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What are the Canadian Expert Consensus Recommendations for the Management of Anaphylaxis?

This summary is based on the Position Paper provided by the Canadian Medical Association (CMA): management of anaphylaxis in primary care: Canadian expert consensus recommendations. The article was retrieved from the CMA Infobase: Clinical Practice Guidelines Database (CPGs) Access the article here (PDF) Context  Anaphylaxis is often managed inadequately. The authors  used findings from a systematic review of gaps in anaphylaxis management to develop evidence-based recommendations for gaps rated as clinically important by a panel of Canadian allergy experts. Key Messages Thirty unique physician gaps from the systematic review were categorized according to gaps of knowledge and anaphylaxis practice behaviors. The panel rated diagnosis of anaphylaxis, and ...

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From the trenches: How to “dodge the bullet” and make the right diagnosis?

This case was submitted by Dr. Ron Kellen  This situation occurred about 20 years ago. My office was in a plaza, on the second floor, requiring 26 steps to access it, with no elevator. At about 2 PM on a weekday, a 60-year-old male patient presented in our office as an emergency case with a terrible toothache. He pointed to his broken 35. On his medical questionnaire, he indicated that he had a little bit of high blood pressure and that he sometimes would get out of breath. He was taking medication once a day for blood pressure, but he ...

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Diabetes and periodontal diseases: what does the consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases say?

This is the summary of the report issued by the Joint European Federation of Periodontology and the American Academy of Periodontology Workshop on Periodontitis and Systemic Diseases: Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases (April 2013) Context Diabetes and periodontitis are complex chronic diseases with an established bidirectional relationship. There is long-established evidence that hyperglycemia in diabetes is associated with adverse periodontal outcomes. However, given the ubiquity of periodontal diseases and the emerging global diabetes epidemic, the complications of which contribute to significant morbidity and premature mortality, it is timely to review ...

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Managing severe Alzheimer disease: what are the evidence-based guidelines?

This summary is based on the guidelines published by the Canadian Medical Association (CMA): Diagnosis and treatment of dementia: 6. Management of severe Alzheimer disease. The article was retrieved from the CMA Infobase: Clinical Practice Guidelines Database (CPGs) Access the article here (PDF) Context The management of severe Alzheimer disease often presents difficult choices for clinicians and families. The disease is characterized by a need for full-time care and assistance with basic activities of daily living. The authors outline an evidence-based approach for these choices based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. The authors developed evidence-based guidelines using systematic literature searches, ...

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How do I protect my patient medically, while safely providing the required treatment?

This case was submitted by Dr. Ron Kellen  Case Details Male patient, 55.  Diagnosed with AIDS in 2/2013 – at which time, CD4 count was 50. Now he says his CD4 count is 200. On Methadone (on-off for 10 years now). Ex heroin IV, and oxycontin, Percocet, etc. narcotics. On anti-convulsive for grand mal seizures. No more seizures since started medications. Smokes medical marijuana to increase his appetite. He is very underweight. On effective AIDS cocktail since Feb, 2013  Just finished thrush treatment of Nystatin swish & swallow (from G.P., not AIDS MD).  Still remnants clearly visible He has only ...

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New CDA Position Statement on Dental Patients with Total Joint Replacement

In June 2013, CDA adopted a new position statement on dental patients with total joint replacement. The Committee on Clinical and Scientific Affairs (CCSA) reviewed clinical evidence, including a thorough systematic review of the literature conducted by the American Dental Association (ADA) and the American Academy of Orthopedic Surgeons (AAOS) which was conducted in 2011. Preamble The issue of whether patients with orthopedic implants, primarily total hip and knee replacements, are prone to implant infection from routine dental procedures via hematogenous seeding of the implant from dental-procedure-related bacteremia has been a controversial topic for dentists, physicians and patients alike. Background ...

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Efudex: Should it be prescribed by dentists?

This question was submitted by a general dentist: When discussing sun damage to lips, a couple of patients indicated that their physician prescribed Efudex. There is apparently no follow-up by the physician and no indication to the patients as to what the desired outcome of the said treatment should be. Should dentists be prescribing this medication and what would the appropriate follow-up and regimen be with this chemotherapeutic agent? Dr. Mark Donaldson provided the following initial and quick response Dr. Mark Donaldson is Director of Pharmaceutical Services at the Kalispell Regional Medical Center,  Clinical Professor in the Department of Pharmacy at ...

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Is there a relationship between GERD and dental erosion?

This summary is based on the Critical Appraisal published in the Journal of Esthetic and Restorative Dentistry: Dental Erosion (June 2013) Context Dental erosion or erosive tooth wear not only can be caused by extrinsic (dietary) acids but also intrinsic acids. Historically, anorexic and bulimic patients have been the population dentists have had to be aware of, but with the increasing prevalence of gastroesophageal reflux disease (GERD) in the general population, another population must be monitored. Tooth wear is usually multifactorial, and it is often difficult to assign a specific etiology; abrasion, attrition, and erosion must all be considered as potential etiologies. This critical ...

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