Canadian family physician Médecin de famille canadien
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To investigate family physicians' views on factors that make health care decisions difficult for patients, interventions family physicians use to support patients making decisions, and interventions proposed by the Ottawa Decision Support Framework (ODSF). ⋯ The ODSF process and related tools have the potential to broaden family physicians' views on supporting patients facing difficult decisions.
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To outline how advance care planning is a process of communication among patients, their families, and health care providers regarding appropriate care for patients when they are no longer able to make decisions for themselves. ⋯ Advance care planning can prevent suffering and enable patients to receive care congruent with their goals at the end of their lives. Family physicians can be key to facilitating this process.
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To review 4 topics in hypoglycemia (HoG) care: diagnosis, circumstances predisposing to HoG, risk of adverse effects, and prevention. QUALITY OF EVIDENCE MEDLINE: was searched using the words hypoglycemia and diabetes mellitus. Other relevant sources were hand searched. Evidence was mostly level III and IV from consensus, from observation, and from the author's clinical experience. ⋯ Clinical diagnosis of HoG deserves greater emphasis; when patients are unaware of having HoG, physicians must rely on blood glucose testing. Patients not taking insulin or insulin secretagogues need neither fear nor test for HoG. The risk of HoG should not preclude efforts to achieve best possible control of blood sugar. Patients with unstable cardiac arrhythmias, drivers of motor vehicles, and those in high-risk industrial occupations require special vigilance for HoG.
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To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors. ⋯ Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care.
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Editorial Review
Does epidural analgesia increase rate of cesarean section?