Canadian family physician Médecin de famille canadien
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A healthy 19-year-old man presents to your emergency department complaining of weakness and lethargy for the past 2 weeks. He sleeps 10 hours a day, yet remains tired. His appetite has been poor and he constantly feels thirsty. ⋯ A bedside glucometer displays “High-High-High.” Laboratory investigations reveal a white blood cell count of 14.2 × 109/L, a hemoglobin level of 143 g/L, a platelet count of 365 × 109/L, a sodium level of 133 mmol/L, a potassium level of 2.9 mmol/L, a chloride level of 103 mmol/L, a blood urea nitrogen level of 17 mmol/L, a creatinine level of 144 μmol/L, a glucose level of 29.7 mmol/L, an arterial pH of 7.10, a Pco(2) of 23 mm Hg, a Po(2) of 95 mm Hg, a bicarbonate level of 11 mmol/L, and an oxygen saturation of 95%. Urinalysis results are positive for high levels of ketones and glucose. How would you approach this patient?
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To describe physician practices with regard to opportunistic screening for breast cancer in women aged 35 to 49 years and 70 years of age and older, and to identify the determinants associated with the practice of prescribing screening mammography. ⋯ Improvements are needed in the practice of teaching breast self-examination to women aged 35 to 49 years and referring them to genetic counseling, as well as in prescribing mammography for women 70 years of age and older who are in good health. Public health actions to improve these practices should focus on physician attitudes and skills and on communicating clearer recommendations.
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To review the current evidence on buprenorphine-naloxone for the treatment of opioid-related disorders, with a focus on primary care settings. ⋯ Buprenorphine is a safe and effective agent for detoxification from opioids. It can be used as a first-line agent in maintenance programs, owing to its lower abuse potential relative to other opioids. Its effectiveness in primary care settings makes it a useful therapeutic tool for family physicians.
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To determine family physicians' practice of, knowledge about, and attitudes toward delivering preventive care during periodic health examinations (PHEs). ⋯ The results of this survey indicate that while many family physicians follow the evidence-based guidelines for preventive care, current levels of preventive care in the primary care setting are below national standards. It is critical that Canadians receive optimal preventive care to improve the outlook of the chronic disease burden on the health care system.