Canadian family physician Médecin de famille canadien
-
Review Case Reports
Approach to managing behavioural disturbances in dementia.
To review practical evidence-based treatment of behavioural symptoms in dementia. SOURCES OF INFORMATION MEDLINE: Was searched from January 1966 to December 2004 and PsycINFO from January 1967 to December 2004 using the key words "BPSD" (behavioural and psychological symptoms of dementia) and "behavioral disturbances dementia." I also reviewed the bibliographies of recent review papers and original articles. ⋯ Optimal treatment of behavioural disturbances in patients with dementia involves nonpharmacologic approaches and using medications with demonstrated efficacy. Pharmacologic treatment should target only those symptoms or behaviours that respond to medication. This approach minimizes unnecessary medication use and reduces adverse outcomes.
-
A pregnant patient with polycystic ovary syndrome asked me whether continuing metformin, which she was taking to treat infertility before her pregnancy, is safe for her fetus. She has heard that metformin is a "drug for diabetes." How safe is it to take metformin during the first trimester of pregnancy and beyond? ⋯ Despite the traditional response that all oral hypoglycemic agents are absolutely contraindicated during pregnancy, evidence that metformin is probably safe during the first trimester of pregnancy and beyond is accumulating. Results of a recent meta-analysis by the Motherisk Program showed no increase in incidence of major malformations and a potential protective effect in this patient population.
-
To determine whether rural family physicians thought they had received enough months of rural exposure during family medicine residency, how many months of rural exposure those who were satisfied with their training had had, and how many months of rural exposure those who were not satisfied with their training wanted. ⋯ Typical rural family physicians prefer to have 6 months of rural exposure during residency. This finding is consistent with the recommendation of a College of Family Physicians of Canada committee that rural family medicine training programs offer at least 6 months of rural rotations. Almost half of rural family physicians wished they had had more rural training. Both rural-focused and non-rural-focused programs should consider providing opportunities for pursuing elective rotations in rural areas in addition to mandatory rotations if they want to respond to these preferences for training.