Canadian family physician Médecin de famille canadien
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To explore what is known about end-of-life (EOL) conversations with frail older adults across all settings including primary care in Canada, and to understand the barriers to, and recommendations for, EOL conversations. ⋯ More empirical research is needed that uses exploratory methods to shed light on the contextual factors that may act as a barrier to EOL conversations. More research is also needed on the roles and responsibilities of interprofessional teams in screening for frailty and engaging in EOL conversations. Moreover, there is a need to better understand how frail older patients and their families want EOL conversations to unfold and what best facilitates these conversations.
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Randomized Controlled Trial
Lung cancer screening primer: Key information for primary care providers.
To review new evidence reported since the 2016 publication of the Canadian Task Force on Preventive Health Care recommendations and to summarize key facets of lung cancer screening to better equip primary care providers (PCPs) in anticipation of wider implementation of the recommendations. ⋯ Lung cancer screening, with its embedded emphasis on smoking cessation, is an excellent addition to PCPs' preventive health care tools. The implementation of formal and pilot lung cancer screening programs across Canada means that PCPs will be increasingly required to counsel their patients around the uptake of lung cancer screening.
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Black and immigrant populations across Canada have lower screening rates than Canadian-born white populations, predisposing them to increased cancer morbidity and mortality. Effective interventions are required to increase cancer screening rates among these populations. ⋯ TAIBU Community Health Centre's continuous quality improvement approach was successful in engaging health care providers and patients to increase cancer screening participation sustainably in a racially and socioeconomically diverse setting. Rates of breast, colorectal, and cervical cancer screening offered to eligible patients increased from 17% to 72%, 18% to 67%, and 59% to 70%, respectively, between 2011 and 2018.
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To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on FP finances in Alberta. ⋯ Practice pattern changes, including the rapid adoption of telemedicine owing to the COVID-19 pandemic, will reduce incomes for fee-for-service community FP practices in Alberta. Fees at current levels could make some practices unsustainable.
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Several children in my office have recurrent vomiting events and they usually end up in the emergency department for intravenous rehydration. One of them has been suffering from those attacks approximately once per month for the past 2 years, leading to a reduction in her quality of life. What is known about cyclic vomiting syndrome and can it be prevented? ⋯ Cyclic vomiting syndrome includes severe episodic vomiting lasting for hours or days, separated by symptom-free intervals. This gut-brain interaction is poorly understood and is difficult to diagnose. Children suffer from relentless vomiting, lethargy, abdominal pain, anorexia, and nausea. Half of the children require intravenous rehydration. Once diagnosis is made, supportive measures to reduce suffering are recommended and include administering fluids, encouraging sleep, promoting quiet environments, and administering antiemetics or sedatives. In adults, tricyclic antidepressants such as amitriptyline, as well as topiramate as second-line therapy, have been proposed for prophylactic treatment. However, pediatric data are very limited and evidence does not support any recommended course of prophylactic therapy for children with the condition.