Canadian Family Physician最新文献

{"title":"Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care.","authors":"Rémi Goupil, Ross T Tsuyuki, Nancy Santesso, Kristin A Terenzi, Jeffrey Habert, Gemma Cheng, Stephanie C Gysel, Jill Bruneau, Alexander A Leung, Norman R C Campbell, Ernesto L Schiffrin, Gregory L Hundemer","doi":"10.46747/cfp.20250616001","DOIUrl":"10.46747/cfp.20250616001","url":null,"abstract":"<p><strong>Background: </strong>Canada has historically been among the world's leaders in hypertension care, but hypertension treatment and control rates have regressed in recent years. This guideline is intended to provide pragmatic primary care-focused recommendations to improve hypertension management in adults at the population level.</p><p><strong>Methods: </strong>We employed Grading of Recommendations Assessment, Development and Evaluation and ADAPTE frameworks in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE II) quality and reporting standards to develop recommendations on managing hypertension for adults aged 18 years and older. We used the HEARTS framework-a model of care developed by the World Health Organization to improve hypertension control and reduce cardiovascular burden-to integrate these recommendations into streamlined, pragmatic, and evidence-based algorithms. The guideline committee predominantly comprised primary care providers and also included patient, methodology, and hypertension specialist representatives. Our process for managing competing interests adhered to Guidelines International Network principles.</p><p><strong>Recommendations: </strong>The 9 recommendations for managing hypertension in adults are grouped under the categories of diagnosis and treatment. Diagnostic recommendations include a standardized approach to measuring blood pressure (BP) and confirming hypertension, as well as providing a uniform definition for hypertension of BP ≥130/80 mm Hg. Treatment recommendations include targeting a systolic BP <130 mm Hg, implementing healthy lifestyle changes, and providing stepwise guidance on optimal medication choices for patients requiring pharmacotherapy.</p><p><strong>Interpretation: </strong>Our aim is to enhance the standard of hypertension care in the Canadian primary care setting. Accurate diagnosis and optimal treatment of hypertension can reduce adverse cardiovascular events and risk of death.</p>","PeriodicalId":55288,"journal":{"name":"Canadian Family Physician","volume":" ","pages":"467-482"},"PeriodicalIF":2.4,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding patients is essential.","authors":"Nitasha Puri","doi":"10.46747/cfp.710708450","DOIUrl":"https://doi.org/10.46747/cfp.710708450","url":null,"abstract":"","PeriodicalId":55288,"journal":{"name":"Canadian Family Physician","volume":"71 7-8","pages":"450"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking return-of-service mandates for international medical graduates: Rostering sustainable and equitable community care in Canada.","authors":"Oluseyi Akinola, Mariana da Silva Jardim, Gina Aggarwal, Taofiq Olusegun Oyedokun, Anjali Menezes","doi":"10.46747/cfp.710708451","DOIUrl":"https://doi.org/10.46747/cfp.710708451","url":null,"abstract":"","PeriodicalId":55288,"journal":{"name":"Canadian Family Physician","volume":"71 7-8","pages":"451-454"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update to acne vulgaris treatment for Canadian practice.","authors":"Samantha Keow, Grace Xiong, Mohannad Abu-Hilal","doi":"10.46747/cfp.710708455","DOIUrl":"https://doi.org/10.46747/cfp.710708455","url":null,"abstract":"<p><strong>Objective: </strong>To provide updates and apply the new 2024 American Academy of Dermatology (AAD) guidelines of care for the management of acne vulgaris (AV) to Canadian practice and summarize current evidence-based practices, treatments, and emerging trends in acne management.</p><p><strong>Quality of evidence: </strong>As per published guidelines, MEDLINE and Embase databases were searched for literature on the effectiveness and safety of available and approved treatments for AV in patients aged 9 and older in the United States. Studies meeting patient or population, intervention, comparison, and outcomes (PICO) criteria were extracted, and quality was assessed using the Cochrane Risk of Bias tool. A Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to classify evidence certainty as high, moderate, low, or very low, and categorize recommendations as strong or conditional. The federal Drug and Health Product Register was then searched for approved and marketed treatments currently available in Canada.</p><p><strong>Main message: </strong>Topical therapies such as benzoyl peroxide, antibiotics, and fixed-dose combinations received strong recommendations, while retinoids, clascoterone, salicylic acid, and azelaic acid received conditional recommendations. Topical minocycline is not yet available in Canada. Oral therapies such as doxycycline and isotretinoin received strong recommendations, while minocycline, combined oral contraceptives, and spironolactone received condition recommendations. Isotretinoin remains the criterion standard for treating severe acne and scarring; frequent monitoring is unnecessary for most patients receiving oral isotretinoin, and it is unlikely to be associated with neuropsychiatric disorders or inflammatory bowel disease. Intralesional corticosteroids were also strongly recommended for acne at high risk of scarring. Additional consideration must be given to pregnant individuals, people with skin of colour, and those undergoing gender-affirming therapy.</p><p><strong>Conclusion: </strong>The 2024 AAD guidelines provide a valuable framework for Canadian management of AV. Mild cases are managed with topical treatments, while moderate to severe cases often require oral medication. Antibiotic monotherapy is discouraged; combination with benzoyl peroxide may mitigate antibiotic resistance. Treatments using multiple modalities and mechanisms of action are recommended.</p>","PeriodicalId":55288,"journal":{"name":"Canadian Family Physician","volume":"71 7-8","pages":"455-466"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing mental health diagnosis within Canadian primary care settings: Application of validated electronic medical record case definitions.","authors":"Leanne Kosowan, Alexander G Singer, Elissa M Abrams, Sameer S Kassim, Braden O'Neill, Jennifer L P Protudjer","doi":"10.46747/cfp.710708e195","DOIUrl":"https://doi.org/10.46747/cfp.710708e195","url":null,"abstract":"<p><strong>Objective: </strong>To validate a primary care electronic medical record (EMR) case definition for mood and anxiety disorders (including depression, anxiety, and bipolar disorder) and schizophrenia that can be used to estimate prevalence and co-occurrence.</p><p><strong>Design: </strong>Retrospective cross-sectional study.</p><p><strong>Setting: </strong>Canada.</p><p><strong>Participants: </strong>De-identified EMR data was used from 1574 primary care providers participating in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) from 1,692,987 patients who had 1 or more visits with a primary care provider. The reference set included 2488 patients, with 434 positive and 2054 negative for 1 or more mental health conditions of interest. A second reference set for schizophrenia represented 760 patients (30 positive and 730 negative).</p><p><strong>Main outcome measures: </strong>The agreement of 29 case definitions was assessed against a reference set by reporting sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Prevalence was estimated and co-occurrence was assessed in the CPCSSN dataset (N=1,692,987).</p><p><strong>Results: </strong>The strongest definition for mood disorders captured anxiety, depression, and bipolar disorder with a sensitivity of 80.7%, specificity of 88.7%, PPV of 59.9%, and NPV of 95.7%; and an estimated prevalence of 21.8% (95% CI 21.7 to 21.9). The inclusion of psychosis did not improve agreement (sensitivity 95.2%, specificity 80.7%, PPV 51.0%, NPV 98.8%), but schizophrenia alone had high agreement (sensitivity 93.3%, specificity 100%, PPV 100%, NPV 99.9%).</p><p><strong>Conclusion: </strong>High co-occurrence of anxiety, depression, and bipolar disorder was found. Algorithms validated to capture these conditions together produced stronger agreement compared with individual definitions. Schizophrenia was less likely to co-occur with other mental health conditions and produced higher agreement when validated separately. Application of validated algorithms to capture mental health conditions can inform disease surveillance and health system planning.</p>","PeriodicalId":55288,"journal":{"name":"Canadian Family Physician","volume":"71 7-8","pages":"e195-e204"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid recommendations: Updates from 2024 guidelines: part 1.","authors":"Danielle O'Toole","doi":"10.46747/cfp.710708496","DOIUrl":"https://doi.org/10.46747/cfp.710708496","url":null,"abstract":"","PeriodicalId":55288,"journal":{"name":"Canadian Family Physician","volume":"71 7-8","pages":"496-498"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simple teaching strategy still relevant.","authors":"Andrea Cuschieri","doi":"10.46747/cfp.710708450_1","DOIUrl":"https://doi.org/10.46747/cfp.710708450_1","url":null,"abstract":"","PeriodicalId":55288,"journal":{"name":"Canadian Family Physician","volume":"71 7-8","pages":"450"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriate advanced imaging for minor traumatic brain injury: In adult patients presenting to a clinical setting.","authors":"Brian H Rowe, Esther Yang, Kevin Skoblenick","doi":"10.46747/cfp.710708490","DOIUrl":"https://doi.org/10.46747/cfp.710708490","url":null,"abstract":"","PeriodicalId":55288,"journal":{"name":"Canadian Family Physician","volume":"71 7-8","pages":"490-493"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of horizontal and traditional block family medicine curricula: Canadian study.","authors":"Miriam Lacasse, Jean-Sébastien Renaud, Batya Grundland, Maria M Hubinette, Fok-Han Leung, Theresa van der Goes","doi":"10.46747/cfp.710708500","DOIUrl":"https://doi.org/10.46747/cfp.710708500","url":null,"abstract":"<p><strong>Objective: </strong>Longitudinal curriculum model outcomes in postgraduate medical education are not well documented. The authors aimed to compare satisfaction, learning, clinical exposure, and practice intentions between longitudinal family medicine (FM) curricula and traditional rotational (\"block\") curricula.</p><p><strong>Design: </strong>This curriculum structure evaluation used a retrospective quasi-experimental study design using data from the College of Family Physicians of Canada Family Medicine Longitudinal Survey.</p><p><strong>Setting: </strong>The project used data from 3 FM residency programs for the entry years 2014 to 2017.</p><p><strong>Participants: </strong>A total of 1283 residents across 49 teaching sites were invited to participate at program entry (T1) and residency completion (T2).</p><p><strong>Main outcome measures: </strong>Data were categorized by horizontal curriculum or block curriculum. The authors used the Kirkpatrick taxonomy to compare satisfaction with the curriculum, learning, behaviour (ie, clinical exposure), and results (practice intention). One-way analyses of variance (ANOVAs) tested the effect of curriculum model on satisfaction and clinical exposure. Analyses of covariance (ANCOVAs) tested the effect of curriculum model on the other outcomes.</p><p><strong>Results: </strong>Residents from 40 teaching sites provided answers to T1 and T2 surveys (N=385: 81 in the horizontal curriculum and 304 in the block curriculum). The average satisfaction score was lower in block curricula (4.28/5 [SD=0.47]) than in horizontal curricula (4.46 [SD=0.42]) (<i>F</i> _1,382=9.39, <i>P</i>=.002, η²=.02). The curriculum structure had no significant impact on learning and on most items in the clinical exposure or practice intention categories.</p><p><strong>Conclusion: </strong>Longitudinal curriculum models in residency might be associated with better resident experience. However, curriculum models do not have a significant impact on most educational outcomes, and residents from all curriculum models feel similarly prepared for practice.</p>","PeriodicalId":55288,"journal":{"name":"Canadian Family Physician","volume":"71 7-8","pages":"500-510"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommandations rapides: Mises à jour des lignes directrices en 2024 : partie 1.","authors":"Danielle O'Toole","doi":"10.46747/cfp.710708e192","DOIUrl":"https://doi.org/10.46747/cfp.710708e192","url":null,"abstract":"","PeriodicalId":55288,"journal":{"name":"Canadian Family Physician","volume":"71 7-8","pages":"e192-e194"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}