Can Fam Physician. 2013 Mar;59(3):265-8
Authors: Gallagher R
PMID: 23486796 [PubMed - in process]Link to Article at PubMed
Autonomic dysreflexia: Recognizing a common serious condition in patients with spinal cord injury.
Can Fam Physician. 2012 Aug;58(8):831-5
Authors: Milligan J, Lee J, McMillan C, Klassen H
OBJECTIVE: To raise family physicians' awareness of autonomic dysreflexia (AD) in patients with spinal cord injury (SCI) and to provide some suggestions for intervention.
SOURCES OF INFORMATION: MEDLINE was searched from 1970 to July 2011 using the terms autonomic dysreflexia and spinal cord injury with family medicine or primary care. Other relevant guidelines and resources were reviewed and used.
MAIN MESSAGE: Family physicians often lack confidence in treating patients with SCI, see them as complex and time-consuming, and feel undertrained to meet their needs. Family physicians provide a vital component of the health care of such patients, and understanding of the unique medical conditions related to SCI is important. Autonomic dysreflexia is an important, common, and potentially serious condition with which many family physicians are unfamiliar. This article will review the signs and symptoms of AD and offer some acute management options and preventive strategies for family physicians.
CONCLUSION: Family physicians should be aware of which patients with SCI are susceptible to AD and monitor those affected by it. Outlined is an approach to acute management. Family physicians play a pivotal role in prevention of AD through education (of the patient and other health care providers) and incorporation of strategies such as appropriate bladder, bowel, and skin care practices and warnings and management plans in the medical chart.
PMID: 22893332 [PubMed - in process]Link to Article at PubMed
Oral anticoagulation in atrial fibrillation: Balancing the risk of stroke with the risk of bleed.
Can Fam Physician. 2012 Aug;58(8):850-8
Authors: Kosar L, Jin M, Kamrul R, Schuster B
PMID: 22893338 [PubMed - in process]Link to Article at PubMed
Hypertension in people with type 2 diabetes: Update on pharmacologic management.
Can Fam Physician. 2011 Sep;57(9):997-1002
Authors: Campbell NR, Gilbert RE, Leiter LA, Larochelle P, Tobe S, Chockalingam A, Ward R, Morris D, Tsuyuki RT, Harris SB
Objective To summarize the evidence for the need to improve pharmacologic management of hypertension in people with type 2 diabetes and to provide expert advice on how blood pressure (BP) treatment can be improved in primary care. Sources of information Studies were obtained by performing a systematic review of the literature on hypertension and diabetes, from which management recommendations were developed, reviewed, and voted on by a group of experts selected by the Canadian Hypertension Education Program and the Canadian Diabetes Association; authors' expert opinions on optimal pharmacologic management were also considered during this process. Main message The pathogenesis of hypertension in patients with diabetes is complex, involving a range of biological and environmental factors and genetic predisposition; as a result, hypertension in people with diabetes incurs higher associated risks and adverse events. Mortality and morbidity are heightened in diabetes patients who do not achieve BP control (ie, a target value of less than 130/80 mm Hg). Large randomized controlled trials and meta-analyses of randomized controlled trials have shown that reducing BP pharmacologically is single-handedly the most effective way to reduce rates of death and disability in patients with diabetes, particularly associated cardiovascular risks. Often, combinations of 2 or more drugs (diuretics, angiotensin-converting enzyme inhibitors, ?-blockers, angiotensin receptor blockers, calcium channel blockers, spironolactone, etc) are required for pharmacotherapy to be effective, particularly for patients in whom BP is difficult to control. However, the health care costs associated with extensively lowering BP are substantially less than the costs associated with treating the complications that can be prevented by lowering BP. Conclusion Detecting and managing hypertension in people with diabetes is one of the most effective measures to prevent adverse events, and pharmacotherapy is one of the most effective ways to maintain target BP levels in primary care.
PMID: 21918140 [PubMed - in process]Link to Article at PubMed
Are family physicians using the CHADS2 score?: Is it useful for assessing risk of stroke in patients with atrial fibrillation?
Can Fam Physician. 2011 Aug;57(8):e305-9
Authors: Klein D, Levine M
Objective To assess whether family physicians are using the CHADS(2) (congestive heart failure, hypertension, age ? 75, diabetes mellitus, and stroke or transient ischemic attack) score in the decision to initiate warfarin therapy to prevent stroke in patients with atrial fibrillation. Design Retrospective analysis of the medical records of patients with atrial fibrillation. Setting Data were gathered from records at 3 clinics in a primary care network in Edmonton, Alta. Participants The medical records of patients with atrial fibrillation who were currently taking warfarin therapy. Main outcome measures Percentage of patients whose CHADS(2) scores indicated warfarin therapy for stroke prophylaxis compared with the actual percentage of patients taking warfarin therapy. Data on patients' age, number of medications, and number of comorbid conditions were also recorded. Results Among these patients, 7% had a CHADS(2) score of 0, for which no warfarin therapy was indicated; 21% had a score of 1, for which either acetylsalicylic acid or warfarin was indicated; and 72% had a score of 2 or greater, for which warfarin therapy was indicated. About 80% of patients were taking medication to control their heart rate. Conclusion The CHADS(2) score is not being used in all cases to assess the need for warfarin therapy for preventing stroke in patients with atrial fibrillation. The CHADS(2) score might be of limited use because it is not sensitive enough to stratify patients clearly into high-, intermediate-, and low-risk groups. Although guidelines for stroke prevention should be followed, the CHADS(2) portion of the guidelines might not be the most effective way to assess patients' risk of stroke.
PMID: 21841094 [PubMed - in process]Link to Article at PubMed
Falls in the elderly: Spectrum and prevention.
Can Fam Physician. 2011 Jul;57(7):771-776
Authors: Al-Aama T
Objective To provide family physicians with a practical, evidence-based approach to fall prevention in the elderly. Sources of information MEDLINE was searched using terms relevant to falls among the elderly in the community and in institutions. Relevant English-language papers published from 1980 to July 2010 were reviewed. Relevant geriatric society guidelines were reviewed as well. Main message Falls are a common and serious health problem with devastating consequences. Several risk factors have been identified in the literature. Falls can be prevented through several evidence-based interventions, which can be either single or multicomponent interventions. Identifying at-risk patients is the most important part of management, as applying preventive measures in this vulnerable population can have a profound effect on public health. Conclusion Family physicians have a pivotal role in screening older patients for risk of falls, and applying preventive strategies for patients at risk.
PMID: 21753098 [PubMed - as supplied by publisher]Link to Article at PubMed