Tuberculosis (TB) the Diagnosis and Management 2011-11-1PDFToward Optimized Practice (TOP)Tuberculosis (TB) | Active Pulmonary Tuberculosis (TB) | Preventative TherapyThis guideline focuses on detection of active pulmonary tuberculosis (TB) that poses a public health risk. While extrapulmonary TB and preventative therapy for latent tuberculosis infection are relevant to primary care physicians^ they are outside the scope of this document.
Rectal Exam - Stanford Medicine 252017-1-1WebsiteTeachingprostatitis | DRE | rectal | physical examThe rectal exam is important to make sure causes of rectal bleeding such as hemorrhoids are not missed. Additionally^ understanding how to palpate the prostate gland is important for looking for cancer and diagnosis prostatitis. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 038 - What Are the Risks and Benefits of Stopping Antipsychotics in the Elderly? 2013-7-4PDFAlberta College of Family Physicians (ACFP)Psychosis | Atypical Antipsychotics | Antipsychotics | Elderly PatientsClinical Question: In elderly patients^ what are the risks and benefits of stopping long-term antipsychotics (initiated for behavioral concerns)? Bottom-line: In elderly patients on long-term antipsychotics^ withdrawal of antipsychotics in four patients may prevent one death at two years. After discontinuation^ neuropsychiatric symptoms appear to vary little^ although one study suggests stopping after four months can cause one in four more patients to have a relapse of neuropsychiatric symptoms. *** Original Documents can be found and downloaded using the link provided below ***
TFP 012 - What is the Benefit of Vitamin D: Trend or Treat? 2013-11-4PDFAlberta College of Family Physicians (ACFP)Vitamin DClinical Question: In patients >50 years old^ what are the benefits of Vitamin D treatment on falls^ fractures and mortality? Bottom-line: Present evidence supports the use of Vitamin D around 800–1000 IU to reduce fractures^ falls and overall mortality in older patients (likely ≥50 years old). There is currently no high level evidence to support regularly testing older patients for Vitamin D insufficiency. *** Original Documents can be found and downloaded using the link provided below ***
TFP 093 - ASA after warfarin for unprovoked VTE: does the little clot fighter make sense? 2013-7-22PDFAlberta College of Family Physicians (ACFP)ASA | Warfarin | Oral Anti- CoagulantsClinical Question: When stopping oral anti- coagulants (like warfarin) after treatment for venous thromboembolism (VTE)^ should ASA be offered? Bottom line: Once warfarin treatment for unprovoked VTE is complete^ ASA (100mg daily) prevents recurrent VTE for one in 19 patients over 2.5 years with no increase in bleeding. ASA does not replace warfarin or novel anticoagulants for the initial treatment of VTE. *** Original Documents can be found and downloaded using the link provided below ***
LABORATORY ENDOCRINE TESTING: HYPOGLYCEMIA - Summary of the Clinical Practice Guideline2014-5-1PDFToward Optimized Practice (TOP)Hypoglycemia | Glucose | InsulinSummary OBJECTIVE Alberta clinicians optimize laboratory tests for investigation of suspected hypoglycemia TARGET POPULATION Patients exhibiting clinical features of hypoglycemia EXCLUSIONS None *** Original Documents can be found and downloaded using the link provided below ***
Pedagogy of Effective presentations1980-1-1MovieTeachingLectureExcellent podcast by Dr. Kelly Burak^ Cumming School of Medicine^ University of Calgary Duration: 7:34
TFP 097 - Fibrates: Statin’s Trusty Sidekick or Lackluster Fallback?2013-10-7PDFAlberta College of Family Physicians (ACFP)Statin Therapy | Non-Fatal Coronary Events | CV | FibratesClinical Question: Do fibrates reduce cardiovascular (CV) events? Bottom-line: When used alone^ fibrates reduce non-fatal coronary events^ but have no effect on mortality or other CV events^ including stroke. Current evidence suggests fibrates provide no advantage when added to statin therapy. *** Original Documents can be found and downloaded using the link provided below ***
TFP 057 - Is colchicine an effective alternative to NSAIDs for the treatment of acute gout? 2014-12-9PDFAlberta College of Family Physicians (ACFP)Acute Gout | Nsaids | ColchicineClinical Question: For patients with acute gout^ is colchicine an effective treatment and when would its use be indicated? Bottom-line: Colchicine is a reasonable option for the treatment of acute gout^ especially in patients in whom NSAIDs are contraindicated. Optimal dosing that balances treatment benefit with potential adverse events still remains to be determined^ but low dose is recommended. *** Original Documents can be found and downloaded using the link provided below ***
Involuntary Movements - Stanford Medicine 252013-11-6WebsiteTeachingdystonia | tic | tremor | physical examInvoluntary movements compose a group of uncontrolled movements that may manifest as a tremor^ tic^ myoclonic jerk^ chorea^ athetosis^ dystonia or hemiballism. Recognition of involuntary movements associated with hyperkinetic movement disorders is an important diagnostic skill. This page describes the diagnosis of the major categories of hyperkinetic movement disorders. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
CERVICAL CANCER SCREENING - Summary of the Clinical Practice Guideline2016-5-1PDFToward Optimized Practice (TOP)Sexual Activity | Pap Test | Cervical Cancer | Human Papillomavirus (HPV) | Cervix Bleeding | Abnormal Bleeding | Sti Screening | Hpv Vaccination | abnormal pap testGraphical summary cervical cancer screening guidelines Age and risk-appropriate screening recommendations and management of abnormal Pap test results Description: Alberta clinicians will understand the recent evidence^ offer age and risk-appropirate cervical cancer screening^ and follow up on abnormal screen results. Target Population: Consider all women 21-69 years of age who are or have ever been sexually active. Include transgender people with a cervix. Exclusions: Women who have never been sexually active Women with symptoms such as vaginal spotting or bleeding need investigation but not screening *** Original Documents can be found and downloaded using the link provided below ***
Nasogastric tube insertion - PocketSnipsMovieVideosNasogastric | Tube Insertion | NGExcellent; accompanied by clear audio instructions and supplementary materials Length: 2:54 Target Audience: Medical students and health professionals Author: Dr. David Topps, PocketSnips Procedural Skills Project, NOSM
Pupillary Responses - Stanford Medicine 252017-1-1WebsiteTeachingphysical exam | Eye | pupilThere are a handful of pupillary abnormalities that every clinician should know. Here we review the basic physiology then describe these abnormal pupillary responses and how to find them. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 014 - Optimal Pain Relief for Acute Pediatric Musculoskeletal Injuries – NSAIDs or Opioids?2015-3-24PDFAlberta College of Family Physicians (ACFP)Pain | Pediatric MusculoskeletalClinical Question: In children with acute musculoskeletal (MSK) injuries what is the optimal approach to pain management? Bottom-line: Current evidence suggests that ibuprofen provides better single-agent relief than acetaminophen or codeine^ and is at least equivalent to acetaminophen with codeine for acute pediatric pain due to injury^ with fewer adverse events.
Tracking Record for Advance Care Planning (ACP): Goals of Care Discussions2009-11-1PDFAlberta Health ServicesAdvance Care Planning | Goals Of Care | Interdisciplinary• The purpose of the Tracking Record is to document the decisions/next steps/outcomes of discussions related to ACP and Goals of Care Designations. • Goals of Care discussions are ongoing and may include any combination of the Six [6] Core Elements. • Any member of the interdisciplinary team may initiate or participate in discussions related to advance care planning and/or goals of care.
Flatulence2013-12-5MovieVideosIndigestion | Flatulence | Fart | Patient EducationExcellent patient education video regarding the causes of flatulence. Length: 3:55 Author Dr. Mike Evans
Prevention and Diagnosis of Acute Bronchitis and Acute Exacerbations of COPD - Summary2008-1-1WebsiteToward Optimized Practice (TOP)Copd | Viral Infections | Environmental Tobacco Smoke | Infuenza VaccineA website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
TFP 188 - Trouble Sleeping: Spend less time in Bed?2017-5-29PDFAlberta College of Family Physicians (ACFP)sleep restriction therapy | Sleep restriction | SRT | insomnia | Primary Insomnia | sleep | Sleep Hygiene | sleep efficiency | sleep latency | Z-Drugs | cognitive behavioural therapy | CBTClinical Question: For people with primary insomnia (not related to other conditions)^ can sleep restriction therapy improve outcomes? Bottom Line: Sleep restriction therapy (SRT) improves time to fall asleep by 12 minutes and time asleep while in bed by 5-10%. Sleep restriction will improve sleep for one in every two to six patients compared to sleep hygiene alone.
TFP 026 - Pharmacotherapy for Smoking: What works and what to consider (PART I)? 2013-10-28PDFAlberta College of Family Physicians (ACFP)Abstinence | Smoking | NicotineClinical Question: In patients ready to make a smoking cessation attempt^ how effective are registered first-line medications and what are the potential concerns? Bottom-line: There are four first-line options of nicotine replacement therapy (NRT) (gum^ patch^ lozenge^ or inhaler) and all improve the chance of abstinence from smoking. For every 17 patients treated with NRT^ one will remain abstained from smoking at six months. Adverse events are low but supportive follow-up will allow monitoring and can improve cessation. *** Original Documents can be found and downloaded using the link provided below ***
Do More Screening Tests Lead to Better Health? Choosing Wisely2015-11-12MovieVideosScreening | Patient EducationExcellent patient education video regarding the need for screening in healthy indviduals Length: 10:17 Author Dr. Mike Evans
TFP 099 - Will the flu shot help my Grandma and Grandpa?2013-11-4PDFAlberta College of Family Physicians (ACFP)Elderly Patients | Influenza Vaccine | Seniors | Trivalent Influenza VaccineClinical Question: Does the seasonal trivalent influenza vaccine (flu shot) prevent influenza or its complications in patients age ≥65 years old? Bottom-line: One high quality randomized controlled trial demonstrated that vaccinating 40 community dwelling seniors with the trivalent influenza vaccine (flu shot) will prevent one case of influenza. Cohort studies demonstrating mortality benefits are biased by healthy user effect. *** Original Documents can be found and downloaded using the link provided below ***
Cerebellar Exam - Stanford Medicine 252014-3-18WebsiteTeachingphysical exam | cerebellumThe cerebellum coordinates unconscious regulation of balance^ muscle tone^ and coordination of voluntary movements. Therefore^ cerebellar disease (including cerebellar stroke^ cerebritis and metabolic insults) leads to clinical signs that occur throughout the body. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 055 - Roflumilast – COPD relief at last?2014-12-12PDFAlberta College of Family Physicians (ACFP)Copd | RoflumilastClinical Question: Is roflumilast (Daxas®) beneficial as an add-on therapy in the management of COPD? Bottom-line: Roflumilast decreases the risk of COPD exacerbations for one in 25^ with no effect on mortality and no clinically important improvements in quality of life. Roflumilast increases the risk of various adverse effects^ including psychiatric (one in 28)^ diarrhea (one in 15)^ and weight loss (one in 17). The net benefit of roflumilast is questionable. *** Original Documents can be found and downloaded using the link provided below ***
Guideline for The Diagnosis and Management of Community Acquired Pneumonia: Adult2008-1-1WebsiteToward Optimized Practice (TOP)Rigors | Chest Radiography | Community Acquired Pneumonia (CAP) | Fever | Cough | Antibiotics A website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
Management of Community Acquired Pneumonia in Adults - Summary2008-1-1WebsiteToward Optimized Practice (TOP)Pleural Empyema | Hydration | Community Acquired Pneumonia | Fever | PainA website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
Teaching in Ambulatory SettingsPDFTeachingFaculty DevelopmentTeaching notes for physicians from the Cumming School of Medicine Office of Faculty Development
TFP 133 - Agitation in Dementia: Are benzos a back-up?2015-3-2PDFAlberta College of Family Physicians (ACFP)Demented Elders | Benzodiazepines | Dementia | PlaceboClinical Question: Are benzodiazepines a reasonable pharmaceutical alternative for management of agitation in demented elders? Bottom-Line: Many trials are old^ most are short and/or small^ and the results are inconsistent. Benzodiazepines appear^ at best^ equivalent to antipsychotics in reducing agitation in the short-term^ but superior to placebo. If used^ they should be stopped as soon as possible due to potential harms. *** Original Documents can be found and downloaded using the link provided below ***
Quality Improvement in Healthcare2014-11-26MovieVideosPatient EducationExcellent patient education video regarding quality improvement in healthcare Length: 11:08 Author Dr. Mike Evans
TFP 052 - Are antihypertensive medications effective for migraine prophylaxis? 2015-5-11PDFAlberta College of Family Physicians (ACFP)Antihypertensive | MigrainesClinical Question: In patients with frequent and/or severe migraines^ are antihypertensive medications effective in reducing frequency or severity of migraines? Bottom-line: A number of antihypertensive medications are effective in migraine prophylaxis. The best data are for propranolol^ which will benefit one in four patients (over placebo). *** Original Documents can be found and downloaded using the link provided below ***
Depression in Multiple Sclerosis - Summary of the Clinical Practice Guideline2015-12-1PDFToward Optimized Practice (TOP)Multiple Sclerosis (MS) | Depression | Depressive DisorderOBJECTIVE Alberta clinicians have the skills and tools to assess^ diagnose^ treat and manage depression in patients with multiple sclerosis (MS) within primary care TARGET POPULATION Adults 18 years of age and older EXCLUSIONS Children less than 18 years of age PRACTICE POINT Be aware that depression is two to three times more common in MS patients than in the general population and can go undetected. Be aware that the suicide rate in people with MS is approximately twice that of the general population. Therefore it is important to be vigilant for depression in patients with MS. *** Original Documents can be found and downloaded using the link provided below ***
Prevention and management of cardiovascular disease risk in primary care - summary and algorithm2015-2-1PDFToward Optimized Practice (TOP)Coronary Artery Disease | Atherosclerotic Vascular Disease | Cerebrovascular Disease | Peripheral Arterial | Algorithm Summary of the Clinical Practice Guideline | February 2015 Lipid Algorithm (Excludes those with familial hypercholesterolemia) *** Original Documents can be found and downloaded using the link provided below ***
Suturing - PocketSnipsMovieVideosSuturingRequires YouTube Login Excellent; accompanied by clear audio instructions and supplementary materials Length: 5:00 Target Audience: Medical students and health professionals Author: Dr. David Topps, PocketSnips Procedural Skills Project, NOSM
TFP 007 - Are some 2nd generation antidepressants more equal than others?2009-8-15PDFAlberta College of Family Physicians (ACFP)Antidepressant | Depression | Esocitalopram | MADRS | Venlafaxine | Nausea | Vomiting | Sertraline | Mirtazapine | BupropionClinical Question: In adults suffering from depression^ are any of the 2nd generation antidepressants better than others? Bottom-line: Among 2nd generation antidepressants^ there is little or no reliable difference in the efficacy or frequency of adverse events^ but the types of adverse events do vary. Clinicians should select antidepressants based on adverse effects profile and cost^ not on efficacy differences.
DIAGNOSIS AND MANAGEMENT OF URINARY TRACT INFECTION IN LONG TERM CARE FACILITIES Clinical Practice Guideline2015-1-1PDFToward Optimized Practice (TOP)Decreased Renal Function | Asymptomatic Bacteriuria | Urinary Tract Infection (UTI) | AntibioticsAlberta clinicians caring for residents in long term care facilities (LTCF)* will: Increase the accuracy of clinical diagnosis of urinary tract infections (UTI) Reduce inappropriate prescribing of antibiotics for asymptomatic bacteriuria Optimize antibiotic therapy for treatment of UTI while minimizing short and long term risks associated with antibiotic use Optimize testing and use of laboratory services for UTI TARGET POPULATION Older adults living in LTCF *LTCF is any congregate living environment for older or disabled persons who have high personal and professional care needs *** Original Documents can be found and downloaded using the link provided below ***
Removal of foreign body – eye: Removing a metal foreign body from the cornea (extraction only^ close-up) 2010-1-23MovieVideosMetal Foreign Body | Cornea | Extraction | Extraction | Cornea | Metal Foreign BodyGood; excellent high-quality^ close-up view of foreign body extraction^ corneal lavage and buffer; see above video by Dr. Larry Mellick for details re: patient history^ preparation^ equipment^ indications and follow-up Length: 1:03 Target Audience: Medical students and health professionals Author: Root Atlas.com (Opthamology resource)
TFP 103 - Duloxetine (Cymbalta®): Jack of All Trades^ Master of None? 2013-12-16PDFAlberta College of Family Physicians (ACFP)Duloxetine | Cymbalta | PlaceboClinical Question: How safe and effective is duloxetine for the treatment of chronic painful conditions? Bottom-line: Compared to placebo^ duloxetine appears efficacious in neuropathic pain^ improving pain by 50 percent or more for one in six people. One in 18 people (over placebo) will have to quit due to adverse events. *** Original Documents can be found and downloaded using the link provided below ***
Approach to the Low Back Exam - Stanford Medicine 252016-10-17WebsiteTeachingphysical exam | Back Pain | Lumbar | SciaticaBack pain is one of the most common complaints in the outpatient setting. While most causes are related to either the bone contacting the nerves as they exit the verbral canal or strain of the lumber muscles^ it's important to be able to confirm this cause with the exam and know when more serious causes such as malignancy^ infection (e.g. lumbar osteomyelitis) and inflammatory arthritis^ to name a few. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
Immunize Alberta2017-3-23WebsiteAlberta Health ServicesImmunization | Children | Parent | Vaccine | VaccinationWhen it comes to childhood immunizations^ Albertans have questions. Alberta Health Services understands^ and we’re here for you. This is why we developed ImmunizeAlberta.ca^ and did so based on insight and feedback gathered from Albertan parents. Whether it's a simple question about the childhood immunization schedule or what to expect after your child gets immunized^ uncertainty about the real risk of diseases^ or concerns about immunization safety: ImmunizeAlberta.ca has the info you need.
Guideline for Red Blood and Introduction Plasma Transfusion A Summary2009-1-1PDFToward Optimized Practice (TOP)Transfusion | Plasma Transfusion | Red Blood CellThis summary of the Expert Working Group: Guidelines for red blood cell and plasma transfusion for adults and children provides information on risks and informed consent^ single coagulation deficiency^ and multiple coagulation deficiency. It has 3 tables: Per Red Blood Cell Unit or Platelet Pool Risks Associated with Transfusion in Canada; Alternatives to Blood and Blood Product Usage; and Risks Associated with Daily Life. Target Population: Patients requiring blood transfusion Exclusions: None specified
TFP 138 - The skinny on BMI and mortality2015-5-11PDFAlberta College of Family Physicians (ACFP)Overweight | BMI | Mortality | EndocrinologyClinical Question: What is the association between body mass index (BMI) and mortality? Bottom-Line: Normal (20-25) to overweight (25-30) BMI carry the lowest risk of mortality^ with -25 appearing lowest (in elderly -27.5). Mortality increases when BMI is below “low-normal” (BMI <20) and obese (BMI ≥30)^ more at the extremes. *** Original Documents can be found and downloaded using the link provided below ***
Prevention and Management of Cardiovascular Disease Risk in Primary Care: Evidence Review of 12 Key Clinical Questions2015-2-1PDFToward Optimized Practice (TOP)Coronary Artery Disease | Atherosclerotic Vascular Disease | Diabetes Mellitus | Chronic Kidney Disease | HemodialysisSupplement to the Clinical Practice Guideline - February 2015 *** Original Documents can be found and downloaded using the link provided below ***
TFP 091 - Aspirin A Day to Keep the Cancer Away 2013-6-10PDFAlberta College of Family Physicians (ACFP)Aspirin (ASA) | Increased Gastrointestinal | Intra-Cranial BleedingClinical Question: Does taking Aspirin (ASA) decrease the risk of dying from cancer? Bottom-line: Meta-analyses suggest that ASA use may decrease the risk of dying from a cancer. However^ these studies may be biased and the net effect is small. If a true benefit exists^ it is likely offset by the harms of increased gastrointestinal and intra-cranial bleeding. *** Original Documents can be found and downloaded using the link provided below ***
Healthy Parents^ Healthy Children2017-3-23WebsiteAlberta Health ServicesDevelopment | Immunization | Children | Baby | Family | Parent | PregnancyA practical guide to pregnancy and being a parent.
Questioning as a teaching toolPDFTeachingFaculty DevelopmentTeaching notes for physicians from the Cumming School of Medicine Office of Faculty Development
TFP 105 - The new anti-platelet ticagrelor: Is it better than the old 'new' clopidogrel? 2014-1-20PDFAlberta College of Family Physicians (ACFP)Dyspnea | Ticagrelor | Death | Post-Acute Coronary Syndrome (ACS) | Brillinta | Anti-Platelet Ticagrelor | Clopidogrel | Myocardial InfarctionClinical Question: How does the newer anti-platelet drug ticagrelor (Brillinta®) compare to clopidogrel for post-acute coronary syndrome (ACS)? Bottom Line: After ACS^ ticagrelor reduces combined cardiovascular death^ stroke^ and myocardial infarction (MI) about 2 percent more than clopidogrel. Ticagrelor increases a few adverse events^ particularly 6 percent more dyspnea^ and effectiveness remains uncertain in North America. *** Original Documents can be found and downloaded using the link provided below ***
TFP 047 - Acetylsalicylic Acid (ASA) to prevent Colorectal Cancer2015-4-16PDFAlberta College of Family Physicians (ACFP)Colorectal Cancer | Acetylsalicylic AcidClinical Question: Does taking Acetylsalicylic acid (ASA) decrease incidence and mortality from colorectal cancer? Bottom-line: Although ASA may decrease the incidence and mortality of colorectal cancer^ the benefit is offset by a much greater increase in gastrointestinal and intra-cranial bleeding. Those who have colorectal cancer may have a survival advantage if they take ASA^ but using ASA for this reason should be individualized and patients should be informed of the increased risk of bleeding. *** Original Documents can be found and downloaded using the link provided below ***
Approach to the Nevi (Mole) Exam - Stanford Medicine 252016-1-22WebsiteTeachingphysical exam | dermatology | skin | moles | neviAll nevi (or moles) should be taken seriously as they may be normal or represent a cancer. Here we review the characteristics of any mole that should increase suspicion of cancer. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 071 - Varenicline and Cardiovascular Risk – Is the cure worse than the affliction? 2012-8-13PDFAlberta College of Family Physicians (ACFP)Varenicline | CVD | CardiovascularClinical Question: Does smoking cessation with varenicline (Champix) increase the risk of cardiovascular disease (CVD)? Bottom-line: Varenicline may increase cardiovascular events^ however^ (if real) the absolute risks are low (<1 in 600) for low CVD risk patients and higher (perhaps 1 in 60) for patients with CVD. Smoking cessation should always be encouraged^ but patients with high risk of cardiovascular disease should understand the potential risks of varenicline and may wish to consider alternative therapies. *** Original Documents can be found and downloaded using the link provided below ***
TFP 063 - Bioidentical Hormone Replacement 2012-3-5PDFAlberta College of Family Physicians (ACFP)Bioidentical Hormone Replacement | Micronized Progesterone | Medroxyprogesterone Acetate | Menopausal AcetateClinical Question: Does “bioidentical hormone” micronized progesterone (MP) instead of “synthetic hormone” medroxyprogesterone acetate (MPA) result in improved menopausal symptom control and/or reduction in harm? Bottom-line: The theory behind bioidentical hormone use is appealing; however its clinical advantage is not supported by reliable evidence. Long-term safety is largely unknown. *** Original Documents can be found and downloaded using the link provided below ***
ENDOCRINE LABORATORY TESTING: HYPOGLYCEMIA Clinical Practice Guideline2014-5-1PDFToward Optimized Practice (TOP)Insulin | Glucose | HypoglycemiaOBJECTIVE Alberta clinicians optimize laboratory tests for investigation of suspected hypoglycemia TARGET POPULATION Patients exhibiting clinical features of hypoglycemia EXCLUSIONS None *** Original Documents can be found and downloaded using the link provided below ***
TFP 200 - Harms of Medical Cannabinoids: Up in Smoke2017-11-27PDFAlberta College of Family Physicians (ACFP)euphoria | sedation | Vomiting | Nausea | spasticity | Pain | paranoia | hallucination | Hypotension | visual disturbance | marihuana | marijuana | medical cannabinoids | cannabinoids | Dizziness | ataxia | dysphoria | nabilone | dronabinol | nabiximolClinical Question: What are the harms associated with medical cannabinoid therapy? Bottom Line: Compared to placebo^ medical cannabinoids cause multiple different adverse events in patients^ from visual disturbance or hypotension (1 in 3-10) to hallucination or paranoia (1 in 20). Stopping due to adverse effects occurs in 1 in every 8-20 patients. Regardless of the type of medical cannabinoid used^ adverse events are common and likely underestimated. Given the extensive harms^ potential benefits must be impressive to warrant a trial of therapy.
Guideline for The Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD)2006-1-1WebsiteToward Optimized Practice (TOP)Increased Dyspnea | Increased Sputum Purulence | Increased Sputum Production | Acute Exacerbation (AECOPD) | Viral Infections | Fever | CopdA website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
DETERMINATION OF GESTATIONAL AGE BY ULTRASOUND Clinical Practice Guideline2014-9-1PDFToward Optimized Practice (TOP)Fetus (baby) | gynecology | obstetrics | Prenatal Care | UltrasoundOBJECTIVE Alberta clinicians assign gestational age based on ultrasound biometry TARGET POPULATION All pregnant women KEY MESSAGE Ultrasound is consistently more accurate than relying on patient recall for menstrual dating Routine ultrasound in the first or second trimester reduces inductions for post term pregnancies A woman’s self-knowledge and awareness of her internal functions^ including ovulation^ can be very accurate. However^ given the physiologic changes that can occur in any one menstrual cycle^ the exact time of ovulation^ fertilization and implantation cannot be precisely known.
TFP 140 - Healing the Heel: Corticosteroid shots for plantar fasciitis 2015-6-8PDFAlberta College of Family Physicians (ACFP)Plantar Fasciitis | Corticosteroid ShotsClinical Question: Are corticosteroid injections effective for plantar fasciitis? Bottom-line: Small^ randomized controlled trials (RCTs) demonstrate that corticosteroid injections significantly reduce plantar fasciitis pain for 1 in 3 people at four weeks. Benefit beyond 12 weeks has not been well demonstrated. Risk of rupture is likely less than what has been reported in observational studies. *** Original Documents can be found and downloaded using the link provided below ***
TFP 165 - Three drugs and still hypertensive: What’s Left? 2016-6-20PDFAlberta College of Family Physicians (ACFP)Aldactone | ARB | Angiotensin Receptor Blocker | Ace InhibitorsClinical Question: Which drug lowers blood pressure (BP) best in patients with resistant hypertension? Bottom-line: Spironolactone provides the largest BP reduction for “4th line therapy” in resistant hypertension (10/4 mmHg)^ causing an additional one in every three patients treated to reach target. Potassium rises on average -0.4 mmol/L (and should be monitored)^ causing around 2 percent to stop due to hyperkalemia (≥5.5 mmol/L). Hard outcome data is lacking. *** Original Documents can be found and downloaded using the link provided below ***
TFP 029 - The Autism and Vaccine Story: Fiction and Deception? 2013-10-28PDFAlberta College of Family Physicians (ACFP)MMR | Autism | Measles | Mumps | Rubella | VaccineClinical Question: Is there any link between the MMR vaccine and autism? Bottom-line: There is convincing evidence from multiple countries showing there is no association between the MMR vaccine (or thimerosal) and autistic disorders. The controversy is based on unethical and untruthful findings. *** Original Documents can be found and downloaded using the link provided below ***
TFP 196 - Infant Sleep Training - Rest Easy? 2017-10-2PDFAlberta College of Family Physicians (ACFP)cry | cry it out | controlled crying | infant | sleep training | sleepClinical Question: What is the evidence for infant sleep training? Bottom Line: Sleep training improves infant sleep problems^ with about 1 in 4 to 1 in 10 benefitting over no sleep training^ with no adverse effects reported after five years. Maternal mood scales also significantly improve^ with patients having worse baseline depression scores benefitting most.
TFP 095 - From Headache to Happiness: New old options for treating acute migraine2013-9-9PDFAlberta College of Family Physicians (ACFP)Caffeine | Ibuprofen | Aspirin (ASA) | Acetaminophen | Acute MigraineClinical Question: Are over-the-counter medications similar in effectiveness to prescription medications? Bottom-line: Many over-the-counter medications have similar efficacy to prescription medications in the treatment of acute migraine^ including acetaminophen^ aspirin^ and ibuprofen. The combination of acetaminophen^ aspirin^ and caffeine may offer additional benefit. *** Original Documents can be found and downloaded using the link provided below ***
Knee Exam - Stanford Medicine 252014-3-16WebsiteTeachingphysical exam | KneeKnee complaints are common and the knee exam is the most important way to address these complaints by finding the cause of knee pain and figuring out what treatment is needed. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 060 - Antipsychotics for depression: An acceptable risk/benefit profile 2012-1-23PDFAlberta College of Family Physicians (ACFP)Antipsychotics | Depression | MonotherapyClinical Question: Are antipsychotics^ either added to standard antidepressants or as monotherapy^ effective for the treatment of depression without psychotic features? Bottom-line: Second-generation antipsychotics appear effective in treating depression when given to augment antidepressants. One antipsychotic (quetiapine) appears effective in treating depression alone but equivalence to antidepressants is uncertain. The evidence has a high risk of bias and adverse events are common. *** Original Documents can be found and downloaded using the link provided below ***
TFP 117 - Generic Versus Brand Name: The other drug war 2014-7-7PDFAlberta College of Family Physicians (ACFP)Generic Brands | Brand Name MedicationsClinical Question: Is there any benefit to prescribing brand name medications versus generic brands? Bottom-line: Based on the best available evidence^ generic medications are bioequivalent and produce similar clinical outcomes to brand name medications. *** Original Documents can be found and downloaded using the link provided below ***
TFP 197 - Early Peanuts for Little Peanuts: The not so paltry benefits 2017-10-16PDFAlberta College of Family Physicians (ACFP)Peanuts | Allergy | eczema | infants | AntihistaminesClinical Question: Does early peanut introduction in infancy influence the development of peanut allergy? Bottom Line: Early peanut introduction reduces the risk of developing peanut allergy in high-risk infants from 17% to 3% at five years. Normal risk infants may also benefit. Since 9% of high-risk infants were excluded due to a positive baseline skin prick test (SPT)^ it may be reasonable to investigate those at highest risk prior to exposure.
TFP 129 - Statins and the elderly: The Who^ What and When? 2015-1-5PDFAlberta College of Family Physicians (ACFP)Pravastatin | Framingham Score | Potency Statins | Cardiovascular Disease (CVD)Clinical Question: Which elderly patients should be offered what type of statin for cardiovascular disease (CVD) prevention? Bottom-Line: For primary prevention age 65-75^ consider moderate- potency statins (example 10-20mg atorvastatin) for moderate or higher risk individuals (≥10 percent risk of CVD over 10 years based on Framingham score). No evidence to start statins in primary prevention patients >75. In secondary prevention age 65-82^ there is evidence for moderate-potency (to high^ as tolerated) statin. Pravastatin should likely not be first-line given the possible cancer signal for those >65. *** Original Documents can be found and downloaded using the link provided below ***
Sterile technique: Sterile Gloves - PocketSnipsMovieVideosSterile TechniquesExcellent; accompanied by clear audio instructions Length: 1:20 Target Audience: Medical students and health professionals Author: Dr. David Topps
TFP 199 - Missing “High” Quality Evidence: Medical Cannabinoids for Pain? 2017-11-14PDFAlberta College of Family Physicians (ACFP)cannabinoids | inhaled | medical | marijuana | Neuropathic Pain | cancer pain | HIV | Multiple Sclerosis | Multiple Sclerosis (MS) | amitriptyline | dihydrocodeine | Back Pain | fibromyalgia | Osteoarthritis | marihuana | nabiximol | nabilone | dronabinolClinical Question: Are medical cannabinoids (MC) effective for the treatment of pain? Bottom Line: Evidence for inhaled marijuana for pain is too sparse and poor to provide good evidence-based guidance. Synthetic MC-derived products may modestly improve neuropathic pain for one in 11-14 users but perhaps not for other pain types. Additionally^ longer and larger studies (better evidence) show no effect. Adverse events are plentiful (see next Tools for Practice).
TFP 104 - Aldosterone antagonists in systolic heart failure - no longer an afterthought2014-1-6PDFAlberta College of Family Physicians (ACFP)Ace Inhibitors | Congestive Heart Failure | Aldosterone AntagonistsClinical Question: What is the role of aldosterone antagonists in patients with chronic systolic heart failure? Bottom-line: Aldosterone antagonists reduce mortality and hospitalizations in patients with congestive heart failure (Class II–-blockers or ACE inhibitors. Close monitoring is required for those at risk of hyperkalemia. *** Original Documents can be found and downloaded using the link provided below ***
TFP 154 - Pills vs. Puffers: Leukotriene receptor antagonists for childhood asthma 2016-1-18PDFAlberta College of Family Physicians (ACFP)Asthma | LeukotrieneClinical Question: Are leukotriene receptor antagonists (LTRAs) effective in pediatric asthma? Bottom-line: Using leukotriene receptor antagonists instead of inhaled corticosteroids as monotherapy will lead to one more exacerbation in every 21 patients. As add-on to inhaled corticosteroids^ leukotriene receptor antagonists are inferior to long acting beta-agonists (LABAs)^ and show similar outcomes to increased doses of inhaled corticosteroids (ICS). Data is limited and not supportive of use in children ≤5 years. *** Original Documents can be found and downloaded using the link provided below ***
Peak flow: Peak expiratory flow rate measurement & explanation2015-1-1MovieVideosRate Explanation | Rate Measurement | Peak FlowExcellent; the preparation^ procedure and interpretation of results are explained clearly. The video is catered to medical students preparing for OSCE exams Length: 2:38 Target Audience: Author: Geeky Medics (UK)
Examination of the Spleen - Stanford Medicine 252014-3-17WebsiteTeachingspleen | abdomen | physical examExcellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The purpose of both palpation and percussion of the spleen is to look for splenic enlargement. Evaluation of splenomegaly is notoriously difficult and embarrassingly easy to miss when present. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 139 - Digoxin: Old friend or best left on the shelf? 2015-5-25PDFAlberta College of Family Physicians (ACFP)Digoxin | Congestive Heart Failure | Atrial Fibrillation | MortalityClinical Question: Does digoxin change clinical outcomes for patients with congestive heart failure or atrial fibrillation? Bottom-line: For systolic congestive heart failure (CHF)^ a randomized controlled trial (RCT) demonstrated that digoxin decreases CHF related hospitalizations (for one in 13 patients) without altering mortality. Stopping digoxin in stable CHF patients may worsen symptoms. Post-hoc analysis suggests low serum digoxin levels may actually decrease mortality. Cohort data for atrial fibrillation (AF) or CHF suggests digoxin increases mortality^ although cause and effect is not established. *** Original Documents can be found and downloaded using the link provided below ***
TFP 062 - Daily Prophylactic Antibiotics in COPD 2012-2-21PDFAlberta College of Family Physicians (ACFP)Prophylactic Antibiotics | CopdClinical Question: Are daily prophylactic antibiotics a reasonable option in preventing acute exacerbation of COPD (and if so^ which patients)? Bottom-line: In selective patients with severe COPD and recurrent exacerbations^ prophylactic antibiotics may reduce exacerbations for about 1 in 10. Balanced against possible increased resistance and adverse events^ present use should be very limited. The long term benefits and impacts on antimicrobial resistance remain to be seen. *** Original Documents can be found and downloaded using the link provided below ***
Identification and Symptom Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - Clinical Practice Guideline2016-1-1PDFToward Optimized Practice (TOP)Myalgic encephalitis | CFS | FatigueObjective: Alberta clinicians will have the information and tools necessary to detect key symptoms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and manage these symptoms over the long term. Target population: Adults and children Exclusions: None *** Original Documents can be found and downloaded using the link provided below ***
Gout Pathway2017-9-1PDFPathwaysSpecialist Link | Urate | Colchicine | Allopurinol | Kenalog | Acute GoutAHS Calgary Zone Clinical Pathway for Gout
DOCTORS OPPOSING VIOLENCE EVERYWHERE (DOVE) Summary of the Clinical Practice Guidelines2015-1-1PDFToward Optimized Practice (TOP)Refer | Relate | Recognize | Physically Or Sexually Abused | Abuse DOCTORS OPPOSING VIOLENCE EVERYWHERE (DOVE) Summary of the Clinical Practice Guidelines *** Original Documents can be found and downloaded using the link provided below ***
TFP 123 - A Serendipitous Discovery and Novel Treatment for Infantile Hemangiomas2014-10-14PDFAlberta College of Family Physicians (ACFP)Topical Timolol | Oral Propranolol | Infantile HemangiomasClinical Question: Are beta-blockers effective in treating small infantile hemangiomas? Bottom-line: One small randomized controlled trial (RCT) and numerous observational studies demonstrate that oral propranolol stops growth and induces regression of infantile hemangiomas (IH) by four weeks. Similar evidence suggests topical timolol stops IH growth and induces regression by >5 percent after 4-6 months for every one in 2-3 patients. *** Original Documents can be found and downloaded using the link provided below ***
TFP 021 - PAP test: Does Lubricant reduce the quality (or adequacy)? 2013-9-17PDFAlberta College of Family Physicians (ACFP)Speculum | Water-Soluble Lubricant | Pap TestClinical Question: Does the use of small amount of water-soluble lubricant on the speculum reduce the adequacy of the PAP test? Bottom-line: A small amount of water-soluble lubricant on a speculum does not reduce the quality of the PAP test and probably does not affect microbiologic results. Adequacy of liquid-based PAP tests may be minimally affected or not at all. *** Original Documents can be found and downloaded using the link provided below ***
TFP 054 - Overactive bladder^ urge incontinence and anticholinergic drugs2015-5-25PDFAlberta College of Family Physicians (ACFP)Anticholinergic Drugs | Urge Incontinence | Overactive BladderClinical Question: In patients with overactive bladder (OAB)^ or urge incontinence^ how well do medications work and are any of them better? Bottom-line: Both anticholinergic drugs and placebo improve overactive bladder^ although medications slightly more (about 1⁄2 a trip less to the bathroom/day). The drugs oxybutynin^ tolterodine^ solifenacin and darifenacin are very similar in efficacy while adverse events (dry mouth and likely constipation) vary. *** Original Documents can be found and downloaded using the link provided below ***
Breast Cancer Screening Summary2013-9-1PDFToward Optimized Practice (TOP)Clinical Breast Exam | Mammogram | Screening | BreastIncluding graphical flowsheet *** Original Documents can be found and downloaded using the link provided below ***
DIAGNOSIS AND MANAGEMENT OF HEMOCHROMATOSIS Clinical Practice Guideline2014-12-1PDFToward Optimized Practice (TOP)Hemochromatosis | Acquired Hemochromatosis | Genetic Hemochromatosis:OBJECTIVE Alberta clinicians are assisted to Diagnose patients at risk for HFE gene-associated hemochromatosis Prevent end-organ disease by early diagnosis Optimize clinical investigations followed by genetic testing Counsel and manage patients with a definitive diagnosis TARGET POPULATION Adults 18 years and older EXCLUSIONS Population screening for hereditary hemochromatosis Children under 18 years of age *** Original Documents can be found and downloaded using the link provided below ***
TFP 122 - Lipoproteins: The risk of (over)interpreting these risk factors? 2014-9-29PDFAlberta College of Family Physicians (ACFP)Lipoproteins | LDL | HDL | Cardiovascular Disease (CVD)Clinical Question: Does lipoprotein testing (like apolipoprotein B) provide meaningful cardiovascular disease (CVD) risk assessment or management information? (For this article^ “lipoproteins” do not include LDL or HDL.) Bottom-line: Lipoproteins (like apolipoprotein B) are associated with CVD but so are -300 other risk factors. Lipoproteins do not add meaningfully to risk estimation before treatment or prediction of benefit with treatment. Assess risk with CVD risk calculators and treat with proven therapies. *** Original Documents can be found and downloaded using the link provided below ***
Diabetes Foot Care Clinical Pathway2017-8-1WebsitePathwaysFoot | Diabetes | Clinical PathwayDiabetes can lead to poor circulation and the loss of feeling in a person’s limbs. These factors increase the chance of foot ulcers^ a major health problem that will affect 15 to 25 per cent of people with diabetes at some point during their life. In Alberta^ the rates of amputations are increasing and diabetic foot ulcers account for 65 per cent of lower limb amputations. Research shows that as many as 85 percent of Lower Limb Amputation can be prevented through early screening for^ and treatment of diabetic foot ulcers. Clinical experts from across the province have been consulted to develop a Diabetic Foot Care Clinical Pathway for patients with diabetes who are at risk of developing a foot ulcer or who already have an ulcer. The pathway assists healthcare providers identify foot problems^ facilitate early intervention and support patients in receiving the appropriate care from the right provider^ at the right time.
TFP 172 - Drugs for male- and female-pattern baldness: Just a hair bit more effective than doing nothing? 2016-10-11PDFAlberta College of Family Physicians (ACFP)Proscar | Propecia | RogaineClinical Question: What is the effect of approved medications for androgenic alopecia in men and women? Bottom-line: For men using finasteride or minoxidil^ one in 4-8 more than placebo will notice at least slight improvement in hair count over 6-12 months^ with no clear evidence one is better. For every 84 men taking finasteride for hair loss^ one extra will experience erectile dysfunction. For women^ only minoxidil improves hair count^ with one in eight reporting a moderate improvement over placebo.
TFP 136 - Atypical antipsychotics for anxiety: Worth worrying about? 2015-4-13PDFAlberta College of Family Physicians (ACFP)Obsessive-Compulsive Disorder (OCD) | Generalized Anxiety Disorder (GAD) | Antidepressants | Anxiety | Atypical AntipsychoticsClinical Question: Are atypical antipsychotics (alone or added to antidepressants) effective in managing anxiety disorders? Bottom Line: Atypical antipsychotics have similar efficacy to antidepressants in generalized anxiety disorder (GAD)^ but are more poorly tolerated and do not improve response rates when added to antidepressants. In obsessive-compulsive disorder (OCD)^ approximately one in 4-8 people will have a response when antipsychotics are added to antidepressants^ while one in nine will stop due to adverse effects. *** Original Documents can be found and downloaded using the link provided below ***
Goals of Care Designations: Quick Reference Guide2011-4-1PDFAlberta Health ServicesQuick Reference Guide | Goals Of Care Designations Goals of Care Designations: Quick Reference Guide
Injections (IM & SC)MovieVideosInjection | Medical Students | TeachingExcellent; high-quality video is complemented by instructional slides with audio instructions re: preparation, indications, positioning, etc. Length: 7:15 Target Audience: Medical Students
TFP 148 - Has insulin met its match? Metformin for gestational diabetes 2015-10-13PDFAlberta College of Family Physicians (ACFP)Insulin | Diabetes | Diabetes Mellitus | Gestational | Metformin | EndocrinologyClinical question: Is metformin a reasonable alternative to insulin in gestational diabetes mellitus (GDM)? Bottom Line: Compared to insulin^ metformin results in 1kg less maternal weight gain and less severe neonatal hypoglycaemia for one in 22 babies^ but results in earlier delivery by about one day. Other clinical outcomes are unchanged and long-term safety of metformin in GDM appears reassuring. Metformin is a reasonable option in GDM requiring treatment. *** Original Documents can be found and downloaded using the link provided below ***
TFP 163 - How low can the potassium and sodium go with commonly prescribed blood pressure medications? 2016-5-24PDFAlberta College of Family Physicians (ACFP)Hyperkalemia | Hypokalemia | Hyponatremia | Potassium | Ace Inhibitors | Sodium | HypertensionClinical Question: What is the risk of electrolyte disturbances with diuretics and ACE Inhibitors and when should we check? Bottom-line: Moderate hyponatremia (Na <130 mmol/L) and hypokalemia (K <3.2 mmol/L) each occur in -4 percent of thiazide users^ and hyperkalemia (K >5.4 mmol/L) occurs in 4 percent of ACE inhibitor (and angiotensin receptor blocker) users. Limited evidence suggests checking electrolytes in the first 2-4 weeks after starting^ and again after increasing doses of these agents^ and at least annually thereafter. *** Original Documents can be found and downloaded using the link provided below ***
Colorectal Cancer Screening Clinical Practice Guideline2013-11-1PDFToward Optimized Practice (TOP)Familial Adenoma Polyposis | Lynch Syndrome | Crc Conditions | Inflammatory Bowel Disease | Colonic Adenomas | Colorectal CancerTARGET POPULATION Asymptomatic men and women of all ages EXCLUSIONS Men and women with signs or symptoms suggesting colorectal cancer screening *** Original Documents can be found and downloaded using the link provided below ***
Assessment to Management of Adult Insomnia - SUMMARY of Clinical Practice Guideline2015-12-1PDFToward Optimized Practice (TOP)Sleep Logs | Daytime Impairment | Primary Insomnia | Secondary Sleep Disorder | Primary Sleep Disorder | Chronic Insomnia | Adult Insomnia | Sleep DisordersObjective: Clinicians in Alberta will know how to assess and diagnose insomnia; when insomnia can be effectively treated and/or managed in primary care using the tools and resources provided^ and when referral to a sleep physician is required. TARGET POPULATION Adults EXCLUSIONS Children under the age of 18 years Overnight/rotating shift workers *** Original Documents can be found and downloaded using the link provided below ***
UCLIC Preceptor HandbookPDFStudents & LearnersUclic | PreceptorGeneral Guide and FAQ's for preceptors in the University of Calgary Longitudinal Integrated Clerkship program in the Cumming School of Medicine
Cardiac Second Heart Sounds - Stanford Medicine 252012-3-10WebsiteTeachingheart sounds | Cardiac | physical examThe cardiac second sounds can provide a number of valuable clues to what is going on with the heart. Diagnoses like pulmonary hypertension^ severe aortic stenosis^ an atrial septal defect and delays in the electrical conduction can be diagnosed or suspected with close attention to second heart sounds. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 101 - NSAIDs and cardiovascular safety: the truth makes my heart hurt 2013-11-18PDFAlberta College of Family Physicians (ACFP)Naproxen | Traditional Nsaids | Cox-2 InhibitorsClinical Question: Do different non-steroidal anti- inflammatory drugs (NSAIDs) have different cardiovascular risks? Bottom-line: COX-2 inhibitors and traditional NSAIDs^ except naproxen^ increase the risk of major vascular events and death. When prescribing NSAIDs^ patients’ gastrointestinal (GI) and cardiovascular (CV) risk should be assessed^ with naproxen or low-dose ibuprofen preferentially chosen for patients at risk of CV disease. *** Original Documents can be found and downloaded using the link provided below ***
INVESTIGATION AND MANAGEMENT OF PRIMARY THYROID DYSFUNCTION Clinical Practice Guideline2014-4-1PDFToward Optimized Practice (TOP)Hyperthyroid | Hypothyroid | Thyroid | TSHOBJECTIVE Alberta clinicians optimize laboratory testing for the investigation and management of primary thyroid dysfunction TARGET POPULATION Adults and children with suspected or confirmed primary thyroid dysfunction EXCLUSIONS Neonatal patients Asymptomatic^ seemingly healthy individuals having a periodic exam PRACTICE POINT Thyroid stimulating hormone (TSH) is the most sensitive and specific test for the investigation and management of primary thyroid dysfunction *** Original Documents can be found and downloaded using the link provided below ***
TFP 127 - What can't they do: Steroids for my sore throat? 2014-12-8PDFAlberta College of Family Physicians (ACFP)Streptococcus Pharyngitis | Sore Throats | Steroids | Antibiotics | CorticosteroidsQuestion: Do corticosteroids reduce pain in patients with acute pharyngitis? Bottom-line: Corticosteroids (when added to antibiotics) reduce pain in patients with sore throats. For every four patients treated^ one additional patient will be pain free at 24 hours^ especially in adults with documented streptococcus pharyngitis and more severe symptoms. *** Original Documents can be found and downloaded using the link provided below ***
TFP 173 - Acid^ freeze^ or duct tape: What works best for common warts?2016-10-24PDFAlberta College of Family Physicians (ACFP)Blistering | Duct Tape | Plantar Warts | Warts | Non-Genital Warts | Cryotherapy | SA | Salicylic Acid | PainClinical Question: What is the efficacy of commonly used treatments for non-genital warts? Bottom-line: Highest quality primary care evidence finds warts resolve with cryotherapy (39 percent) and salicylic acid (24 percent) more than no treatment (16 percent) at 13 weeks. Cryotherapy has more pain and blistering (up to -80 percent)^ but greater patient satisfaction (-70 percent). Evidence for duct tape is limited and inconsistent.
DIAGNOSIS AND TREATMENT OF HELICOBACTER pylori INFECTION IN ADULTS Clinical Practice Guideline2016-6-1PDFToward Optimized Practice (TOP)H. Pylori | Peptic Ulcer Disease (PUD) | Non-Ulcer Dyspepsia (NUD) | Dyspepsia | Helicobacter PyloriObjective: Alberta clinicians will understand the indications to test for Helicobactor pylori (H. pylori)^ different testing methods available (urea breath test [UBT]^ histology on gastroscopy^ stool tests)^ and the different treatment regimens available. TARGET POPULATION Adults meeting specific clinical criteria (see Indications) EXCLUSIONS Pregnant or breastfeeding women Children (under 18 years of age) *** Original Documents can be found and downloaded using the link provided below ***
Local anesthetic - PocketSnipsMovieVideosAnestheticExcellent; accompanied by clear audio instructions and supplementary materials Length: 1:41 Target Audience: Medical students and health professionals Author: Dr. David Topps
TFP 178 - All You Need is Glove: Are non-sterile gloves safe for excisions in the office?2017-1-9PDFAlberta College of Family Physicians (ACFP)Sterile Gloves | Non-sterile glovesClinical Question: Does the use of non-sterile (clean) gloves for office-based excisions result in more infections when compared to the use of sterile gloves? Bottom-line: Using non-sterile gloves does not increase the number of infections when compared to sterile gloves for outpatient minor/uncomplicated skin (not flap) excisions and laceration repair in immune-competent adults. The current standard of care of using sterile gloves in these procedures is likely unnecessary and more costly. Unclear if this applies to sebaceous cyst excision^ as these weren’t studied.
TFP 186 - Doxylamine and Pyridoxine for Nausea and Vomiting of Pregnancy: A review of 'retch'ed evidence2017-5-1PDFAlberta College of Family Physicians (ACFP)Diclectin | pyridoxine | Doxylamine | Nausea | Vomiting | Pregnancy | B6 | Antihistamines | dicyclomine | drowsiness | retching | metoclopramide | Ginger | phenothiazine | prochlorperazineClinical Question: What is the safety and efficacy of doxylamine/pyridoxine (Diclectin) in nausea and vomiting of pregnancy? Bottom Line: Doxylamine/B6 appears safe short-term and may be slightly better than placebo in reducing nausea and vomiting in pregnancy (~1 point better on 15-point scale). B6 alone may have similar effect on nausea but other effects unclear. Results are at high risk of bias due to initially undeclared industry support and methodological concerns.
TFP 081 - Type 2 Diabetes and A1c Targets: Pragmatic dogma2013-1-21PDFAlberta College of Family Physicians (ACFP)A1c Targets | Pragmatic Dogma | Type 2 Diabetes | EndocrinologyClinical Question: What are reasonable Hemoglobin A1c (A1c) targets for our patients with Type 2 Diabetes Mellitus? Bottom-line: While many patients can safely attain an A1c at or just below 7 percent^ older patients^ those with long-standing diabetes^ multiple co-morbidities^ and/or high risk of hypoglycemia^ reasonable targets are perhaps 7-8 percent or even higher.
TFP 016 - Long-Acting Beta-Agonist Inhalers in Asthma: Breathing Evidence Into the Debate?2013-10-28PDFAlberta College of Family Physicians (ACFP)Beta-Agonist Inhalers | Long-Acting | AsthmaClinical Question: Are the serious adverse events associated with long-acting beta-agonists (LABA) in asthma important enough to limit their use? Bottom-line: In asthmatic patients^ LABA should not be used without inhaled steroids because^ alone^ LABA inhalers cause an increase in serious adverse events. It is difficult to determine if asthma patients who use LABA in conjunction with an inhaled steroid are at increased risk^ but if so^ it is likely in the range of one in 3^334 patients. LABA does not increase adverse events in COPD patients. *** Original Documents can be found and downloaded using the link provided below ***
TFP 160 - Can we count on Clomiphene for Anovulatory Infertility?2016-4-11PDFAlberta College of Family Physicians (ACFP)ClomidClinical Question: How effective is clomiphene for inducing pregnancy in females with polycystic ovarian syndrome (PCOS) presenting as oligomenorrhea or anovulation? *** Original Documents can be found and downloaded using the link provided below ***
TFP 119 - Can I exchange my family because they all have heart attacks? 2014-8-18PDFAlberta College of Family Physicians (ACFP)Cardiovascular Disease (CVD) | Heart AttacksClinical Question: What risks do different family histories of cardiovascular disease (CVD) carry? Bottom-line: Family history of CVD modifies future CV risk depending on the number and age of affected first-degree relatives. Siblings of patients with CVD have a -40 percent risk increase^ while offspring of parents with premature CVD have a 60-75 percent increased risk. Consistent definitions of premature CVD would allow a better estimate of the true attributable risk. *** Original Documents can be found and downloaded using the link provided below ***
LABORATORY ENDOCRINE TESTING: CUSHING’S SYNDROME Summary of the Clinical Practice Guideline2014-5-1PDFToward Optimized Practice (TOP)Cushing | Cortisol | AdrenalSummary OBJECTIVE Clinicians in Alberta investigate for suspected Cushing’s syndrome including selecting optimal laboratory tests and timely referral to an endocrinologist. TARGET POPULATION Adults and children exhibiting clinical features of Cushing’s syndrome EXCLUSIONS None RECOMMENDATIONS Refer to endocrinologist as soon as Cushing’s syndrome is suspected Order a 24 hour urine collection for cortisol Order a urine creatinine to ensure a complete 24 hour urine collection Consider repeating tests if results are borderline values X DO NOT order serum cortisol levels. They have low predictive value and are not recommended *** Original Documents can be found and downloaded using the link provided below ***
INVESTIGATION AND MANAGEMENT OF ERECTILE DYSFUNCTION AND MALE HYPOGONADISM Summary of the Clinical Practice Guideline2016-3-1PDFToward Optimized Practice (TOP)Sexual | ED | Erectile FunctionOBJECTIVE Alberta clinicians understand the investigation and management of erectile dysfunction^ are aware of indicators for referral and the importance of counselling. TARGET POPULATION - Men who are unable to have or sustain an erection adequate for satisfactory sexual activity for at least three months - Men who have symptoms of decreased sexual desire and/or erectile dysfunction EXCLUSIONS Patients with other forms of sexual dysfunction (i.e.^ premature ejaculation) *** Original Documents can be found and downloaded using the link provided below ***
TFP 017 - X-rays for Non-specific Low Back Pain: A non-specific pain?2013-8-27PDFAlberta College of Family Physicians (ACFP)Non-Specific | Low Back Pain | X-RaysClinical Question: In patients with lower back pain^ do lumbar X-rays modify any patient outcome? Bottom-line: In non-specific low back pain^ X-rays do nothing to improve outcomes and may worsen some (such as pain) *** Original Documents can be found and downloaded using the link provided below ***
Hip and Knee Replacement2013-4-28MovieVideosPatient Education | hip | KneeExcellent patient education video regarding hip and knee replacement surgery. Length: 7:11 Author Dr. Mike Evans
Best Advice for People Taking Opioid Medication2013-3-1MovieVideosOpioids | Patient Education | Morphine | AddictionExcellent patient education video regarding opioid therapy. Length: 11:35 Author Dr. Mike Evans
DIAGNOSIS AND MANAGEMENT OF HEMOCHROMATOSIS Summary of the Clinical Practice Guideline2014-12-1PDFToward Optimized Practice (TOP)Hemochromatosis | Acquired Hemochromatosis | Genetic Hemochromatosis:Summary Objective Alberta clinicians are assisted to Diagnose patients at risk for HFE gene-associated hemochromatosis Prevent end-organ disease by early diagnosis Optimize clinical investigations followed by genetic testing Counsel and manage patients with a definitive diagnosis TARGET POPULATION Adults 18 years and older EXCLUSIONS Population screening for hereditary hemochromatosis Children under 18 years of age *** Original Documents can be found and downloaded using the link provided below ***
TFP 176 - Stockpile^ use during outbreaks^ re-stock and repeat2016-12-1PDFAlberta College of Family Physicians (ACFP)Oseltamivir (Tamiflu®) | Zanamivir (Relenza®) | Influenza | Influenza-Like Illness | Post-Exposure Prophylaxis | PEP | Flu | Rimantadine | VaccinationClinical Question: How effective are oseltamivir and zanamivir at decreasing post-exposure transmission of influenza? Bottom Line: For institutionalized seniors^ six weeks of oseltamivir or 14 days of zanamivir or will prevent one additional influenza case in every 25-27 treated. For every 7-8 households given post- exposure prophylaxis (PEP)^ one household will avoid anyone developing influenza. Authors: Michael R. Kolber^ Christina Korownyk
LABORATORY ENDOCRINE TESTING: HYPERCALCEMIA - Summary of the clinical practice guideline2014-5-1PDFToward Optimized Practice (TOP)Calcium | ParathyroidSummary OBJECTIVE Alberta clinicians optimize laboratory testing for suspected hypercalcemia TARGET POPULATION Patients with signs or symptoms of hypercalcemia EXCLUSIONS Children <1 month of age
Sleep Disorders Questionnaire2015-12-1PDFToward Optimized Practice (TOP)Patient Education | Sleep Logs | Secondary Sleep Disorder | Primary Sleep Disorder | Sleep DisordersThis questionnaire is a screening tool for physicians to assist their clinical evaluation of insomnia. It can be used to screen for a sleep disorder. The physician should perform a more detailed clinical evaluation and/or refer to specialist when appropriate. *** Original Documents can be found and downloaded using the link provided below ***
TFP 183 - What is Urgent About Hypertensive Urgency?2017-3-20PDFAlberta College of Family Physicians (ACFP)Intracerebral/Retinal Hemmorage | Aortic Dissection | Encephalopathy | Dizziness | Headache | Atrial Fibrillation | HF | Heart Failure | Hydralazine | Reserpine | Hydrochlorothiazide | CVD | Cardiovascular Disease (CVD) | BP | Blood Pressure | Elevated Blood Pressure | Hypertensive | Hypertensive urgencyClinical Question: What are the risks for asymptomatic patients who present with significantly elevated blood pressure? Bottom-line: Patients with markedly elevated blood pressures (BPs) (mean 186/121 mmHg) have ~40% risk of cardiovascular disease (CVD) at 18 months if untreated. The risk for treated patients ranges from 14% at one month to 1.2% at six months. Outcomes influenced by presenting BPs (and measurement accuracy)^ patient comorbidities^ follow-up^ socio-economic status and ethnicity. For most asymptomatic patients with BPs >180/110 mmHg^ addition or initiation of oral agents at presentation with close outpatient followup is reasonable.
Assessment to Management of Adult Insomnia - Clinical Practice Guideline2015-12-1PDFToward Optimized Practice (TOP)Daytime Impairment | Primary Insomnia | Primary Sleep Disorder | Chronic Insomnia | Acute Insomnia | Adult InsomniaObjective: Clinicians in Alberta will know how to assess and diagnose insomnia; when insomnia can be effectively treated and/or managed in primary care using the tools and resources provided^ and when referral to a sleep physician is required. TARGET POPULATION Adults EXCLUSIONS Children under the age of 18 years Overnight/rotating shift workers *** Original Documents can be found and downloaded using the link provided below ***
TFP 146 - Anti-CCP: A truly helpful Rheumatoid Arthritis lab test?2015-9-14PDFAlberta College of Family Physicians (ACFP)RA | Rheumatoid | ArthritisClinical Question: For Adult Rheumatoid Arthritis (RA)^ what is the diagnostic utility of Anti-Cyclic Citrullinated Protein antibodies (Anti-CCP)? Bottom-line: Anti-CCP^ with -96 percent specificity and -14 positive likelihood ratio^ is good for assisting with the diagnosis of RA. Anti- CCP is present in only 1⁄4 to 1⁄2 of patients before or at diagnosis^ so a negative test does NOT rule out RA. It can also predict more aggressive joint erosion. *** Original Documents can be found and downloaded using the link provided below ***
Guideline for The Diagnosis and Management of Acute Pharyngitis2008-1-1WebsiteToward Optimized Practice (TOP)Fever | Acute Pharyngitis | Viral Pharyngitis | Group A Streptococcal Pharyngitis | Swollen Anterior Cervical NodesA website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
INVESTIGATION AND MANAGEMENT OF ERECTILE DYSFUNCTION AND MALE HYPOGONADISM Clinical Practice Guideline2016-3-1PDFToward Optimized Practice (TOP)Sexual Activity | Erectile Function | SexualOBJECTIVE Alberta clinicians understand the investigation and management of erectile dysfunction^ are aware of indicators for referral and the importance of counselling. TARGET POPULATION - Men who are unable to have or sustain an erection adequate for satisfactory sexual activity for at least three months - Men who have symptoms of decreased sexual desire and/or erectile dysfunction EXCLUSIONS Patients with other forms of sexual dysfunction (i.e.^ premature ejaculation) *** Original Documents can be found and downloaded using the link provided below ***
Laboratory Guideline for Serological Testing for Suspected Viral Hepatitis2014-4-1PDFToward Optimized Practice (TOP)Alanine Aminotransferase (ALT) | Suspected Viral Hepatitis | HepatitisAlberta clinicians are assisted to identify patients with suspected viral hepatitis and optimize laboratory tests for the investigation TARGET POPULATION Children and adults with suspected viral hepatitis EXCLUSIONS Where an infectious etiology is not a consideration Outbreak investigations Pregnant women undergoing routine prenatal screening for viral hepatitis *** Original Documents can be found and downloaded using the link provided below ***
What's the Best Diet? Healthy Eating 1012015-9-24MovieVideosEating | Patient Education | DietExcellent patient education video regarding the benefits of healthy eating. Length: 15:13 Author Dr. Mike Evans
Why Am I Waiting in the Emergency Department?2017-2-10MovieVideosER | Emergency Room | WaitPatient education video explaining the emergency room process Length: 5:42 Author Dr. Mike Evans
Examination of the Tongue - Stanford Medicine 252017-1-1WebsiteTeachingtongue | physical examThe tongue exam can reflect a number of underlying diagnoses such as infections^ nutritional deficiencies^ malignancy and even neurological dysfunction. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
Examination of the Hand (The Hand in Diagnosis) - Stanford Medicine 252013-7-20WebsiteTeachingNail | hand | physical examThe examination of the hand and nails can lead to a number of diagnoses. Some of these include liver disease (Terry's nails)^ kidney disease (Lindsay's nails)^ lung disease (nail clubbing)^ endocarditis and many others. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
Shoulder Injection - Posterior Approach2014-4-10MovieVideosShoulder | glenohumeralThis is a video series teaching proper technique for performing musculoskeletal injections from McMaster Time: 3:53
Joint aspiration/injection: Knee Injection - Lateral Approach MovieVideosJoint Aspiration | Joint Injection | Knee Injection | Lateral ApproachVery good; indications for the lateral approach are clearly defined; all steps of the procedure are explained in the video. The video does not describe preparation for the procedure. Length: 3:50 Target Audience: Medical students Author: McMaster MSK Injection Techniques, Department of Medicine, McMaster University
TFP 023 - Ezetimibe lowers LDL cholesterol^ but what else?2015-1-26PDFAlberta College of Family Physicians (ACFP)Ldl Cholesterol | Ezetimibe | EndocrinologyClinical Question: Does ezetimibe modify clinical outcomes? Bottom-line: Only the IMPROVE-IT trial provides meaningful data on ezetimibe. In acute coronary syndrome patients^ adding ezetimibe to moderate-intensity statin prevents one cardiovascular event for every 50 people treated for seven years. Baseline LDL level did not influence this benefit. There are no data for ezetimibe in primary prevention^ but the benefit is likely proportional to (lower) baseline CVD risk. *** Original Documents can be found and downloaded using the link provided below ***
Diagnosis and Treatment of AOM in Children Summary of the Alberta Clinical Practice Guideline for Acute Otitis Media2008-1-1WebsiteToward Optimized Practice (TOP)Children | Acute Otitis Media (AOM) | Myringitis | Ear Infections | Diagnosis Of Otitis Media With Effusion (OME) | Streptococcus Pneumoniae | Nontypeable Haemophilus In Uenzae | Moraxella CatarrhalisA website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
Neck Vein Examination & Wave Forms - Stanford Medicine 252012-12-5WebsiteTeachingwaveform | neck | jugular | physical examThe jugular venous exam is important aspect of assessing a patient's volume status^ especially in patients with heart failure^ liver failure and kidney failure. Both elevation of the neck veins and the variations of the neck vein waveforms share valuable information about a patient's diagnosis. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
Teaching on the run tips 11: the junior doctor in difficulty2008-10-10PDFTeachingJMO | Junior Medical DoctorSetting Your junior medical officer (JMO) has been with you for 5 of his 10 weeks and you are not happy with how things are going. He is disorganised on ward rounds~ makes few chart notes and often doesn’t have a grasp of patients’ problems~ leaving things mostly to the registrar. This is his fourth term and he should be performing better. You think it’s time for a chat. Fiona R Lake and Gerard Ryan *** Original Documents can be found and downloaded using the link provided below ***
TFP 005 - Motivating Patients to Move: A Light at the End of the Couch? 2009-7-14PDFAlberta College of Family Physicians (ACFP)Prevention | Physical Activity | Pedometer | Intervention | Inactivity | Goals | Exercise | Chronic Disease | Blood Pressure | Activity | Systematic Review | Steps | Walking | WeightClinical Question: How do I motivate my patients to participate in regular physical activity? Bottom-line: Pedometers^ used with specific exercise goals^ provide an inexpensive^ tangible measure of a patient’s physical activity^ and have been demonstrated to increase physical activity levels. *** Original Documents can be found and downloaded using the link provided below ***
TFP 075 - Screening for Abdominal Aortic Aneurysm 2012-10-15PDFAlberta College of Family Physicians (ACFP)Screening | Abdominal Aortic Aneurysm | Asymptomatic PatientsClinical Question: Does screening asymptomatic patients in primary care for abdominal aortic aneurysm (AAA) alter mortality? Bottom-line: Ultrasound screening men for AAA (65–74 years) may confer a small AAA-related mortality benefit but does not change all-cause mortality. Population- based screening is not indicated for women. *** Original Documents can be found and downloaded using the link provided below ***
Providing Effective Feedback1980-1-1MovieTeachingPendletonExcellent podcast by Dr. Kelly Burak^ Cumming School of Medicine^ University of Calgary Duration: 7:29
Ultrasound for twin and multiple pregnancies - Clinical practice guideline2017-6-7PDFToward Optimized Practice (TOP)gynecology | obstetrics | Fetus (baby) | Ultrasound | Prenatal UltrasoundDescription: Alberta radiologists will optimize the use of ultrasound by reporting all required elements and effectively communicate results and recommendations. Alberta clinicians will know how to interpret ultrasound results and recommendations^ and ensure patients receive timely referral or appropriate follow-up based on ultrasound report recommendations. Target population: Pregnant women with multiple gestation Exclusions: None
TFP 073 - Novel Oral Anti-coagulants (NOACs): is newer better?2012-9-18PDFAlberta College of Family Physicians (ACFP)Warfarin | Noacs | Non-Valvular Atrial Fibrillation (AF) | Rivaroxaban | ApixabanClinical Question: For patients with non-valvular atrial fibrillation (AF)^ do the NOACs (dabigatran^ rivaroxaban^ apixaban) have advantages over warfarin? Bottom-line: Compared to warfarin^ NOACs offer some benefits for patients with non-valvular atrial fibrillation. The decision to use a NOAC or warfarin should be made after reviewing the patient’s previous INR stability^ kidney function and discussing the potential benefits and risks^ direct and indirect costs with the patient. *** Original Documents can be found and downloaded using the link provided below ***
Reducing Your Risk for Heart Attacks & Strokes: A shift in thinking . . . Patient handout2015-2-1PDFToward Optimized Practice (TOP)Statin | Diet | Cholesterol | Cardiovascular Disease (CVD) | Handout Description: Alberta primary care clinicians and their teams can offer primary and secondary prevention for cardiovascular disease (CVD) focused on CVD risk estimation and lipid management. Target Population: - Men aged 40-75 - Women aged 50-75 Exclusions: - Men and women of any age with previously diagnosed familial hypercholesterolemia
TFP 112 - Testosterone supplementation in men. Let us pause for a moment. 2014-4-28PDFAlberta College of Family Physicians (ACFP)Libido | Erectile Function | Androgen Decline | TestosteroneClinical Question: Is testosterone supplementation effective and safe for androgen decline in aging males? Bottom-line: In older men^ testosterone increases some muscle strength by 7 percent^ with moderate improvements in erectile function and libido. There also appears to be an increase of adverse events^ particularly cardiovascular in those with higher risk. Many results are inconsistent^ at high risk of bias^ and difficult to quantify in real world application. *** Original Documents can be found and downloaded using the link provided below ***
TFP 167 - Keeping our eye on the ball for infectious conjunctivitis management 2016-7-18PDFAlberta College of Family Physicians (ACFP)Topical Antibiotics | Conjunctivitis | Red EyeClinical Question: Do topical antibiotics benefit infectious conjunctivitis? Bottom-line: Nonvenereal infectious conjunctivitis is self-limited^ with very low rates of complications. Topical antibiotics^ compared to placebo^ will lead to the resolution of symptoms in an additional -1 in 12 patients at -7 days. Delayed prescriptions (for three days) reduce overall antibiotic use with similar outcomes. *** Original Documents can be found and downloaded using the link provided below ***
Internal Capsular Stroke - Stanford Medicine 252017-1-1WebsiteTeachingphysical exam | StrokeThe internal capsule is a unique location where a large number of motor and sensory fibers travel to and from the cortex. Damage of any kind in this location will cause some relatively unique findings that can allow you to localize the lesions to the internal capule by exam alone. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
Urinalysis2011-1-1MovieVideosUrinalysisExcellent; demonstration videos are embedded within a voice-over PowerPoint presentation; very clear instructions are provided throughout Length: 5:30 Target Audience: Medical students Author: University of Manchester Medical School
The Diagnosis and Management of Nursing Home Acquired Pneumonia (NHAP): A Summary2015-3-1PDFToward Optimized Practice (TOP)Ronchi | Pleuritic Chest Pain | Nursing Home Acquired Pneumonia (NHAP) | Hydration | Wheezes | X-RaySummary OBJECTIVE In caring for residents in long term care facilities (LTCF) Alberta clinicians will: Increase the accuracy of clinical diagnosis of NHAP Initiate timely treatment for NHAP Optimize use of laboratory and diagnostic imaging services in the diagnosis of NHAP Optimize use of antibiotics in the treatment of NHAP Ensure practices to prevent respiratory infections are in place in the LTCF Facilitate teamwork and communication in the evaluation and management of residents with NHAP TARGET POPULATION Patients with pneumonia acquired in a LTCF LTCF is any congregate living environment for older and/or disabled persons that have high personal and professional care needs. EXCLUSIONS Hospital acquired pneumonia (HAP) (onset within 14 days of discharge from an acute care facility) Aspiration pneumonia Pneumonia in patients with cystic fibrosis^ tuberculosis or bronchiectasis *** Original Documents can be found and downloaded using the link provided below ***
Sterile technique: Universal Precautions incl Sterile Gloves - U of C - requires loginMovieVideosHandwashing | Sterile GlovesExcellent instructional video provides an overview of handwashing, donning and sterile glove technique Target Audience: Medical students
Cervical Cancer Screening - FAQs. Patient Handout2016-5-1PDFToward Optimized Practice (TOP)Patient Education | Handout | Sti Screening | Human Papillomavirus (HPV) | HPV | Cervix | Cervical CancerWhen to start and stop screening Frequently asked questions (FAQs) and decision points for providers to assist a woman’s choice for initiating and discontinuing Pap testing. *** Original Documents can be found and downloaded using the link provided below ***
Core Skills: IV line start up - U of C - requires loginMovieVideosIV | IntraosseousExcellent; videos embedded within instructional webpages re: equipment, preparation, placement, insertion, removal, etc.; includes a self-test quiz Length: Multiple Videos Target Audience: Medical Students
Core Skills: Suturing - U of C - requires loginMovieVideosSuturingExcellent instructional videos are embedded in webpages with written details regarding theory, prep, anesthetic, basic techniques, etc.; Self-assessment quiz included Length: 5:00 Target Audience: Medical students Author: Core Skills, University of Calgary
Laboratory Guideline for Ordering Stool Test for Investigation of Suspected Infectious Diarrhea2014-3-1PDFToward Optimized Practice (TOP)Diffcile Toxin Tests | Stool Bacterial Cultures | Infectious DiarrheaOBJECTIVE Alberta clinicians use a single initial stool test to improve the accuracy of stool testing for infectious diarrhea and tool collecting convenience for patients TARGET POPULATION Children and adults with suspected infectious diarrhea EXCLUSIONS Patients involved in a community or hospital outbreak Food handlers to whom Public Health regulations apply When an infectious etiology is not suspected *** Original Documents can be found and downloaded using the link provided below ***
TFP 035 - The long and short of long-acting insulin analogues (versus NPH)2013-12-5PDFAlberta College of Family Physicians (ACFP)Levemir | Lantus | Type 1 Diabetes Mellitus | Diabetes Mellitus | Diabetes | Type 2 DiabetesClinical Question: In patients with diabetes^ how do the long-acting insulin analogues (LAIA) (e.g. glargine and detemir) compare to NPH? Bottom-line: Compared to NPH insulin^ LAIAs have no advantage in A1c^ no evidence for hard outcomes^ and no difference in severe hypoglycemia. The small reductions in other hypoglycemic symptoms have a high risk of bias. Patients with significant hypoglycemia from NPH should consider using lower NPH doses first. If NPH dosage reduction doesn’t resolve hypoglycemic episodes^ patients and clinicians may consider LAIAs. *** Original Documents can be found and downloaded using the link provided below ***
TFP 088 - Hormone Therapy: Does Timing Make a Difference?2013-4-29PDFAlberta College of Family Physicians (ACFP)Hormone Therapy | Oral Hormone Therapy | MenopauseClinical Question: Is there evidence that starting combination oral hormone therapy (HT) closer to menopause result in reduced risk of harm or even possible benefit? Bottom-line: Evidence supporting the timing hypothesis of hormone therapy is not convincing. There is no consistent evidence of benefit with hormone therapy beyond symptomatic relief. Smaller but real risks are likely present even in those close to menopause. *** Original Documents can be found and downloaded using the link provided below ***
Spirometry: Spirometry and Peak FlowMovieVideosPeak Flow | SpirometryExcellent; indications, preparation and procedural techniques are explained clearly. FEV1/FVC ratios and peak flow measurements are also discussed via embedded instructional slides. Length: 7:23 Target Audience: Medical students Author: Oxford University Medical School
TFP 089 - Viscosupplementation (hyaluronic acid or hylan): Cushioning the blow (to your wallet)?2013-5-13PDFAlberta College of Family Physicians (ACFP)Viscosupplementations | Hylan | Hyaluronic Acid | Knee OsteoarthritisClinical Question: Do injections of viscosupplementations (hylan or hyaluronic acid) improve symptoms of knee osteoarthritis? Bottom-line: Research on viscosupplementation (hylan or hyaluronic acid) for knee osteoarthritis has frequently been of poor quality and has exaggerated effectiveness. The best evidence indicates no meaningful benefit (if any at all) with potential adverse events (including cost). *** Original Documents can be found and downloaded using the link provided below ***
TFP 106 - Vitamin D Levels: Vitamin Do or Vitamin Don’t 2014-2-3PDFAlberta College of Family Physicians (ACFP)Serum Levels | Vitamin DClinical Question: In adults^ what is the evidence to test serum vitamin D levels? Bottom Line: Routine testing of vitamin D levels is unnecessary. Laboratories often report serum levels between 50 and 75–80 nmol/L as insufficient but this is not supported by consistent or reliable evidence. Additionally^ large variability in the test limits interpretation of repeat measurements. *** Original Documents can be found and downloaded using the link provided below ***
The medical learner in difficultyPDFTeachingFaculty DevelopmentTeaching notes for physicians from the Cumming School of Medicine Office of Faculty Development
Thyroid Exam - Stanford Medicine 252014-3-16WebsiteTeachingphysical exam | Thyroid | Grave's | Hashimoto's | thyroiditis | goiterThe thyroid exam is important as it’s often the first step towards diagnosing thyroid diseases such as Grave’s disease^ Hashimoto’s thyroiditis and multinodular goiters. Both inspection and palpation are important aspects of the thyroid exam. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
Digital block - PocketSnipsMovieVideosDigital BlockExcellent; accompanied by clear audio instructions and supplementary materials Length: 1:28 Target Audience: Medical students and health professionals Author: Dr. David Topps
TFP 019 - Vitamin B12 Deficiency: Monthly shots or daily pills? 2013-9-9PDFAlberta College of Family Physicians (ACFP)Intramuscular (IM) Vitamin B12 | Oral Vitamin B12 | Vitamin B12 DeficiencyClinical Question: In patients with Vitamin B12 deficiency^ is oral Vitamin B12 as effective as intramuscular (IM) Vitamin B12? Bottom-line: Oral Vitamin B12 is as effective as IM in most B12 deficient patients. A dose of 1000mcg (1mg) orally a day appears adequate and most commonly recommended. *** Original Documents can be found and downloaded using the link provided below ***
Alberta Clinical Practice Guideline for Radiography of the Ankle and Foot - Summary2007-1-1PDFToward Optimized Practice (TOP)Radiography | Ankle And Foot | X-Ray | 5th Metatarsal | Navicular Bone Description: Blunt ankle trauma is a common presenting complaint. This guideline utilizes Dr. Steill’s Ottawa Ankle Rules for decisions on the use of radiography in the diagnosis of ankle injuries and the detection of fractures. Target Population: Adults presenting with ankle injuries Exclusions: Pregnant women Patients with a head injury Patients with multiple painful injuries Intoxicated patient Patients with diminished sensation due to neurological deficit Reviewed 2014
TFP 083 - Febuxostat: Precipitating crystals of evidence about gout prevention 2013-2-19PDFAlberta College of Family Physicians (ACFP)Febuxostat | Precipitating Crystals | Gout Prevention | AllopurinolClinical Question: Does febuxostat (Uloric) offer any advantages over allopurinol in preventing gout? Bottom-line: Febuxostat is not better than allopurinol for preventing gout and has a higher rate of initial flares. It should only be considered in patients who have experienced a serious adverse event with allopurinol. *** Original Documents can be found and downloaded using the link provided below ***
TFP 043 - Vascular Intervention for Multiple Sclerosis2015-3-4PDFAlberta College of Family Physicians (ACFP)Angioplasty | Multiple SclerosisClinical Question: In patients with multiple sclerosis (MS)^ is angioplasty of obstructed extra-cranial venous lesions safe and does it improve MS symptoms? Bottom-line: While the initial study may be promising^ it is critically flawed for assessing benefit. It is currently premature to recommend endovascular angioplasty to MS patients. Due to the fluctuating nature of relapsing-remitting MS^ a long term^ multi-centre^ blinded randomized control trial is absolutely required to determine if endovascular angioplasty is beneficial. *** Original Documents can be found and downloaded using the link provided below ***
TFP 070 - The Venous Thromboembolism Risks with Varying Hormonal Contraception 2012-7-23PDFAlberta College of Family Physicians (ACFP)Venous Thromboembolism | Sogc | Hormonal Contraceptions | VT | Progestins | Transdermal Estrogen | Vaginal Ring | Intrauterine Device | IUD | PregnancyClinical Question: How does the venous thromboembolism (VT) risk compare across varying hormonal contraceptions? Bottom-line: Due to limits in the evidence^ there is real uncertainty whether the risks of VT vary with different hormonal contraceptives. If they do^ the increased risk appears to be about 1 extra VT per year for 2000 women. *** Original Documents can be found and downloaded using the link provided below ***
TFP 068 - Hemoglobin A1c for the diagnosis of Type II Diabetes 2012-6-11PDFAlberta College of Family Physicians (ACFP)Hemoglobin A1c | Type 2 DiabetesClinical Question: What are the advantages and disadvantages of using Hemoglobin A1c (A1c) as a diagnostic test for Type II Diabetes Mellitus? Bottom-line: While Hemoglobin A1c can be used for diagnosis of diabetes^ controversy remains around appropriate cut-offs and agreement with other tests. Using the ≥6.5 percent cut-off recommended by the American Diabetes Association and the WHO may give inconsistent results from other glucose tests. *** Original Documents can be found and downloaded using the link provided below ***
Guideline for the Diagnosis and Treatment of Chronic Undiagnosed Dyspepsia in Adults2009-1-1PDFToward Optimized Practice (TOP)H. Pylori | Dyspepsia | Chronic Undiagnosed Dyspepsia | Upper Respiratory Tract Infection (URTI)Dyspepsia is a group of symptoms which alert clinicians to consider disease of the upper GI tract. This guideline assists with differentiating between H. pylori^ GERD and chronic dyspepsia. Target Population: Adults Exclusions: Children <18 years Pregnant/lactating women
Guideline for the Radiography of the Ankle and Foot (Ottawa Ankle Rules)2014-3-1PDFToward Optimized Practice (TOP)Medial Malleolus | Tibia | Navicular Bone | 5th Metatarsal | X-Ray | Ankle And Foot | Radiography Description: Blunt ankle trauma is a common presenting complaint. This guideline utilizes Dr. Steill’s Ottawa Ankle Rules for decisions on the use of radiography in the diagnosis of ankle injuries and the detection of fractures. Target Population: Adults presenting with ankle injuries Exclusions: Pregnant women Patients with a head injury Patients with multiple painful injuries Intoxicated patient Patients with diminished sensation due to neurological deficit Reviewed 2014
Practical Doc - By Rural Doctors~ For Rural Doctors1980-1-1WebsiteTeachingRural Physician | TeachingPractical Doc was formed in response to the ongoing need to provide practicing rural physicians with a place where they can access online skills~ resources~ and support. More than a clearinghouse for content~ Practical Doc merges the needs of a physician who may be looking for information with the support that can be sometimes hard to find when working in a rural community.
Throat swab: Obtaining Swabs for Culture MovieVideosSwabs | Throat Swab | CultureExcellent; video provides clear audio instructions throughout; discusses equipment, preparation, donning, positioning, procedural technique and how to handle the sample. Length: 2:56 Target Audience: Medical students and health professionals Author: Medical Assisting e-Learning, Simtics
TFP 086 - Cutting out Sodium in Heart Failure: A Taste of the Evidence 2013-6-12PDFAlberta College of Family Physicians (ACFP)Sodium Restriction | Systolic Heart Failure (HF) | Rcts | 8 NNHClinical Question: Does sodium restriction improve outcomes in those with systolic heart failure (HF)? Bottom-line: Please see original article and correction. *** Original Documents can be found and downloaded using the link provided below ***
TFP 098 - Is Diabetes a Coronary Heart Disease Equivalent? 2013-10-21PDFAlberta College of Family Physicians (ACFP)Endocrinology | Type 1 Diabetes Mellitus | Cardiovascular Disease (CVD) | CV | Coronary Artery Disease | CVD | Diabetes | Type 2 DiabetesClinical Question: Do patients with diabetes have the same risk of cardiovascular (CV) events as patients with existing coronary heart disease (CHD)? Bottom-line: Though diabetes does confer an increased risk of CV events^ it is not automatically equivalent to having experienced a myocardial infarction (MI) (and thus does not always warrant aggressive pharmacotherapy). CV risk should be predicted^ and therapy guided^ by taking into account individual risk factors. *** Original Documents can be found and downloaded using the link provided below ***
TFP 161 - Docusate: A Placebo Pill for Soft Poops 2016-4-25PDFAlberta College of Family Physicians (ACFP)Constipation | Senna | ColaceClinical Question: Is docusate effective in the prevention and treatment of constipation? Bottom line: Docusate appears similar to placebo in increasing stool frequency and is inferior to other products for treating functional^ medication-induced^ or post-operative constipation. *** Original Documents can be found and downloaded using the link provided below ***
TFP 155 - “I got water up my nose.” From swimming accident to rhinosinusitis cure? 2016-2-1PDFAlberta College of Family Physicians (ACFP)Spray | Nasal | Rinse | Cold | Sinusitis | IrrigationClinical Question: Is nasal saline irrigation (NSI) helpful for rhinosinusitis? Bottom-line: Nasal saline irrigation does not improve acute rhinosinusitis (example “colds”). It can improve allergic and chronic rhinosinusitis^ improving symptoms -30 percent and improving quality of life with rhinosinusitis at least 10 percent for one in two patients. Isotonic is as good as hypertonic and rinses are better than sprays (but with more adverse events). *** Original Documents can be found and downloaded using the link provided below ***
Lumbar puncture - U of C - requires login2015-1-1MovieVideosLumbar PunctureRequires ucalgary login Excellent; Instructional videos are embedded within webpages that describe indications^ positioning^ equipment^ preparations^ and the procedure itself. Length: Variable Target Audience: Medical students Author: Core Skills^ University of Calgary
Amenorrhea (without hirsutism) and menopause - Summary2014-5-1PDFToward Optimized Practice (TOP)Hirsutism | Lab Test | Menstrual Period | MenopauseClinical Practice Guideline Summary - Reviewed May 2014 *** Original Documents can be found and downloaded using the link provided below ***
Creating Effective Presentations2017-1-1MovieTeachingLectureExcellent podcast by Dr. Kelly Burak^ Cumming School of Medicine^ University of Calgary Duration: 9:55
Application of tissue glue: Wound Closure #10: Tissue Adhesives1980-1-1MovieVideosWound Closure #10 | Tissue AdhesivesGood; explains how tissue adhesives work^ indications for their use and how to apply adhesives using a partner in the ER. Length: 1:57 Target Audience: Medical students and health professionals Author:VIPER (Video Instruction of Procedures in the ER)^ ALiEM Educational videos
TFP 045 - Polyethylene Glycol (PEG) for Paediatric and Adult Chronic Constipation 2015-3-10PDFAlberta College of Family Physicians (ACFP)Adult Chronic Constipation | Paediatric Constipation | Polyethylene GlycolClinical Question: How effective is Polyethylene Glycol (PEG) in Paediatric and Adult Chronic Constipation? Bottom-line: In adults and paediatric patients with chronic constipation^ PEG is as or more effective than other agents. Compared to placebo^ it relieves constipation in one in every 2-3 patients and adds 1-3 bowel movements per week. *** Original Documents can be found and downloaded using the link provided below ***
Cognitive Impairment: Professional Services And Resources In Alberta For Patient/Family/Caregiver And Future/Advanced Planning Tools & Tips For Aging Individuals2017-3-6PDFToward Optimized Practice (TOP)Elderly Patients | ElderlySupplement to the Clinical Practice Guidelines: - Part 1: Symptoms to Diagnosis - Part 2: Diagnosis to Management Description: Alberta primary care physicians and their interdisciplinary teams will be able to assess patients presenting with cognitive concerns and manage the majority of these patients and support their caregivers. Target Population: - Older adults (65 years of age and greater) Exclusions: - Children - Younger adults (less than 65 years of age) with early onset dementia
TFP 152 - Tempered Enthusiasm for Tiotropium in Asthma 2015-12-7PDFAlberta College of Family Physicians (ACFP)ICS | Agonist | Laba | AsthmaClinical Question: Is tiotropium useful as add-on therapy in asthmatic patients who are poorly controlled on an Inhaled Corticosteroid (ICS) or ICS + Long-Acting Beta Agonist (LABA)? Bottom-line: In moderate-severe asthma^ uncontrolled on ICS or ICS+LABA^ the addition of Tiotropium prevents exacerbations for one in 18-36 patients over 4-52 weeks. Much of the research is at high risk of bias and changes in other surrogate outcomes (like FEV1) are of uncertain clinical importance. *** Original Documents can be found and downloaded using the link provided below ***
TFP 198 - SGLT2 Inhibitors and Diabetics: Does sugar in the pee protect thee?2017-10-30PDFAlberta College of Family Physicians (ACFP)A1c | volume depletion | renal failure | genital infections | Mortality | Stroke | non-fatal myocardial infarction | Cardiovascular Disease (CVD) | Metformin | dapagliflozin | canagliflozin | empagliflozin | Diabetes | Type 2 DiabetesClinical Question: In patients with type 2 diabetes^ do sodium-glucose co-transporter 2 (SGLT2) inhibitors affect mortality or cardiovascular disease (CVD)? Bottom Line: In diabetic patients at high-risk for CVD^ empagliflozin reduces mortality for 1 in 39 patients at ~3 years (compared to placebo)^ while canagliflozin and empagliflozin both reduce CVD death^ non-fatal myocardial infarction (MI)^ and stroke for ~1 in 60 patients. Both medications increased genital infections for ~1 in 6-22 and canagliflozin increased volume depletion (1 in 14-38) and amputations (1 in 96). Cost may limit use.
Bedside Teaching Podcast1980-1-1MovieTeachingSnapps | One Minute Preceptor | Faculty DevelopmentExcellent podcast by Dr. Kelly Burak^ Cumming School of Medicine^ University of Calgary Duration: 7:15
TFP 033 - Bisphosphonates: Forever or Five Years and Stop? 2013-12-2PDFAlberta College of Family Physicians (ACFP)Osteoporosis | Bisphosphonates | Bmd Measurement | Bmd TestingClinical Question: Can patients with osteoporosis who have taken bisphosphonates for five years discontinue treatment without increasing future fracture risk? Bottom-line: Available evidence suggests that after five years of treatment^ discontinuation of bisphosphonates carries little to no increased future fracture risk. Choosing appropriate patients to continue therapy beyond five years^ and determining when or if to reinitiate therapy in those discontinued^ remains uncertain. *** Original Documents can be found and downloaded using the link provided below ***
TFP 128 - Evidence that’s tough to swallow: Short course antibiotics for pediatric strep throat 2014-12-15PDFAlberta College of Family Physicians (ACFP)Group A Streptococcal (GAS) pharyngitis | Penicillin | Pediatric Strep Throat | AntibioticsClinical Question: Is treatment with short course antibiotics as effective as a 10-day course of penicillin for children with Group A Streptococcal (GAS) pharyngitis? Bottom-line: In children with GAS pharyngitis^ short course antibiotics (versus 10 days of penicillin) have similar clinical responses but higher rates of adverse events^ likely due to drug selection. The best evidence for rheumatic fever prevention remains with 10-day penicillin. *** Original Documents can be found and downloaded using the link provided below ***
TFP 004 - Bell’s Palsy: What To Do And Not To Do? 2009-7-9PDFAlberta College of Family Physicians (ACFP)Corticosteroids | Randomized-Control Trial | RCT | Bell's Palsy | Prednisolone | Palsy | PlaceboClinical Question: Do corticosteroids or antiviral medications provide any benefit to patients with Bell’s Palsy? Bottom-line: The best evidence indicates that corticosteroids (in doses of prednisolone 25mg BID or 60mg x5 days then tapered by 10mg/day) improve the odds of complete recovery from Bell’s Palsy. Antivirals (used either alone or in addition to prednisolone) seem to offer no advantage (although research continues in severe Bell’s Palsy). *** Original Documents can be found and downloaded using the link provided below ***
Guideline for The Diagnosis and Management of Acute Bacterial Sinusitis2008-1-1WebsiteToward Optimized Practice (TOP)Acute Bacterial Sinusitis | Rhinitis | Rhinosinusitis A website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
TFP 201 - Any Other “Doobie”ous Effects of Medical Cannabinoids?2017-12-11PDFAlberta College of Family Physicians (ACFP)epilepsy | Dravet epilepsy | marihuana | marijuana | Sativex | Cesamet | metoclopramide | HIV | Cancer | palliative care | neuroleptic | Anxiety | glaucoma | chemotherapy | spasticity | Multiple Sclerosis (MS) | nabiximol | Vomiting | Nausea | nabilone | dronabinol | Pain | cannabinoids | medical cannabinoidsClinical Question: Besides pain^ are medical cannabinoids effective for other conditions? Bottom Line: For most conditions (example anxiety)^ cannabinoid evidence is sparse (at best)^ low quality and non-convincing. Dronabinol/nabilone improve control of nausea/vomiting post- chemotherapy for 1 in 3 users over placebo. Nabiximols likely improve multiple sclerosis spasticity ≥30% for approx. 1 in 10 users over placebo. Patients’ preference for cannabinoids exceeds cannabinoids effectiveness.
Casting and Splinting - U of C - requires loginMovieVideosCasting | SplintingExcellent; Instructional videos are embedded within webpages; Pages provide information on Learning Objectives, Equipment, Application, Removal and Splinting Length: Variable Target Audience: Medical students Author: Core Skills, University of Calgary
Top Ten Sleep Tips2015-12-1PDFToward Optimized Practice (TOP)Sleep Hygiene | Patient Education | Sleep Logs | Secondary Sleep Disorder | Primary Sleep Disorder | Sleep DisordersPatient handout Reproduced with permission from: Davidson JR. Sink into sleep: a step-by-step workbook for reversing insomnia. New York City: Demos Medical Publishing; 2012. 208 p. *** Original Documents can be found and downloaded using the link provided below ***
Environmental Exposures from Oil and Gas Emissions - Clinical Practice Guideline2017-3-24PDFToward Optimized Practice (TOP)Environmental exposure Description: Alberta clinicians will have a systematic approach to addressing patient complaints and clinical presentations that may be associated with odors and emissions from oil and gas development and operation activity. Target Population: Everyone Exclusions: Exposures occurring in occupational settings and/or the home environment
TREATMENT OF GERD IN ADULTS - Summary of the Clinical Practice Guideline 2009-1-1PDFToward Optimized Practice (TOP)Gerd | Gastroesophageal Re Ux Disease (GERD) | H. PyloriOBJECTIVE Alberta clinicians understand how to investigate and treat gastroesophageal reflux disease (GERD) and know when to refer patients for endoscopy. TARGET POPULATION Adults 18 years of age and older EXCLUSIONS Children under 18 years of age Minor Revision 2016 *** Original Documents can be found and downloaded using the link provided below ***
Guideline for The Management of Acute Bronchitis2008-1-1WebsiteToward Optimized Practice (TOP)Antibiotics | Bronchitis | Viral | Antimicrobial Resistance | PertussisA website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
UCLIC Student overall schedule - link to Osler2016-7-29WebsiteStudents & LearnersScheduleOverall schedule - requires password
Diagnosis and Management of Osteoporosis - Summary of Clinical Practice Guideline2016-2-1PDFToward Optimized Practice (TOP)Bmd Testing | Bmd Measurement | OsteoporosisOBJECTIVE Alberta clinicians will understand who and how to screen^ assess^ diagnose^ treat and manage osteoporosis and/or fracture risk. TARGET POPULATION All men and women 50 years of age and older EXCLUSIONS All men and women under 50 years of age *** Original Documents can be found and downloaded using the link provided below ***
Differentiating Acne Vulgaris vs. Acne Rosacea - Stanford Medicine 252016-1-22WebsiteTeachingphysical exam | dermatology | skin | Acne | rosaceaAcne vulgaris is what most people think of when they hear acne. However another type of acne^ called acne rosacea (usually referred to as just rosacea) needs a different type of treatment then acne vulgaris. It is important to be able to differentiate the two diagnoses. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 080 - Antihistamines for the Common Cold: Facts on a Possible Fix? 2013-1-7PDFAlberta College of Family Physicians (ACFP)Common Cold | Antihistamines | Treating SymptomsClinical Question: Are antihistamines effective in treating symptoms of the common cold? Bottom-line: Antihistamines alone have no meaningful impact on the common cold. Although evidence is at moderate to high risk of bias^ antihistamines combined with decongestants and/or analgesia may have a small impact on improving symptoms for one in 4-7 patients but should not be used in children under 6. *** Original Documents can be found and downloaded using the link provided below ***
TFP 107 - Cholinesterase inhibitors and treatment of Alzheimers dementia 2014-2-18PDFAlberta College of Family Physicians (ACFP)Dementia | Alzheimer Disease | Cholinesterase InhibitorsClinical Question: What are the benefits and harms of cholinesterase inhibitors (ChEI) for Alzheimers dementia? Bottom-line: Evidence for ChEI in Alzheimers dementia is generally limited by small differences and high drop-out rates. Approximately one in ten patients show meaningful clinical improvement when treated for six months and -1 in ten patients stop using the drug due to an adverse event. *** Original Documents can be found and downloaded using the link provided below ***
Depression in Multiple Sclerosis - Clinical Practice Guideline2015-12-1PDFToward Optimized Practice (TOP)Multiple Sclerosis (MS) | Depression | Depressive DisorderOBJECTIVE Alberta clinicians have the skills and tools to assess^ diagnose^ treat and manage depression in patients with multiple sclerosis (MS) within primary care TARGET POPULATION Adults 18 years of age and older EXCLUSIONS Children less than 18 years of age PRACTICE POINT Be aware that depression is two to three times more common in MS patients than in the general population and can go undetected. Be aware that the suicide rate in people with MS is approximately twice that of the general population. Therefore it is important to be vigilant for depression in patients with MS. *** Original Documents can be found and downloaded using the link provided below ***
TFP 169 - Pre-Exposure Prophylaxis (PrEP): Are you PrEP’d for the future of HIV prevention?2016-8-29PDFAlberta College of Family Physicians (ACFP)Pre-exposure prophylaxis | PrEP | HIV | HIV infectionClinical Question: In patients at higher risk of contracting HIV^ can daily antiviral therapy prevent infection? Bottom-line: Tenofovir/emtricitabine (PrEP) once daily reduces the risk of HIV by -50 percent^ preventing infection for -1 in 50 per year. A year of therapy costs -$12^000 and -1 in 34 develop nausea/vomiting due to the drug.
Cancer Related Fatigue2013-4-11MovieVideosTired | Patient Education | Fatigue | CancerExcellent patient education video regarding the fatigue in cancer. Length: 9:47 Author Dr. Mike Evans
TFP 114 - My fracture really hurts^ can I use non-steroidal anti- inflammatories? 2014-5-26PDFAlberta College of Family Physicians (ACFP)Fracture Healing | Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)Clinical Question: Do non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of fracture non-union or impede healing? Bottom-line: Limited RCT data suggests that NSAIDs do not impair fracture healing. Cohort studies associating NSAID use with fracture non-union are likely demonstrating that patients with non-healing (and painful) fractures are just using more analgesics. As NSAIDs provide equivalent or superior acute pain relief to other common analgesics often with fewer adverse effects^ patients should not be denied their short-term use in fracture management. *** Original Documents can be found and downloaded using the link provided below ***
Measuring and Understanding the Ankle Brachial Index (ABI) - Stanford Medicine 252012-7-4WebsiteTeachingphysical exam | Peripheral Arterial DiseaseThe Ankle Brachial Index (ABI) is the systolic pressure at the ankle^ divided by the systolic pressure at the arm. It has been shown to be a specific and sensitive metric for the diagnosis of Peripheral Arterial Disease (PAD). Additionally^ the ABI has been shown to predict mortality and adverse cardiovascular events independent of traditional CV risk factors. The major cardiovascular societies advise measuring an ABI in every smoker over 50 years old^ every diabetic over 50^ and all patients over 70. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
Should You Get the HPV Vaccine?2012-10-3MovieVideosHPV | Genital Warts (condyloma) | Human Papillomavirus (HPV) | Hpv Vaccination | Wart | Patient EducationExcellent patient education video regarding the pros and cons of the HPV vaccine Length: 8:46 Author Dr. Mike Evans
TFP 126 - Z-drugs for sleep: Should we 'Catch Some Z’s'? 2014-11-24PDFAlberta College of Family Physicians (ACFP)Reduced Verbal Memory | Inconsistent Cognitive Effects | Mild Infections | Eszopiclone | Zolpidem | Zopiclone | Z-DrugsClinical Question: Are Z-drugs (zopiclone^ zolpidem^ and eszopiclone) safe and effective in insomnia? Bottom-line: Z-drugs help people fall asleep faster (-13-22 minutes) and perhaps get -5 percent more time sleeping while in bed. Z-drugs may increase the risk of mild infections (one in 43 patients) and have some inconsistent cognitive effects like reduced verbal memory or attention. *** Original Documents can be found and downloaded using the link provided below ***
Guideline for the Diagnosis and Management of Acute Otitis Media2008-1-1WebsiteToward Optimized Practice (TOP)Antibiotics | Acute Otitis Media (AOM) | Myringitis | Ear Infections | Diagnosis Of Otitis Media With Effusion (OME)A website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
TFP 084 - Cranberry juice/tablets for the prevention of urinary tract infection: Naturally the best? 2013-3-4PDFAlberta College of Family Physicians (ACFP)Recurrent | Cranberry Juice/Tablets | Urinary Tract Infection (UTI)Clinical Question: Does Cranberry juice or extract prevent recurrent urinary tract infections (UTI)? Bottom-line: Available evidence does not support cranberry products for reduction of UTIs. The overall quality of evidence is poor. *** Original Documents can be found and downloaded using the link provided below ***
TFP 189 - Moving along the management of constipation predominant IBS – Is it worth the cost?2017-6-12PDFAlberta College of Family Physicians (ACFP)alosetron | tegaserod | abdominal pain | Diarrhea | CSBM | Bowel Movements | Constipation | Linaclotide | Irritable Bowel Syndrome (IBS)Clinical Question: What is the efficacy and safety of linaclotide in constipation predominant irritable bowel syndrome (IBS-C)? Bottom Line: Compared to placebo^ for every seven patients treated with linaclotide one more will be a “responder” [30% improvement in pain and one additional “complete” spontaneous bowel movement (CSBM) per week for six weeks in 12]. Overall^ patients experience ~3 additional “spontaneous” bowel movements (BM) per week^ at the price of $15 per BM. For every 21 patients treated^ one will stop due to diarrhea. Post-marketing surveillance should help clarify long-term safety.
Diagnosis and Management of Acute Bacterial Sinusitis: Children - Summary2008-1-1WebsiteToward Optimized Practice (TOP)Sinusitis | Haemophilus Influenzae | Acute Bacterial Sinusitis | Streptococcus Pneumoniae A website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
TFP 078 - Lung Cancer Screening – Low dose CT^ High dose False Positives 2012-11-26PDFAlberta College of Family Physicians (ACFP)Lung Cancer Screening | Low Dose Ct | High Dose False PositivesClinical Question: Does screening high risk individuals with low dose CT (LDCT) result in reduced lung cancer mortality? Bottom-line: Benefit from screening for lung cancer with LDCT has been demonstrated in only one trial^ without a “usual care” group. The high number of false positives^ which require further^ sometimes invasive investigations^ is worrisome. Smoking cessation should remain the priority to decrease lung cancer mortality. *** Original Documents can be found and downloaded using the link provided below ***
Inflammatory Bowel Disease (IBD) 2013-6-3MovieVideosPatient Education | Crohn's | Ulcerative ColitisExcellent patient education video regarding Inflammatory Bowel Disease Length: 6:45 Author Dr. Mike Evans
Precordial Movements in the Cardiac Exam - Stanford Medicine 252012-12-5WebsiteTeachingphysical exam | Cardiac | precordialAs the heart contracts^ movements can be palpated and often visualized over the chest. The location and character of these precordial movements correlate with abnormalities of the heart^ such as in hypertrophic heart disease. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 158 - Is less more with isotretinoin and acne?2016-3-14PDFAlberta College of Family Physicians (ACFP)Accutane | AcneClinical Question: What is the efficacy and tolerability of low-dose compared to conventional dose isotretinoin in the treatment of acne? Bottom-line: Small randomized controlled trials (RCTs) and observational studies demonstrate low-dose (-20mg/day) isotretinoin improves acne similar to conventional dosing. Low-dose may reduce common side effects (chapped lips^ dry skin^ epistaxis) by 16-35 percent but may be associated with increased relapse rates^ particularly with severe acne and/or possibly impacted by lower total accumulated dose. *** Original Documents can be found and downloaded using the link provided below ***
Prevention and management of cardiovascular disease risk in primary care - Guideline2015-2-1PDFToward Optimized Practice (TOP)Coronary Artery Disease | Cardiovascular Events | Atherosclerotic Vascular Disease | Peripheral Arterial Disease | Cerebrovascular Disease | Diabetes Mellitus | Chronic Kidney Disease | HemodialysisClinical Practice Guideline | February 2015 OBJECTIVE Alberta primary care clinicians and their teams offer primary and secondary prevention for cardiovascular disease (CVD) focused on CVD risk estimation and lipid management TARGET POPULATION Men aged 40-75 Women aged 50-75 EXCLUSIONS Men and women of any age with previously diagnosed familial hypercholesterolemia *** Original Documents can be found and downloaded using the link provided below ***
Wound dressing: Sterile Dressing Change ProcedureMovieVideosSterile Dressing | Wound DressingExcellent; video discusses indications, equipment, preparation and step-by-step technique with clear instructions throughout Length: 14:38 Target Audience: Nursing students and health professionals Author: Teaching and Learning Technologies, Faculty of Nursing, University of Alberta
Bedside Ultrasound Examination - Stanford Medicine 252011-12-14WebsiteTeachingphysical exam | UltrasoundBedside ultrasound has become a standard part of the exam for many clinicians. Here we review some basic aspects of the bedside exam and the ultrasound machines used. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
Diagnosis and Management of Osteoporosis - Clinical Practice Guideline2016-2-1PDFToward Optimized Practice (TOP)Osteoporosis | Bmd Measurement | Bmd TestingOBJECTIVE Alberta clinicians will understand who and how to screen^ assess^ diagnose^ treat and manage osteoporosis and/or fracture risk. TARGET POPULATION All men and women 50 years of age and older EXCLUSIONS All men and women under 50 years of age *** Original Documents can be found and downloaded using the link provided below ***
Ear syringing2015-1-1MovieVideosEar SyringingOK; video demonstrates the procedure on adult patient; some silliness included Length: 4:52 Target Audience: General public Author: Dr. Paul Thomas^ Pediatrician^ Integrative Pediatrics^ LLC^ Portland^ Oregon
Amenorrhea (without hirsutism) and menopause2014-5-1PDFToward Optimized Practice (TOP)Hirsutism | Lab Test | Menstrual Period | MenopauseClinical Practice Guideline - Jan 2008^ Reviewed May^ 2014 OBJECTIVE Clinicians in Alberta optimize laboratory tests for investigation of amenorrhea (without hirsutism) and suspected menopause TARGET POPULATION Women with primary amenorrhea Girls with the lack of breast development by age 14 years^ or by the lack of menses by age 16 in the presence of normal secondary sexual development^ or by the lack of menses by three years after the larche Women with secondary amenorrhea (more than six months without menses after prior establishment of menses) EXCLUSIONS Pregnant women *** Original Documents can be found and downloaded using the link provided below ***
TFP 059 - Taking blood pressure-lowering Medications at Night2012-1-9PDFAlberta College of Family Physicians (ACFP)CVD | Antihypertensive | Blood PressureClinical Question: Will taking one or more antihypertensive drugs at night improve cardiovascular disease (CVD) outcomes and reduce drug side-effects? Bottom-line: Taking one or more BP meds before bed may potentially help reduce cardiovascular risk but due to limitations of the evidence^ strong recommendations are difficult. *** Original Documents can be found and downloaded using the link provided below ***
Active Tuberculosis (TB) Diagnosis Algorithm2011-11-1PDFToward Optimized Practice (TOP)Diagnosis Algorithm | Tuberculosis (TB) (TB) Diagnosis Algorithm *** Original Documents can be found and downloaded using the link provided below ***
Chronic Undiagnosed Dyspepsia in in Adults - Summary2009-2-1PDFToward Optimized Practice (TOP)Gastroesophageal Re Ux Disease (GERD) | Peptic Ulcer Disease (PUD) | Non-Ulcer Dyspepsia (NUD) | Nsaid Induced Gastropathy | Non-Ugi Pathologies | Cardiac | Hepatobiliary | Colonic | MusculoskeletalDyspepsia is a group of symptoms which alert clinicians to consider disease of the upper GI tract. This guideline assists with differentiating between H. pylori^ GERD and chronic dyspepsia. Target Population: Adults Exclusions: Children <18 years Pregnant/lactating women
Teaching ProfessionalismPDFTeachingFaculty DevelopmentTeaching notes for physicians from the Cumming School of Medicine Office of Faculty Development
23 and 1/2 hours: What is the single best thing we can do for our health?2011-12-2MovieVideosExercise | Patient EducationExcellent patient education video regarding the benefits of exercise. Length: 9:18 Author Dr. Mike Evans
TFP 042 - Children with Acute Otitis Media: Benefits and Risks of Antibiotics 2015-3-10PDFAlberta College of Family Physicians (ACFP)Antibiotics | Acute Otitis MediaClinical Question: In children with Acute Otitis Media (AOM) what are benefits and risks of antibiotics? Bottom-line: Although most children will recover from Acute Otitis Media without complications^ antibiotics will improve outcomes for 1 in 3 to 1 in 10^ depending on outcome and complicating factors. They will cause adverse events^ particularly diarrhea^ in up to 1 in every 5. *** Original Documents can be found and downloaded using the link provided below ***
TFP 015 - Atenolol and beta-blockers for primary hypertension: Do they perform under pressure? 2009-11-30PDFAlberta College of Family Physicians (ACFP)Beta-Blockers | Atenolol | Antihypertensive | Blood PressureClinical Question: Are beta-blockers^ particularly atenolol^ as effective as other antihypertensive medications in preventing important outcomes in hypertensive patients? Bottom-line: Atenolol is an inferior choice for blood pressure treatment. Beta-blockers in general should not be considered first- line in age ≥60^ and some have suggested they should not be first- line in any patient with uncomplicated hypertension. *** Original Documents can be found and downloaded using the link provided below ***
What is the single best drink for your health?2014-10-19MovieVideosPatient Education | WaterExcellent patient education video regarding the pros and cons of the HPV vaccine Length: 4:09 Author Dr. Mike Evans
TFP 121 - Can I get my cholesterol checked fast (without fasting)? 2014-9-15PDFAlberta College of Family Physicians (ACFP)Total Cholesterol (TC) | LDL | HDL | Fasting | Lipid Testing | Cardiovascular Disease (CVD)Clinical Question: Can non-fasting lipid levels be used to predict future cardiovascular disease (CVD) risk? Bottom-line: Minimal differences exist between fasting and non- fasting HDL^ LDL^ and total cholesterol (TC). Also^ non-fasting HDL and non-HDL levels correlate with future CVD events. Therefore^ fasting for lipid testing is not required. *** Original Documents can be found and downloaded using the link provided below ***
Guideline for The Diagnosis and Management of Community Acquired Pneumonia:Pediatric2008-1-1WebsiteToward Optimized Practice (TOP)Antibiotics | Pneumonia | Community Acquired Pneumonia (CAP) | Bronchopneumonia | Pneumonitis Syndrome | Conjugated Haemophilus Infuenzae Type B Vaccine A website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
TFP 187 - CBC (Confusing Broad Check) for Screening?2017-5-15PDFAlberta College of Family Physicians (ACFP)CBC | Complete Blood Count | Screening | asymptomatic non-pregnant adults | periodic health check | Periodic Health Exam | PHE | case-finding | hospital admission screening | pre-op screening | leukocyte | Anemia | colon cancerClinical Question: What is the evidence for screening with a CBC (Complete Blood Count) in asymptomatic^ non-pregnant adults? Bottom Line: CBC or its components should NOT be ordered for screening asymptomatic non-pregnant adults as it does not reduce mortality. When CBC is tested routinely without cause^ up to 11% are abnormal but <1% require management change. It is unclear which patients benefit and serious disease is virtually never found.
LABORATORY ENDOCRINE TESTING: HYPERCALCEMIA - clinical practice guideline2008-1-1PDFToward Optimized Practice (TOP)Calcium | ParathyroidOBJECTIVE Alberta clinicians optimize laboratory testing for suspected hypercalcemia TARGET POPULATION Patients with signs or symptoms of hypercalcemia EXCLUSIONS Children <1 month of age
Lecturing for Effective LearningPDFTeachingFaculty DevelopmentTeaching notes for physicians from the Cumming School of Medicine Office of Faculty Development
Course objectives and outlines, including updated Core DocsWebsiteStudents & LearnersClerkshipThe documents posted are the Intellectual property and copyrighted by the University of Calgary, Cumming School of Medicine. Permission to use content from these documents can be obtained by contacting the Undergraduate Medical Education office at umehelpdesk@ucalgary.ca.
TFP 185 - Drinking in the Evidence Around Mild-Moderate Dehydration Management in Kids with Gastroenteritis2017-4-18PDFAlberta College of Family Physicians (ACFP)dehydration | rehydration | apple juice | OndansetronClinical Question: What is the best management of mild-moderate dehydration in children with gastroenteritis? Bottom Line: For children with mild to moderate dehydration due to gastroenteritis^ oral rehydration is equivalent to IV therapy. Half- strength apple juice is as good as electrolyte maintenance solution and appears to be superior in children ≥24 months. Liquid versus frozen administration is likely a matter of preference.
Foley catheter insertion - PocketSnipsMovieVideosBladder CatheterizationExcellent; accompanied by clear audio instructions and supplementary materials Length: Target Audience: Medical students and health professionals Author: Dr. David Topps, PocketSnips Procedural Skills Project, NOSM
TFP 067 - High Dose Statin Compare To Low Dose in People with Heart Disease2012-5-22PDFAlberta College of Family Physicians (ACFP)Myocardial Infarction | Heart Disease | StatinClinical Question: In patients with coronary heart disease (like previous myocardial infarction)^ what are the benefits and harms of prescribing high dose compared to low dose statins? Bottom-line: In patients with coronary heart disease^ using high dose statins (compared to low-moderate dose) prevents one CHD event for every 91 patients but results in one in 47 patients discontinuing therapy due to adverse events. However^ low-moderate dose statin (compared to placebo) provides 2-3 times greater benefit than increasing to high dose statin. Therefore^ getting and keeping patients on any statin is key^ with dose adjusted up to tolerable levels. *** Original Documents can be found and downloaded using the link provided below ***
Reflex Exam (Deep Tendon Reflexes) - Stanford Medicine 252014-3-16WebsiteTeachingphysical exam | reflex | neurological | neuroThe reflex exam is fundamental to the neurological exam and important to locating upper versus lower motor neuron lesions. There are five deep tendon reflexes and a number of superficial and visceral reflexes covered here. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
90:10 The Single Most Important Thing You Can Do For Your Stress2012-6-9MovieVideosExercise | Patient Education | StressExcellent patient education video regarding the benefits of exercise in stress. Length: 11:00 Author Dr. Mike Evans
Food Triggers^ Caffeine and Migraine Attacks2013-10-1PDFToward Optimized Practice (TOP)Handout | Secondary Headaches | Primary Headaches | Headache Disorders | Headache | MigrainesPatient handout about migraine triggers *** Original Documents can be found and downloaded using the link provided below ***
TFP 040 - Topical NSAIDs: Do they top Placebo or Oral NSAIDs? 2015-2-10PDFAlberta College of Family Physicians (ACFP)Acute Pain | Chronic Pain | Placebo | NsaidsClinical Question: Are topical NSAIDs effective in reducing pain in acute and chronic (including osteoarthritis) musculoskeletal pain? Bottom-line: In acute and chronic (like osteoarthritis) musculoskeletal pain^ topical NSAIDs are superior to placebo and equivalent to oral NSAIDs. Topical NSAIDs adverse event rates are not statistically greater than placebo. *** Original Documents can be found and downloaded using the link provided below ***
Teaching on the run tips 12: planning for learning during clinical attachments2008-10-10PDFTeachingJMO | AssessmentSetting The new junior medical officer is arriving next week. You have just been to a workshop about planning for JMO learning during clinical attachments and feel enthused about applying what you learned to her 3-month attachment with you. This also means you will be well prepared for the accreditation visit. Fiona R Lake and Gerard Ryan *** Original Documents can be found and downloaded using the link provided below ***
What is the Best Way to Treat Acne?2013-6-15MovieVideosAcne | ZitExcellent patient education video regarding the treatment of acne Length: 8:51 Author Dr. Mike Evans
Joint aspiration/injection: Knee Injection - Anterior Approach MovieVideosJoint Aspiration | Joint Injection | Knee Injection | Anterior ApproachVery good; indications for the anterior approach are clearly defined; all steps of the procedure are explained in the video. The video does not describe preparation for the procedure. Length: 4:03 Target Audience: Medical students Author: McMaster MSK Injection Techniques, Department of Medicine, McMaster University
Prevention in Hand Website2017-1-1WebsiteTeachingEvidence based medicine | CPG | Clinical Practice Guidelines | Chronic Disease | PreventionThe Prevention in Hand (PiH) initiative launched in 2014 as a result of a partnership between the College of Family Physicians of Canada (CFPC) and the Public Health Agency of Canada (PHAC). PiH’s user-friendly website and mobile application provide valuable health care resources to help health professionals and the public quickly and easily access current and accurate information about the prevention of chronic diseases.
Low Back Pain 2014-1-24MovieVideosLumbar | Patient Education | Disc | SciaticaExcellent patient education video regarding the treatment of low back pain Length: 11:05 Author Dr. Mike Evans
TFP 056 - Is quadruple the new triple therapy for H. pylori?2011-11-14PDFAlberta College of Family Physicians (ACFP)H. Pylori | QuadrupleClinical Question: Does quadruple therapy (QT) result in superior eradication rates of H. pylori over traditional triple therapy (TT)? Bottom-line: The optimal treatment regimen for H. pylori remains controversial^ with differences in number and type of drugs^ dosing^ and length of treatment. Until local resistance patterns are identified and deemed a concern^ there is not overwhelming evidence to change current prescribing patterns in primary care. *** Original Documents can be found and downloaded using the link provided below ***
LABORATORY ENDOCRINE TESTING GONADAL DISORDERS: HIRSUTISM Summary of the Clinical Practice Guideline 2008-1-1PDFToward Optimized Practice (TOP)Hirsutism | HairOBJECTIVE Alberta clinicians optimize laboratory testing for investigation of suspected hirsutism TARGET POPULATION Women with moderate^ severe or rapidly developing hirsutism EXCLUSIONS None RECOMMENDATIONS X NO laboratory investigation is required for mild hirsutism - Refer to endocrinologist for severe or rapidly developing hirsutism - Consider testing for total testosterone^ DHEAS and androstenedione (drawn after 10 a.m.) X DO NOT test for LH^ FSH^ estradiol^ progesterone^ DHEA to diagnose hirsutism in absence of menstrual disorders
Venipuncture - PocketsnipsMovieVideosVenipunctureExcellent; accompanied by clear audio instructions Length; 2:24 Target Audience: Medical students and health professionals Author: Dr. David Topps
TFP 194 - Needed for Eye and Brain Development? Omega-3s in infant formula2017-9-5PDFAlberta College of Family Physicians (ACFP)Omega 3 | Omega-3 Fatty Acids | LCPUFA | infants | formula | infant formula | brain development | eye development | neurocognitive development | visual acuity | Snellen chart | Visual evoked potentials | VEPClinical Question: Does adding omega-3 long-chain polyunsaturated fatty acids to infant formula improve brain and eye development in healthy^ full-term infants? Bottom Line: Adding omega-3 to infant formula has no consistently meaningful effects on neurocognitive development. One group using one measure of visual acuity consistently found benefits (about 1- line difference on Snellen chart) at 12 months that others do not and long-term data is lacking.
TFP 074 - Coffee: Advice for our Vice 2012-10-1PDFAlberta College of Family Physicians (ACFP)Coffee | General PopulationClinical Question: Does drinking coffee impact mortality or other health outcomes in the general population? Bottom-line: Coffee consumption is associated with no change or a small reduction in mortality in cohort studies. While the evidence is not strong enough to recommend non-drinkers to start consuming coffee^ coffee drinkers can be reassured that it does not appear to result in excess harm (except in pregnancy). *** Original Documents can be found and downloaded using the link provided below ***
Advance Care Planning: Goals of Care Designation (Adult) Policy2011-3-1PDFAlberta Health ServicesInter-Professional Practice | Advance Care Planning | Patient Centric | Goals Of Care Designation PolicyThe Advance Care Planning: Goals of Care Designation Policy replaced the three adult resuscitation policies in Alberta Health Services^ Calgary and Area with one policy effective November^ 2008.
TFP 013 - How Long Before Antidepressants Work: Happy News? 2013-10-28PDFAlberta College of Family Physicians (ACFP)AntidepressantClinical Question: How quickly do the effects of antidepressants become clinically evident? Bottom-line: Antidepressants begin to work as early as one week and continue to provide incremental benefits on depressive symptoms weekly for at least six weeks. *** Original Documents can be found and downloaded using the link provided below ***
Multiple Sclerosis: My Bladder Management Action Plan - Patient handout2013-11-1PDFToward Optimized Practice (TOP)Handout | Bladder Infections | Bladder | Multiple SclerosisThis Multiple Sclerosis: My Bladder Management Action Plan will help you recognize early signs of bladder problems and take the appropriate steps to prevent or^ if need be^ treat possible bladder infection. *** Original Documents can be found and downloaded using the link provided below ***
Delivery of Effective Presentations1980-1-1MovieTeachingLectureExcellent podcast by Dr. Kelly Burak^ Cumming School of Medicine^ University of Calgary Duration: 8:07
TFP 102 - Coughing up the Data on Croup 2013-12-2PDFAlberta College of Family Physicians (ACFP)Dexamethasone | Croup | GlucocorticoidsClinical Question: Are glucocorticoids beneficial for mild to moderate croup and^ if so^ is lower dose equivalent to standard dose? Bottom-line: Glucocorticoids^ including dexamethasone^ are beneficial in the treatment of mild to moderate croup^ with a NNT of 5 for symptom improvement and a NNT of 17 for return to care. Low- dose dexamethasone (0.15 mg/kg) may be equivalent to the more commonly prescribed 0.6 mg/kg. *** Original Documents can be found and downloaded using the link provided below ***
TFP 142 - The Low FODMAP Diet: Food for thought or just an irritable idea? 2015-7-6PDFAlberta College of Family Physicians (ACFP)Irritable Bowel Syndrome (IBS) | Low Fodmap DietClinical Question: Does the low FODMAP diet improve symptoms for patients with irritable bowel syndrome? Bottom-line: A low FODMAP diet may improve symptoms for patients with primarily diarrhea subtype irritable bowel syndrome (IBS). However^ most studies were low quality (small numbers and short duration)^ and therefore more high quality studies are needed. *** Original Documents can be found and downloaded using the link provided below ***
A Summary of the Guideline for the Evidence-Informed Primary Care Management of Low Back Pain2015-9-1PDFToward Optimized Practice (TOP)Lumbar | Acute Back Pain | Low Back PainSummary OBJECTIVE To help Alberta clinicians make evidence-informed decisions about care of patients with non- specific low back pain TARGET POPULATION Adult patients 18 years or older in primary care settings *** Original Documents can be found and downloaded using the link provided below ***
TFP 162 - Dexamethasone Versus Prednisone for Pediatric Asthma: Will the results take your breath away? 2016-5-9PDFAlberta College of Family Physicians (ACFP)Prednisone | Pediatric | Dexamethasone | AsthmaClinical Question: Are 1-2 doses of dexamethasone as effective as the standard five day prednisone regimen for treatment of pediatric asthma exacerbations? Bottom-line: Treatment of pediatric asthma exacerbations with short-course dexamethasone (0.6 mg/kg x 1-2 doses) is a safe and effective alternative to traditional five day courses of prednisone. For every -20 children treated with dexamethasone^ there will be one less vomited dose. *** Original Documents can be found and downloaded using the link provided below ***
TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE (GERD) IN ADULTS Clinical Practice Guideline2009-1-1PDFToward Optimized Practice (TOP)Gerd | Gastroesophageal Reflux Disease | Gastroesophageal Re Ux Disease | H. PyloriOBJECTIVE Alberta clinicians understand how to investigate and treat gastroesophageal reflux disease (GERD) and know when to refer patients for endoscopy. TARGET POPULATION Adults 18 years of age and older^ pregnant women EXCLUSIONS Children under 18 years of age Minor revision 2016 *** Original Documents can be found and downloaded using the link provided below ***
TFP 156 - The louse is (no longer) in the house2016-2-16PDFAlberta College of Family Physicians (ACFP)Pediculicide | Nits | Lice | LouseBottom-line: Dimeticone (or dimethicone) appears superior to traditional lice treatments (like permethrin or malathion)^ getting one more in 3-4 patients lice free with no increased adverse events. Dimeticone is a silicone-based product that suffocates lice and is applied to dry hair^ left eight hours^ and often repeated after one week. *** Original Documents can be found and downloaded using the link provided below ***
TFP 034 - Rosiglitazone – Reasonable Option or Regrettable Choice? 2013-12-3PDFAlberta College of Family Physicians (ACFP)Diabetes Mellitus | Diabetes | Type 2 DiabetesClinical Question: Is rosiglitazone a reasonable second or third line agent in the management of Type 2 Diabetes (DM2)? Bottom-line: Strong evidence supports increased cardiovascular risk^ specifically MI^ in Type 2 Diabetes patients receiving rosiglitazone. In the absence of any demonstrated patient oriented benefits^ there is no indication for its use. *** Original Documents can be found and downloaded using the link provided below ***
LABORATORY ENDOCRINE TESTING: GALACTORRHEA Summary of the Clinical Practice Guideline2014-5-1PDFToward Optimized Practice (TOP)Milk | Lactation | BreastOBJECTIVE Alberta clinicians optimize laboratory testing for investigation of suspected galactorrhea TARGET POPULATION Patients with non-puerperal secretions of milk EXCLUSIONS None RECOMMENDATIONS Evaluate secretions during breast examination Repeat testing if equivocal prolactin results Measure prolactin level at least one hour after a breast examination as breast trauma or manipulation can affect prolactin levels Refer to algorithm for diagnostic options *** Original Documents can be found and downloaded using the link provided below ***
TFP 110 - Treating to Target: Can we hit the mark? 2014-3-31PDFAlberta College of Family Physicians (ACFP)Surrogate Marker Targets | Primary Care | Glycosylated Hemoglobin | CholesterolClinical Question: Is it possible to achieve guideline- specified targets of surrogate markers (cholesterol^ blood pressure^ glycosylated hemoglobin) in primary care? Bottom-line: Even in ideal settings with highly selected patients^ less than 25 percent of patients achieve multiple targets for surrogate markers. However^ clinical outcomes improve when proven interventions (examples statins^ metformin^ ACE inhibitors^ thiazides) are used without necessarily achieving targets. Clinicians should “worry” less about attaining exact surrogate marker targets and focus more on using proven therapies. *** Original Documents can be found and downloaded using the link provided below ***
Diagnosis and Prevention of Acute Pharyngitis Summary of the Alberta Clinical Practice Guideline2008-1-1WebsiteToward Optimized Practice (TOP)Bacterial Pathogen | Group A Streptococcus | Β-Haemolytic Streptococci | Neisseria Gonorrhoeae | Arcanobacterium Haemolyticum | Tonsils | Peritonsillar PillarsA website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
Summary of the Laboratory Guidelines for Investigation of Suspected Infectious Diarrhea2014-3-1PDFToward Optimized Practice (TOP)Stool Bacterial Cultures | Collecting Stool Specimen | Special Stool Collection Container | Infectious DiarrheaSummary OBJECTIVE Alberta clinicians use a single initial stool test to improve the accuracy of stool testing for infectious diarrhea and tool collecting convenience for patients TARGET POPULATION Children and adults with suspected infectious diarrhea EXCLUSIONS Patients involved in a community or hospital outbreak Food handlers to whom Public Health regulations apply When an infectious etiology is not suspected *** Original Documents can be found and downloaded using the link provided below ***
ParacentesisMovieVideosParacentesisExcellent; accompanied by clear audio instructions and informative text slides Length: 9:28 Target Audience: Medical students and health professionals Author: New England Journal of Medicine
TFP 002 - Lacerations: Sterile Gloves and Water?2009-6-1PDFAlberta College of Family Physicians (ACFP)Gloves | Non-Sterile | Sterile | Infection | Laceration | Saline | Water | RCT | Randomized-Control TrialClinical Question: In the management of simple lacerations^ are sterile gloves and sterile saline required to reduce infection? Bottom-line: The present evidence indicates that simple lacerations can be cleaned with tap water and repaired with clean non-sterile gloves without an increased risk of infection. *** Original Documents can be found and downloaded using the link provided below ***
Five Steps to Effective Teaching at the Bedside1980-1-1PDFTeachingFaculty Development | BedsideTeaching notes for physicians from the Cumming School of Medicine Office of Faculty Development
TFP 076 - Amoxicillin^ still an A-list Antibiotic for Infections of the Airway2012-10-29PDFAlberta College of Family Physicians (ACFP)Bacterial Respiratory Tract Infections | Β-Lactam Antibiotics | Infections Of The Airway | AmoxicillinClinical Question: When needed^ are β-lactam antibiotics (i.e. amoxicillin) a reasonable choice in mild to moderate bacterial respiratory tract infections in primary care? Bottom-line: In mild to moderate respiratory tract infections that require antibiotics^ there is no evidence of benefit with broader spectrum antibiotics over traditional β-lactam antibiotics (i.e. amoxicillin)^ particularly in primary care. Broad spectrum treatment may be considered in certain high risk patients. *** Original Documents can be found and downloaded using the link provided below ***
Summary for the Diagnosis of Gluten-Sensitive Enteropathy (Celiac Disease) 2010-2-1PDFToward Optimized Practice (TOP)Weight Loss | Diarrhea | Celiac Disease | Age | Immune Medical Condition | Gluten | Abdominal Distention | Severe Malnutrition | Delayed Puberty | Paresthesia**Currently under review and will be updated. Date of updated Celiac CPG release is still to be determined.**
TFP 041 - Does calcium supplementation increase the risk of MI? 2015-2-17PDFAlberta College of Family Physicians (ACFP)Calcium Supplementation | Myocardial Infarction | CardiovascularClinical Question: Does calcium (Ca+) supplementation contribute to increased risk of myocardial infarction (MI) and other cardiovascular disease (CVD)? Bottom-line: The present evidence suggests that calcium supplementation^ particularly ≥1000mg/day^ may lead to an increase risk of MI. This evidence is poor and the risk^ if present^ is likely <1 percent. *** Original Documents can be found and downloaded using the link provided below ***
TFP 193 - Riboflavin for Migraine Prophylaxis: Something “2-B” excited about?2017-8-14PDFAlberta College of Family Physicians (ACFP)Riboflavin | Vitamin | B2 | Migraine | Prophylaxis | Diarrhea | magnesium | discoloured urine | coenzyme Q10 | feverfew | propranolol | amitriptylineClinical Question: Does daily riboflavin (vitamin B2) prevent migraines? Bottom-line: Studies of riboflavin are inconsistent and often have high placebo response rates. Most randomized^ controlled trials (RCTs) found no reduction in migraine frequency. One study found for every three adults treated with riboflavin^ one patient would have a ≥ 50% reduction in migraine frequency compared to placebo. Adverse effects are poorly reported^ but include diarrhea and discoloured urine.
TFP 109 - Anti-platelets after stroke: Are two better than one?2014-3-17PDFAlberta College of Family Physicians (ACFP)Dp-Asa | Aggrenox® | Transient Ischemic Attack | Dipyridamole | Non-Cardioembolic Ischemic StrokeClinical Question: In non-cardioembolic ischemic stroke^ should we treat with two anti-platelet agents (like adding dipyridamole or clopidogrel to ASA) or just one? Bottom-line: Evidence supports using single agent (ASA or clopidogrel) after stroke or transient ischemic attack. Some evidence favours combined dipyridamole and ASA (DP-ASA^ Aggrenox®) but new results question this benefit. *** Original Documents can be found and downloaded using the link provided below ***
Multiple Sclerosis and Management of Urinary Tract Infection Summary of the clinical practice guideline2013-11-1PDFToward Optimized Practice (TOP)Fatigue | Confusion | Urinary Tract Infection (UTI) | Chills | FeverSummary OBJECTIVE Urgent primary care assessment and management of urinary tract infections (UTIs) in patients with multiple sclerosis (MS) Preventing re-occurrence of UTIs TARGET POPULATION Adults with multiple sclerosis (MS) displaying signs and symptoms (typical and atypical) suggesting urinary tract infection (UTI) Adults with MS living in the community; ambulatory care setting EXCLUSIONS Institutionalized patients^ i.e.^ nursing homes^ long term care *** Original Documents can be found and downloaded using the link provided below ***
TFP 120 - Melatonin for sleep: Exhausted by other options? 2014-9-2PDFAlberta College of Family Physicians (ACFP)Sleep Disorders | MelatoninClinical Question: Is melatonin effective for sleep disorders? Bottom Line: The quality of melatonin research is generally poor and at high risk of bias. If the results are believable^ melatonin may help people fall asleep faster (-10 minutes) and spend more time asleep (-15 minutes); both of these amounts may be of limited clinical value. *** Original Documents can be found and downloaded using the link provided below ***
TFP 108 - Tools for Stools: Oral Cholera Vaccine for Traveler’s Diarrhea Prophylaxis 2014-3-3PDFAlberta College of Family Physicians (ACFP)Dukoral | Traveler’s Diarrhea Prophylaxis | Oral Cholera VaccineClinical Question: Should oral cholera vaccine (DukoralTM) be routinely recommended to prevent traveler’s diarrhea (TD)? Bottom-line: Randomized Controlled Trials (RCT) evaluating DukoralTM for TD did not show a benefit and routine use is not recommended. *** Original Documents can be found and downloaded using the link provided below ***
TFP 025 - Gabapentin & Chronic Pain: Missing Evidence and Real Effect? 2013-10-22PDFAlberta College of Family Physicians (ACFP)Neuropathic Pain | Chronic Pain | GabapentinClinical Question: What is the evidence to support gabapentin (or pregabalin) in chronic peripheral neuropathic pain? Bottom-line: The apparent benefit of gabapentin in chronic pain was exaggerated by publication and reporting biases. In carefully selected patients with peripheral neuropathic pain^ gabapentin may offer moderate or more pain relief for one in every 6–8 patients but causes adverse events in a similar number. There is no trial evidence pregabalin is superior to gabapentin. *** Original Documents can be found and downloaded using the link provided below ***
Cryotherapy: Freezing a Plantar Wart with Liquid Nitrogen2014-1-1MovieVideosCryotherapy | WartExcellent; instructor films real patient encounter and explains pathology of warts^ indications for cryotherapy and a demonstration of the procedure Length: 5:40 Target Audience: Medical students^ health professionals and the general public Author: Dr. Paul Thomas^ Pediatrician
TFP 174 - Target/higher dosing of medications in heart failure - is it necessary? 2016-11-1PDFAlberta College of Family Physicians (ACFP)Mortality | Beta-Blockers | Systolic Heart Failure (HF) | Ace Inhibitors | ARB | Target Dose | Angiotensin-Converting Enzyme Inhibitors | Heart Failure | Carvedilol | Angiotensin Receptor Blocker | Enalapril | Lisinopril | Losartan | Dizziness | Bradycardia | Hospitalization | Triple TherapyClinical Question: Does getting to target/higher doses of heart failure (HF) medications improve outcomes and/or increase side effects? Bottom-line: In HF patients^ higher dose angiotensin-converting enzyme (ACE) inhibitors^ beta-blockers^ and angiotensin receptor blockers (ARB) versus lower doses result in non-significant improvements in mortality^ and inconsistent decreases in HF hospitalizations. Higher doses cause more dizziness or hypotension (4-15 percent)^ dose reductions (20 percent)^ and stopping (2-8 percent). Starting on low doses and focusing on tolerability is essential.
TFP 053 - Advantages and limitations of 'delayed prescriptions' of antibiotics for upper respiratory tract infection (URTI)2015-5-12PDFAlberta College of Family Physicians (ACFP)Upper Respiratory Tract Infection (URTI)Clinical Question: What are the advantages and limitations of ‘delayed prescriptions’ of antibiotics for upper respiratory tract infection (URTI)? Bottom-line: Delayed antibiotic prescriptions versus immediate prescriptions substantially reduce antibiotic use but may slightly worsen some symptomatic outcomes. Delayed prescriptions may also reduce return to care rates and for mild URTI^ are not associated with important negative consequences. *** Original Documents can be found and downloaded using the link provided below ***
TFP 046 - Is any diet better for weight loss or preventing negative health outcomes? 2015-4-16PDFAlberta College of Family Physicians (ACFP)Diet | Weight LossClinical Question: Is any diet better for weight loss or preventing negative health outcomes like heart disease or mortality? Bottom-line: Weight loss for all diets is best at 6 months^ regain is common^ and by two years there is no consistent difference between diets. Only the Mediterranean diet has demonstrated positive results in hard outcomes like mortality^ despite not having differences in weight or surrogate markers like lipid profiles. *** Original Documents can be found and downloaded using the link provided below ***
TFP 058 - COLD FX® evidence: consistently reported inconsistently 2015-5-26PDFAlberta College of Family Physicians (ACFP)Cold Fx® | Cvt-002 | Upper Respiratory Tract Infection (URTI) | InfluenzaClinical Question: Does CVT-002 (COLD FX®) reduce the chance of upper respiratory tract infections (URTI) or influenza? Bottom-line: Much of the COLD FX® research is limited by trial design and reporting/analysis issues. The evidence is neither consistent nor convincing enough to recommend COLD FX® to prevent viral URTI in seniors or adults. *** Original Documents can be found and downloaded using the link provided below ***
Diagnosis and Management of Acute Bacterial Sinusitis: Adults Summary of the Alberta Clinical Practice Guideline2008-1-1WebsiteToward Optimized Practice (TOP)Sinusitis | bugsanddrugs | Bugs A website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
Low Back Pain - Management of Psychosocial Yellow Flags2015-12-1PDFToward Optimized Practice (TOP)Lumbar | Acute Back Pain | Low Back Pain *** Original Documents can be found and downloaded using the link provided below ***
TFP 036 - In atrial fibrillation: rate versus rhythm and how slow do you go?2013-12-9PDFAlberta College of Family Physicians (ACFP)Atrial Fibrillation | Non-Valvular Atrial Fibrillation (AF)Clinical Question: For patients with persistent atrial fibrillation (AFib)^ how does medically attempting to restore/maintain sinus rhythm compare to rate control (and what should the target heart rate be)? Bottom-line: Patients with persistent Afib are more likely to benefit from rate control than rhythm control. Targeting resting heart rate to <80 does not appear necessary. Regardless of the treatment strategy^ anti-thrombotic therapy is central to management. *** Original Documents can be found and downloaded using the link provided below ***
Alberta Referral Directory (Path to Care) User guide pamphlet2017-1-1PDFAlberta Health ServicesConsult | Specialist | Referral | Access | TriageExplanatory guide for the ARD. The provincial Alberta Referral Directory is the central source of up-to-date referral information for consulting physicians and services. Please note that the Path to Care directory has been retired.
TFP 132 - Can We Stop Migraines Bound to Rebound? 2015-2-17PDFAlberta College of Family Physicians (ACFP)Headache | Migraines | CorticosteroidsClinical Question: Is adjunctive migraine therapy with corticosteroids helpful to decrease migraine recurrence? Bottom-Line: Parenteral dexamethasone^ when added to standard migraine treatment^ prevents severe headache recurrence at 24-72 hours for one out of 11 patients. *** Original Documents can be found and downloaded using the link provided below ***
TFP 116 - Vitamin D and Low Mood: The easy perky pill. 2014-6-23PDFAlberta College of Family Physicians (ACFP)Low Mood | Depression | Vitamin DClinical Question: Can Vitamin D improve or prevent low mood or depression? Bottom-line: The present evidence does not support prescribing (or testing) Vitamin D in the treatment or prevention of low mood or depression. Most randomized controlled trials (RCTs) found no effect and the few that found small benefits are at very high risk of bias. *** Original Documents can be found and downloaded using the link provided below ***
TFP 182 - Chew on This: Why gum is good for your post-operative bum2017-3-8PDFAlberta College of Family Physicians (ACFP)Surgery | Chewing GumClinical Question: Does chewing gum after surgery improve bowel function? Bottom Line: Chewing gum in post abdominal surgery patients shortens time to first flatus (by 10 hours)- time to first bowel motion (by -1/2 day)- and length of hospital stay (by roughly 0.7 days). For every five patients treated- one fewer will develop ileus. Chewing gum in non-post-surgical constipation has not been studied.
INVESTIGATION AND MANAGEMENT OF PRIMARY THYROID DYSFUNCTION Summary of the Clinical Practice Guideline2014-4-1PDFToward Optimized Practice (TOP)Hyperthyroid | Hypothyroid | Thyroid | TSHSummary TARGET POPULATION Adults and children with suspected or confirmed primary thyroid dysfunction EXCLUSIONS Neonatal patients Asymptomatic^ seemingly healthy individuals having a periodic exam RECOMMENDATIONS Order TSH as the single best initial test to diagnose primary hyperthyroidism and hypothyroidism when symptoms are present *** Original Documents can be found and downloaded using the link provided below ***
Application of tissue glue: Fingertip Amputation Treated with Cyanoacrylate Tissue Adhesive: 2015-1-1MovieVideosTissue Glue | Fingertip Amputation | Cyanoacrylate Tissue AdhesiveExcellent; high-quality video discusses indications^ preparation^ procedural technique^ and includes instructional text to complement audio instructions Length: 6:01 Target Audience: Medical students and health professionals Author: Dr. Larry Mellick^ Professor of Pediatrics and Emergency Medicine^ Medical College of Georgia
Multiple Sclerosis and Management of Urinary Tract Infection 2013-11-1PDFToward Optimized Practice (TOP)Multiple Sclerosis (MS) | Urinary Tract Infection (UTI)OBJECTIVE Urgent primary care assessment and management of urinary tract infections (UTIs) in patients with multiple sclerosis (MS) Preventing re-occurrence of UTIs TARGET POPULATION Adults with multiple sclerosis (MS) displaying signs and symptoms (typical and atypical) suggesting urinary tract infection (UTI) Adults with MS living in the community; ambulatory care setting EXCLUSIONS Institutionalized patients^ i.e.^ nursing homes^ long term care *** Original Documents can be found and downloaded using the link provided below ***
TFP 192 - Bringing Up the Best Evidence: Ondansetron in nausea/vomiting of pregnancy2017-7-24PDFAlberta College of Family Physicians (ACFP)cardiac defect | congenital defect | cleft palate | malformations | Hyperemesis | metoclopramide | pyridoxine | Doxylamine | Vomiting | Nausea | Pregnancy | OndansetronClinical Question: What are the benefits and risks of ondansetron for nausea and vomiting of pregnancy? Bottom Line: Ondansetron may reduce nausea or vomiting of pregnancy by 25% for one in two users^ compared to doxylamine/pyridoxine. There is real uncertainty if ondansetron in pregnancy is associated with any risk to the fetus. Some observational studies suggesting congenital or cardiac defects may be increased by as much as 1% but these are inconsistent and not supported by better evidence.
Screening and Early Diagnosis of Prostate Cancer 2010-1-1PDFToward Optimized Practice (TOP)Lower Urinary Tract Symptoms (LUTS) | Abnormal Digital Rectal Examination (DRE) | Prostate Specific Antigen (PSA) testing | Prostate Cancer Refer to the Canadian Task Force Prostate Cancer Screening Guideline: canadiantaskforce.ca/guidelines/published-guidelines/prostate-cancer/
Laboratory Endocrine Testing: Acromegaly A Summary of the Alberta Laboratory Endocrine Testing Guidelines2014-5-1PDFToward Optimized Practice (TOP)Glucose Intolerance | Sleep Apnea | Arthritis | Neuropathy | Hyperhidrosis | Acral Overgrowth | Coarse Facial Features | Headaches | HypopituitarismOBJECTIVE Clinicians in Alberta select optimal laboratory tests for investigation of suspected acromegaly TARGET POPULATION Any person with signs or symptoms of acromegaly EXCLUSIONS None *** Original Documents can be found and downloaded using the link provided below ***
TFP 159 - NSAIDs: Inflamed effects on inflammation? 2016-3-29PDFAlberta College of Family Physicians (ACFP)Piroxicam | Diclofenac | ASAClinical Question: Do non-steroidal anti-inflammatory drugs (NSAIDs) reduce swelling and inflammation in acute injury? Bottom Line: Randomized Controlled Trials (RCTs) of NSAIDs effect on musculoskeletal injury swelling show highly inconsistent results: Some slight improvements (2-11 percent)^ some slight worsening (8 percent) and most no effect. It is unlikely NSAIDs have any reliable effect on acute injury swelling but they do improve pain for -1 in 4 over one week. *** Original Documents can be found and downloaded using the link provided below ***
Goals of Care Designation Order2010-2-1PDFAlberta Health ServicesGoals Of Care | Goals Of Care Designation OrderGoals of Care and interventions are for cure or control of the Patient’s condition. The Patient would desire and is expected to benefit from ICU care if required.
LABORATORY ENDOCRINE TESTING: PHEOCHROMOCYTOMA Summary of the Clinical Practice Guideline2014-5-1PDFToward Optimized Practice (TOP)Adrenal | HypertensionSummary OBJECTIVE Alberta clinicians optimize laboratory testing for investigation of suspected pheochrmocytoma and refer to an endocrinologist as soon as possible TARGET POPULATION Patients with typical symptoms^ hypertension refractory to multiple drug regimens^ accelerated hypertension^ known familial syndromes^ paradoxic hypertensive responses to antihypertensives^ hypertensive episodes during surgical procedures^ incidental findings of an adrenal tumor EXCLUSIONS None *** Original Documents can be found and downloaded using the link provided below ***
TFP 082 - Cutting out the sodium: The bland supremacy?2013-2-4PDFAlberta College of Family Physicians (ACFP)Sodium | Reduce Mortality | Cardiovascular Disease (CVD)Clinical Question: Does sodium restriction reduce mortality from cardiovascular disease (CVD)? Bottom-line: The impact of salt intake on CVD outcomes is controversial. Trials demonstrating beneficial trends enrolled patients with an average sodium intake of 3900 mg/day and reduced their intake on average by 900mg/day. More evidence with clinical outcomes is required to better define benefits/harms with different levels of daily sodium intake. *** Original Documents can be found and downloaded using the link provided below ***
TFP 175 - Chocolate: Can anything this tasty be good for us?2016-11-21PDFAlberta College of Family Physicians (ACFP)Flavanols | Angina | Migraine | Heart Failure | Chocolate | Cocoa | Depression | Cardiovascular Disease (CVD) | Stroke | Myocardial Infarction | Blood PressureClinical Question: Is chocolate consumption linked to health concerns like cardiovascular disease? Bottom-line: Chocolate consumption is associated with no change or a small reduction in cardiovascular disease in cohort studies. Evidence is too weak to recommend chocolate consumption for health benefits. Surrogate marker changes are minimal and perhaps unreliable. Chocolate likely increases acne lesions in susceptible individuals. Authors: G. Michael Allan^ Mary Anne Zupancic
TFP 065 - Niacin added to Statins for Cardiovascular disease2012-4-10PDFAlberta College of Family Physicians (ACFP)Niacin | Statins | CardiovascularClinical Question: In patients with cardiovascular disease and low HDL levels^ does adding niacin to statin therapy decrease future cardiovascular events? Bottom-line: In patients with cardiovascular disease already on statin therapy^ adding niacin does not improve cardiovascular events. Among lipid treatments^ only statin monotherapy has strong evidence for CVD prevention (regardless of lipid levels). *** Original Documents can be found and downloaded using the link provided below ***
Understanding Pain in less than 5 minutes^ and what to do about it!2013-1-15MovieVideosChronic PainThis is a great^ easy to follow video about chronic pain. It helps you understand what current research has been saying about chronic pain - thats its not a joint or muscle problem^ rather a 're-wiring' of the brain perception of itself. In other words^ the brain has become more sensitive than before. The best way to tackle chronic pain^ is to better understand what changes have happened with the brain through a Functional Neurological assessment^ and apply a tailored brain-based therapy. Recommended by Alberta Health Services Length: 5:00
Diagnosis and Management of Croup - Alberta Clinical Practice Guideline - Summary2008-1-1PDFToward Optimized Practice (TOP)Steamers | Wanes | Mist Tents | Sedatives | Oral Decongestants | Nebulization | Epinephrine | Blow-By Oxygen | Dexamethasone | Croup | Antibiotics Description: This summary of the guideline assists in the diagnosis of croup through history taking^ examination and investigation. It also provides recommendations for emergency management including pharmacotherapy^ instructions for admissions^ discharge^ and supportive care and follow-up. Target Population: Children with mild^ moderate or severe croup - primarily six months to three years old but may include all from three months to 18 years Exclusions: None specified Minor revision: 2015
EVIDENCE-INFORMED PRIMARY CARE MANAGEMENT OF LOW BACK PAINClinical Practice Guideline2015-12-1PDFToward Optimized Practice (TOP)Lumbar | Acute Back Pain | Low Back PainOBJECTIVE To help Alberta clinicians make evidence-informed decisions about care of patients with non- specific low back pain TARGET POPULATION Adult patients 18 years or older in primary care settings EXCLUSIONS Pregnant women; patients under the age of 18 years; diagnosis or treatment of specific causes of low back pain such as: surgical conditions including instability; referred pain (from abdomen^ kidney^ ovary^ pelvis^ bladder); inflammatory conditions (rheumatoid arthritis^ ankylosing spondylitis); infections (discitis^ osteomyelitis^ epidural abscess); degenerative and structural changes (spondylosis^ spondylolisthesis^ gross scoliosis and/or kyphosis); fracture; neoplasm; metabolic bone disease (osteoporosis^ osteomalacia^ Paget’s disease) *** Original Documents can be found and downloaded using the link provided below ***
TFP 111 - A pill for the second clot I do not want2014-4-14PDFAlberta College of Family Physicians (ACFP)PE | DVT | VTE | Apixaban | Dabigatran | Rivaroxaban | Anti-Coagulants | WarfarinClinical Question: Are novel anti-coagulants as effective as warfarin in treating acute venous thromboembolism (VTE)? Bottom-line: Studies show novel anti-coagulants are non-inferior to warfarin in the treatment of VTE and generally have less major bleeding. Regulatory approval^ patient values^ and drug costs should help in deciding which therapy to use.
TFP 027 - Pharmacotherapy for Smoking: Which work and what to consider (Part II)?2013-10-28PDFAlberta College of Family Physicians (ACFP)Cessation | SmokingClinical Question: In patients ready to make a smoking cessation attempt^ how effective are registered first-line medications and what are the potential concerns? Bottom-line: Bupropion^ nortriptyline^ and varenicline are all effective in smoking cessation^ perhaps varenicline more so. Adverse events vary and may in part relate to quitting smoking^ but are important in drug selection and require monitoring. *** Original Documents can be found and downloaded using the link provided below ***
TFP 048 - Steroid Injections & Lateral Epicondylitis (Tennis Elbow) – What is the Evidence?2015-4-20PDFAlberta College of Family Physicians (ACFP)Steroid Injections | Lateral Epicondylitis | Corticosteroid InjectionsClinical Question: Are corticosteroid injections effective in the management of lateral epicondylitis (tennis elbow)? Bottom-line: Corticosteroid injections are effective for symptom management of lateral epicondylitis in the short term (≤4 weeks)^ however in the long term (6-12 months) they result in poorer outcomes than no intervention at all. Physiotherapy seems to have the best outcomes overall. *** Original Documents can be found and downloaded using the link provided below ***
TFP 190 - Proton Pump Inhibitors (PPIs): Is Perpetual Prescribing Inevitable?2017-6-26PDFAlberta College of Family Physicians (ACFP)Proton Pump Inhibitors | PPI | deprescribing | Gastroesophageal Reflux Disease | Gerd | Dyspepsia | histamine receptor antagonists | H2RA | H. Pylori | Clostridium Difficile | C. difficile | tapering | Fractures | B12 | magnesium | Oral Vitamin B12Clinical Question: How successful are attempts to stop PPIs and how can clinicians improve chances of success? Bottom Line: Using a range of deprescribing strategies^ about 25% of patients with gastroesophageal reflux disease (GERD) or dyspepsia can stop PPI use and another 30-50% can decrease their dose. Older patients and those who taper appear more successful in stopping PPIs.
What You Should Know About Your Acute Low Back Pain2015-1-1PDFToward Optimized Practice (TOP)Lumbar | Handout | Acute Back PainPatient handout re: Acute low back pain *** Original Documents can be found and downloaded using the link provided below ***
TFP 094 - Simplicity for simplex (cold sores): a pill in the pocket takes the tingling away 2013-8-19PDFAlberta College of Family Physicians (ACFP)Topical Acyclovir Or Docosanol (Abreva®) | Valacyclovir | Famciclovir | Recurrent Herpes Labialis | Cold SoresClinical Question: Do antivirals (oral or topical) or docosanol (Abreva®) improve healing time for patients with recurrent herpes labialis (cold sores)? Bottom-line: One or two doses of famciclovir may improve cold sore healing by about 2 days^ while valacyclovir and longer courses of topical acyclovir or docosanol (Abreva®) may improve healing by 0.5-1 day. *** Original Documents can be found and downloaded using the link provided below ***
TFP 131 - Anti-virals for Flu: Looking for evidence for “Stockpile^ store^ expire^ repeat”2015-2-3PDFAlberta College of Family Physicians (ACFP)Pneumonia | Zanamivir (Relenza®) | Oseltamivir (Tamiflu®) | Neuramidase Inhibitors (NIs) | Flu | Anti-ViralsClinical Question: Do neuramidase inhibitors (NIs) oseltamivir (Tamiflu®) and/or zanamivir (Relenza®) improve clinical outcomes in healthy patients with influenza or influenza-like illness? Bottom-Line: Biased^ poor quality^ mostly unpublished evidence demonstrates that oseltamivir and zanamivir shorten the duration of influenza symptoms by -1/2 a day. Objectively defined pneumonia or hospitalizations are not decreased. *** Original Documents can be found and downloaded using the link provided below ***
TFP 171 - AcetaMINophen for Back and Osteoarthritis Pain: Is the effect in the name? 2016-9-26PDFAlberta College of Family Physicians (ACFP)Opioids | Physiotherapy | Steroids | Nsaids | ExerciseClinical Question: Is acetaminophen effective for the management of back pain or osteoarthritis? Bottom Line: Acetaminophen is not efficacious for back pain^ and provides no clinically meaningful impact on osteoarthritis. There are many other better interventions for these conditions like: short-term oral NSAIDs for back pain; topical NSAIDs or intra-articular steroids for osteoarthritis; and exercise for both.
Pulmonary Exam: Percussion & Inspection - Stanford Medicine 252014-3-14WebsiteTeachinginspection | percussion | Chest | pulmonary | physical examThe pulmonary exam is one of the most important and often practiced exam by clinicians. While auscultation is most commonly practiced^ both percussion and inspection are equally valuable techniques that can diagnose a number of lung abnormalities such as pleural effusions^ emphysema^ pneumonia and many others. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 168 - Liraglutide: Weighing the evidence for weight loss 2016-8-15PDFAlberta College of Family Physicians (ACFP)Obesity | Victoza | Diabetes Mellitus | Weight Loss | DiabetesClinical Question: Does liraglutide reduce weight and improve health in obese patients? Bottom-line: Once daily Liraglutide 3.0 mg injections reduce weight 3.4 percent-4.6 percent over one year and one in 3-4 patients treated will get a 5 percent weight loss over placebo. Adverse events (like nausea and vomiting) will cause one in 17 to stop liraglutide. The effect was not sustained beyond drug cessation and long-term health effects in obese non-diabetics are unknown.
TFP 092 - Probiotics^ C the Difference for the prevention of C. Diff 2013-6-24PDFAlberta College of Family Physicians (ACFP)Nnt Of 26 | Clostridium Difficile Associated Diarrhea (CDAD) | Clostridium Difficile | Probiotics | AntibioticsClinical Question: Do probiotics prevent Clostridium difficile associated diarrhea (CDAD) in patients taking antibiotics? Bottom-line: Probiotics reduce the incidence of CDAD in patients on antibiotics with a NNT of 26. However^ the ideal product^ length of therapy^ and safety of probiotics (particularly in the immunocompromised) is unknown. *** Original Documents can be found and downloaded using the link provided below ***
DIAGNOSIS AND MANAGEMENT OF NURSING HOME ACQUIRED PNEUMONIA (NHAP) Clinical Practice Guideline2015-3-1PDFToward Optimized Practice (TOP)Nursing Home Acquired Pneumonia (NHAP) | Aspiration Pneumonia | Environ- Mental Tobacco SmokeOBJECTIVE In caring for residents in long term care facilities (LTCF) Alberta clinicians will: Increase the accuracy of clinical diagnosis of NHAP Initiate timely treatment for NHAP Optimize use of laboratory and diagnostic imaging services in the diagnosis of NHAP Optimize use of antibiotics in the treatment of NHAP Ensure practices to prevent respiratory infections are in place in the LTCF Facilitate teamwork and communication in the evaluation and management of residents with NHAP TARGET POPULATION Patients with pneumonia acquired in a LTCF LTCF is any congregate living environment for older and/or disabled persons that have high personal and professional care needs. EXCLUSIONS Hospital acquired pneumonia (HAP) (onset within 14 days of discharge from an acute care facility) Aspiration pneumonia Pneumonia in patients with cystic fibrosis^ tuberculosis or bronchiectasis *** Original Documents can be found and downloaded using the link provided below ***
PAP TestMovieVideosPap TestExcellent; accompanied by very clear audio instructions; history, physical exam, pap smear and sample collection and analysis are thoroughly explained Length: 13:22 Target Audience: Medical students and health professionals Author: New England Journal of Medicine
Management of Community Acquired Pneumonia in Children (CAP) - Summary2008-1-1WebsiteToward Optimized Practice (TOP)Pain | Antibiotics | Fever | Chest Physiotherapy | Analgesics/Antipyretics | HypoxemiaA website version of Bugs & Drugs is available with no special access or logins required by accessing any of the following: AHS staff / physicians at: http://bugsanddrugs.albertahealthservices.ca/ Netcare Users^ via Clinical eTOOLS All Albertans at: http://bugsanddrugs.org/
TFP 135 - Corticosteroid shots and knees: A match made in osteoarthritis heaven? 2015-3-30PDFAlberta College of Family Physicians (ACFP)Joint Infection | Knee Injections | Corticosteroid Shots | OsteoarthritisClinical Question: What is the effectiveness of intra- articular corticosteroid injections in knee osteoarthritis? Bottom Line: Corticosteroid intra-articular knee injections reduce osteoarthritis pain -40 percent more than placebo and one in every 3-5 patients injected will have global symptom improvement in the first four weeks. Long-term pain relief is less certain but serious adverse events^ like joint infection^ are very rare (one in >14^000). *** Original Documents can be found and downloaded using the link provided below ***
What is the Single Best Thing You Can Do to Quit Smoking? 2012-12-12MovieVideosTobacco | Smoking | Patient Education | AddictionExcellent patient education video regarding smoking cessation Length: 12:47 Author Dr. Mike Evans
TFP 195 - Shooting the Breeze on Supervised Injection Sites2017-9-18PDFAlberta College of Family Physicians (ACFP)Supervised injection sites | Safe Injection Sites | naloxone | opioid | overdose | HIV | HIV infection | intravenous drug user | osteomyelitis | endocarditisClinical Question: Do supervised injection sites (SIS) reduce mortality^ hospitalizations^ ambulance calls^ or disease transmission? Bottom-line: Best evidence from cohort or modeling studies suggest that SIS are associated with lower overdose mortality (88 fewer overdose deaths/100^000 person years)^ 67% fewer ambulance calls for treating overdoses and a decrease in HIV infections. Effects on hospitalizations are unknown.
TFP 153 - Ginger for Nausea and Vomiting of Pregnancy: A queasy question 2016-1-4PDFAlberta College of Family Physicians (ACFP)Hyperemesis | Vomiting | PregnancyClinical Question: Is ginger an option for nausea and vomiting of pregnancy? Bottom Line: In the first trimester^ at best^ ginger may improve nausea and vomiting -4 on a 40 point-scale or stop vomiting for one in three women at six days. Safety in the largest cohort study suggests no increase in fetal malformations or stillbirths^ although smaller studies found trends suggesting otherwise. *** Original Documents can be found and downloaded using the link provided below ***
TFP 010 - Antioxidant vitamin cure-alls: Will good theories ever die? 2013-10-7PDFAlberta College of Family Physicians (ACFP)Mortality | Vitamin | AntioxidantClinical Question: Does daily supplementation of antioxidant vitamins (A^ E^ and C) decrease mortality in the general population? Bottom-line: The current evidence does not support the use of antioxidant supplementation^ and patients should be dissuaded from using beta-carotene^ vitamin E^ and perhaps high-dose vitamin A^ as they appear to increase mortality. *** Original Documents can be found and downloaded using the link provided below ***
TFP 164 - Alpha blockers for BPH-LUTS: Let it flow or still slow?2016-6-6PDFAlberta College of Family Physicians (ACFP)Terazosin | Dutasteride | Finasteride | Flomax | Tamsulosin | Doxazosin | ProstateClinical Question: How effective are alpha-blockers in reducing lower urinary tract symptoms (LUTS) in men with benign prostatic hypertrophy (BPH)? Bottom Line: Alpha-blockers are effective as first line therapy for LUTS-BPH. Compared to placebo^ around 1 in 10 will have improved symptoms and/or avoid symptom progression while approximately 1 in 50 will experience hypotension or dizziness. Mainly indirect comparisons suggest doxazosin and terazosin may be slightly more effective but have increased risk of adverse events. *** Original Documents can be found and downloaded using the link provided below ***
Cognitive Impairment - Part 2: Diagnosis to Management Clinical Practice Guideline2017-2-17PDFToward Optimized Practice (TOP)Demented Elders | Dementia | Older Adults (65+)Alberta primary care physicians and their interdisciplinary teams will be able to assess patients presenting with cognitive concerns and manage the majority of these patients and support their caregivers. Primary care management of mild to moderate stages of dementia. Target Population: Older adults (65 years of age and greater) Exclusions: Children Younger adults (less than 65 years of age) with early onset dementia
Third trimester fetal well-being studies: Criteria and managing results2017-6-7PDFToward Optimized Practice (TOP)gynecology | obstetrics | Fetus (baby) | Ultrasound | Prenatal UltrasoundDescription: Alberta obstetric providers will: Understand common risk factors of perinatal morbidity/mortality^ and potential indications for monitoring fetal well-being with ultrasound Be aware of the standard components for ultrasound evaluation of fetal well-being in the third trimester Provide appropriate notification and actions based on ultrasound findings Target population:All pregnant women Exclusions:None
TFP 150 - DPP-4 Inhibitors: Protecting your sweet heart? 2015-11-9PDFAlberta College of Family Physicians (ACFP)Pancreatitis | Hypoglycemia | Diabetes Mellitus | Diabetes | Type 2 DiabetesClinical Question: In Type 2 Diabetes^ do dipeptidyl peptidase-4 (DPP-4) inhibitors affect outcomes [like cardiovascular disease (CVD)] other than glucose? Bottom-line: While DPP-4 inhibitors lower A1c by 0.3-0.8 percent^ they do not modify CVD or mortality. Adverse events were generally uncommon^ but a tiny risk of pancreatitis remains possible^ and saxagliptin increased hypoglycemia (-1 in 50) and heart failure (-1 in 150). *** Original Documents can be found and downloaded using the link provided below ***
TFP 008 - Type 2 Diabetes and ASA: Always or Maybe Sometimes? 2013-10-7PDFAlberta College of Family Physicians (ACFP)ASAClinical Question: Should ASA be recommended in all patients with type 2 diabetes with no history of cardiovascular disease (CVD)? Bottom-line: According to present evidence^ ASA should not routinely be used in type 2 diabetics with no history of CVD. Some high-risk patients may benefit but this group has not yet been defined with evidence. *** Original Documents can be found and downloaded using the link provided below ***
MOTIVATIONAL INTERVIEWING (MI) with Survivors of Violence – A Reference Guide2015-1-1PDFToward Optimized Practice (TOP)Motivational Interviewing (MI) | Conviction Confidence ModelGuide for motivational interviewing *** Original Documents can be found and downloaded using the link provided below ***
TFP 147 - Electronic Cigarettes—Hoot that helps^ hurts^ or just hype?2015-9-28PDFAlberta College of Family Physicians (ACFP)Nicotine | E-Cigarette | Electronic | Tobacco | CigaretteClinical Question: Do electronic nicotine replacement systems (electronic cigarettes) help smokers decrease or quit smoking? Bottom-line: Compared to nicotine patches^ smokers motivated to quit who used nicotine electronic cigarettes (NEC) had similar quit rates but one in seven more reduced daily cigarette consumption by ≥50 percent. The long-term adverse effects and whether NECs lead to traditional cigarette use is unknown. *** Original Documents can be found and downloaded using the link provided below ***
TFP 191 - Sacubitril/Valsartan: Getting to the Heart of This Novel Therapy2017-7-10PDFAlberta College of Family Physicians (ACFP)sacubitril | valsartan | Entresto | Heart Failure | Systolic Heart Failure (HF) | Ace Inhibitors | Beta-Blockers | Aldosterone Antagonists | B-type natriuretic peptide | BNP | Enalapril | cardiovascular death | Hypotension | angioedema | Blood Pressure | BP | Angiotensin Receptor Blocker | HospitalizationClinical Question: Is sacubitril/valsartan (Entresto®) effective for systolic heart failure (HF)? Bottom Line: Based on one randomized controlled trial (RCT)^ for every 36 patients with heart failure switched from ACE inhibitors to sacubitril/valsartan^ one fewer will die and one fewer will be admitted for heart failure over 27 months. Beta-blockers and aldosterone antagonists should be offered first and continued concurrently.
TFP 141 - Time to Laceration Repair: Definitively dogmatic to purposefully pragmatic 2015-6-22PDFAlberta College of Family Physicians (ACFP)Infections | Traumatic Lacerations | Laceration RepairClinical Question: Is the time from injury to wound closure a risk factor for infection in traumatic lacerations? Bottom Line: There is no evidence that a “golden period” or cut-off point exists in which to repair simple^ traumatic lacerations to reduce infections. Other patient and wound characteristics (e.g. diabetes^ wound size^ location^ and contamination) are likely more predictive of infection than time to wound closure. In the absence of evidence for maximum duration^ clinical judgment/experience and patient preferences should inform decisions. *** Original Documents can be found and downloaded using the link provided below ***
Environmental Exposures from Oil and Gas Emissions - Summary of the Clinical Practice Guideline2017-3-24PDFToward Optimized Practice (TOP)Environmental exposure Description: Alberta clinicians will have a systematic approach to addressing patient complaints and clinical presentations that may be associated with odors and emissions from oil and gas development and operation activity. Target Population: Everyone Exclusions: Exposures occurring in occupational settings and/or the home environment
Cryotherapy; Cryosurgical Procedures2014-1-1MovieVideosCryosurgical | ProceduresGood; high-quality video demonstrates various applications of cryotherapy^ but does not include information on prep or indications Length: 3.12 Target Audience: Medical students and health professionals Author: Richard P. Usatine^ The Journal of Family Practice
Low Back Pain - Clinical Assessment of Psychosocial Yellow Flags2015-12-1PDFToward Optimized Practice (TOP)Psycho-Social Yellow Flags | Low Back PainSuggested steps to better early behavioural management of low back pain problems *** Original Documents can be found and downloaded using the link provided below ***
Alberta Referral Directory (Path to Care)2017-11-8WebsiteAlberta Health ServicesConsult | Specialist | Referral | Access | Triage | Forms | TemplatesThe provincial Alberta Referral Directory is the central source of up-to-date referral information for consulting physicians and services. Please note that the Path to Care directory has been retired. This website will require a login.
TFP 118 - Glucosamine: Naturally effective? 2014-7-21PDFAlberta College of Family Physicians (ACFP)Glucosamine | OsteoarthritisClinical Question: Does glucosamine improve pain and function in osteoarthritis? Bottom Line: Multiple meta-analyses indicate that glucosamine does not reliably improve pain or function in osteoarthritis. Any suggestion of benefit with certain formulations is at high risk of bias associated with low quality studies^ industry funding^ and selective reporting/publication. *** Original Documents can be found and downloaded using the link provided below ***
The Pelvic Exam - Stanford Medicine 252017-9-27WebsiteTeachingphysical exam | pelvic | gynecologyThe pelvic exam is a vital part of every woman's preventative care and is also important towards making a number of diagnoses when presenting with abdominal or pelvic complaints. Here we cover each aspect of the pelvic exam and demonstrate both in text and in our video how this done. Excellent teaching resource including videos produced by the Stanford Medicine 25 team led by Dr. Abraham Vergese. The Stanford Medicine 25 team is the core group of physicians^ faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine.
TFP 179 - Recurrent Vulvovaginal Candidiasis: Can the yeast be beat?2017-1-23PDFAlberta College of Family Physicians (ACFP)Recurrent vulvovaginal candidiasis | yeast | fluconazole | itraconazole | clotrimazole | candida albicans | candida glabrataClinical Question: What is the most effective management for women with recurrent vulvovaginal candidiasis (four or more episodes within one year)? Bottom Line: Prophylaxis with six months of azole therapy (like fluconazole) will result in relapse in 9-19 percent of women compared to 50-64 percent on placebo (one fewer woman would relapse for every 2-4 treated). Efficacy^ however^ declines after therapy cessation and clinical cure remains elusive. Limited evidence suggests women may prefer episodic over maintenance therapy.
Breast Cancer Screening: Clinical Practice Guideline2013-9-1PDFToward Optimized Practice (TOP)Cancer | Breast | Woman | Women | Female | Prevention | Risk Factor | Screening | Mammography | Self-Examination | Genetics | Tomosynthesis | Thermography | Ultrasound | MRIGOAL To provide guidance on the appropriate use of screening tools for breast cancer and to help physicians^ clinicians and women make informed decisions about screening for breast cancer TARGET POPULATION Asymptomatic women of all ages EXCLUSIONS Women with signs and symptoms suggesting breast cancer Women with a history of ductal carcinoma in situ or invasive breast cancer Men *** Original Documents can be found and downloaded using the link provided below ***
TFP 072 - Dual Antiplatelet Therapy Following Stent Placement and/or Acute Coronary Syndrome: 12 months or Forever? 2012-9-4PDFAlberta College of Family Physicians (ACFP)Acute Coronary Syndrome | Stent Placement | Dual Antiplatelet Therapy | Coronary Artery Disease | Copidogrel Plus SspirinClinical Question: In patients with coronary artery disease who have stent placement and/or acute coronary syndrome (ACS)^ should we prescribe dual antiplatelet therapy (DAPT)^ like clopidogrel plus aspirin^ beyond 12 months? Bottom-line: Current evidence and guidelines suggest that it is reasonable to continue dual antiplatelet therapy for 12 months following stent placement or acute coronary syndrome. After 12 months^ one antiplatelet (example clopidogrel) may be stopped and low-dose ASA continued. *** Original Documents can be found and downloaded using the link provided below ***
Demonstrate inhaler technique: Asthma inhaler techniqueMovieVideosAsthma | Inhaler TechniqueExcellent; Senior Nurse instructs patient how to use MDI inhaler, MDI with spacer, and dry powder inhaler Length: 5:03 Target Audience: General public Author: BMJ Learning
LABORATORY ENDOCRINE TESTING ADRENAL INSUFFICIENCY(ADDISON’S DISEASE) Summary of the Clinical Practice Guideline | January 20082014-5-1PDFToward Optimized Practice (TOP)Muscle Weakness | Diarrhea | Vomiting | Nausea | Low Blood Pressure | Loss Of Appetite | Weight LossOBJECTIVE Clinicians in Alberta provide urgent referral to an endocrinologist and optimize laboratory tests for investigation of adrenal insufficiency (Addison’s disease) TARGET POPULATION Children and adults with signs or symptoms of primary or secondary adrenal insufficiency (Addison’s disease) EXCLUSIONS None *** Original Documents can be found and downloaded using the link provided below ***
TFP 031 - ASA in Primary Prevention: Do the Benefits Outweigh Risks? 2013-7-22PDFAlberta College of Family Physicians (ACFP)Prevention | Cardiovascular Disease (CVD) | PrimaryClinical Question: Are the benefits worth the risks of ASA in primary prevention (patients with no history of cardiovascular disease (CVD))? Bottom-line: The majority of primary prevention patients will not benefit from daily ASA therapy. It is possible that there is net benefit in higher-risk primary prevention patients. Although the best risk level to initiate ASA is uncertain^ it may be those with a ≥15-20 percent risk of CVD over 10 years. *** Original Documents can be found and downloaded using the link provided below ***