http://www.capre.ca/ en-us ℗ & © 2008 Remedy Communications Limited Critically Appraised Practice Reflection Exercise Queen's University The Critically Appraised Practice Reflection Exercise (CAPRE) is an on-line, accredited resource of critically appraised information on current knowledge about a particular area. Produced by the Centre for Studies in Primary Care at Queen's University, CAPRE provides physicians and patients with information on current knowledge about a particular therapeutic area. Through CAPRE, healthcare professionals can first review and then present critically appraised information to patients, provide patients with an opportunity to consider the impact of the critically appraised suggestions and decide the best of action or treatment. At the completion of each CAPRE module, users are eligible to receive Mainpro-C credits. The Critically Appraised Practice Reflection Exercise (CAPRE) is an on-line, accredited resource of critically appraised information on current knowledge about a particular area. Produced by the Centre for Studies in Primary Care at Queen's University, CAPRE provides physicians and patients with information on current knowledge about a particular therapeutic area. Through CAPRE, healthcare professionals can first review and then present critically appraised information to patients, provide patients with an opportunity to consider the impact of the critically appraised suggestions and decide the best of action or treatment. At the completion of each CAPRE module, users are eligible to receive Mainpro-C credits. Remedy Communications Limited info@capre.ca Tue, 27 May 2008 19:00:00 GMT darryl@remedylimited.com (Darryl Spreen) 1 Walter W. Rosser, MD, CCFP, FCFP, MRCGP(UK) CAPRE focuses on common problems faced in family practice. CAPRE provides physicians and patients with critically appraised information on current knowledge about a particular therapeutic area. Through CAPRE, critically appraised information is present to the patient. The patient then has an opportunity to review the information and, at a follow-up visit, the physician and patient decide on the best course of action. CAPRE provides physicians and patients with critically appraised information on current knowledge about a particular therapeutic area. Through CAPRE, critically appraised information is present to the patient. The patient then has an opportunity to review the information and, at a follow-up visit, the physician and patient decide on the best course of action. http://www.capre.ca/podcast/rosser.mp4 Tue, 20 May 2008 19:00:00 GMT 1:56 CAPRE, evidence-based medicine Walter W. Rosser, MD, CCFP, FCFP, MRCGP(UK) Reducing blood pressure to 140/90 mmHg in those older than 65 years is of benefit, explains Dr. Rosser. All persons over 65 years should have their blood pressure assessed at least annually. If the blood pressure is found to be greater than 140/90 mmHg on three separate occasions, then initiation of simple salt restriction followed by stepped-drug therapy commencing with a thiazide-type diuretic is beneficial. All persons over 65 years should have their blood pressure assessed at least annually. If the blood pressure is found to be greater than 140/90 mmHg on three separate occasions, then initiation of simple salt restriction followed by stepped-drug therapy commencing with a thiazide-type diuretic is beneficial. http://www.capre.ca/podcast/capre_bp_over_65.mp3 Thu, 22 May 2008 19:00:00 GMT 4:06 blood pressure, hypertension, systolic hypertension, systolic blood pressure, diastolic hypertension, diastolic blood pressure, diuretic, calcium channel blocker, cardiovascular disease, beta-blocker, angiotensin converting enzyme inhibitor, ACE inhibitor Walter W. Rosser, MD, CCFP, FCFP, MRCGP(UK) Dr. Rosser explains that patients younger than 65 years with elevated blood pressure should try lifestyle modification first. All persons between the ages of 21 and 65 years should have their blood pressure accurately measured once every two to three years. If the blood pressure is found on three separate occasions over a three- to six-month period to have a reading greater than 140/90 mmHg on average, lifestyle modification should be attempted prior to consideration of drug therapy. All persons between the ages of 21 and 65 years should have their blood pressure accurately measured once every two to three years. If the blood pressure is found on three separate occasions over a three- to six-month period to have a reading greater than 140/90 mmHg on average, lifestyle modification should be attempted prior to consideration of drug therapy. http://www.capre.ca/podcast/capre_bp_under_65.mp3 Fri, 23 May 2008 19:00:00 GMT 1:52 hypertension, diastolic, blood pressure, diabetes, stroke, heart attack, cardiovascular disease, beta-blocker, diuretic, calcium channel blocker, angiotensin converting enzyme, ACE inhibitor, alpha-adrenergic Walter W. Rosser, MD, CCFP, FCFP, MRCGP(UK) Dr. Rosser reviews the optimal treatment approach for those suffering from musculoskeletal or arthritic problems. Acetaminophen in doses up to 4 g per day is the first-line treatment for osteoarthritis (OA). Topical capsaicin or diclofenac sodium should be considered as second-line therapy with consideration of intra-articular steroids as a third option. Nonsteroidal anti-inflammatories (NSAIDs) and COX-2 inhibitor drugs are indicated for the treatment of inflammatory arthritis, some unresponsive OA and, in some instances, muscle injuries or pain. Acetaminophen in doses up to 4 g per day is the first-line treatment for osteoarthritis (OA). Topical capsaicin or diclofenac sodium should be considered as second-line therapy with consideration of intra-articular steroids as a third option. Nonsteroidal anti-inflammatories (NSAIDs) and COX-2 inhibitor drugs are indicated for the treatment of inflammatory arthritis, some unresponsive OA and, in some instances, muscle injuries or pain. http://www.capre.ca/podcast/capre_msk.mp3 Mon, 26 May 2008 19:00:00 GMT 4:37 arthritis, osteoarthritis, diclofenac sodium, non-steroidal anti-inflammatory, NSAID, COX-2, celecoxib, ibuprofen, GI toxicity, gastrointestinal, dyspepsia, peptic, glucosamine, chondroitin, intra-articular Richard Birtwhistle, MD, MSc, FCFP Dr. Birtwhistle reviews the need for practical guidance to confirm a diagnosis of COPD. Given that physicians do not initially diagnose COPD with spirometry and that spirometry thresholds do not always correlate with patient symptoms, many guidelines recommend the use of the Medical Research Council dyspnea scale to help classify the severity of COPD. Given that physicians do not initially diagnose COPD with spirometry and that spirometry thresholds do not always correlate with patient symptoms, many guidelines recommend the use of the Medical Research Council dyspnea scale to help classify the severity of COPD. http://www.capre.ca/podcast/capre_diagnosis.mp3 Thu, 16 October 2008 19:00:00 GMT 1:49 Chronic obstructive pulmonary disease, COPD, diagnosis, lung disease, spirometry, dyspnea scale Richard Birtwhistle, MD, MSc, FCFP The paramount need to prevent exacerbations is reviewed by Dr. Birtwhistle. Preventing exacerbations is of paramount importance both to the patient and his/her physician. Prompt recognition and treatment of acute exacerbations are important goals in the management of COPD. Preventing exacerbations is of paramount importance both to the patient and his/her physician. Prompt recognition and treatment of acute exacerbations are important goals in the management of COPD. http://www.capre.ca/podcast/capre_exacerbations.mp3 Fri, 17 October 2008 19:00:00 GMT 1:42 arthritis, osteoarthritis, diclofenac sodium, non-steroidal anti-inflammatory, NSAID, COX-2, celecoxib, ibuprofen, GI toxicity, gastrointestinal, dyspepsia, peptic, glucosamine, chondroitin, intra-articularChronic obstructive pulmonary disease, COPD, exacerbation, exacerbations, breathlessness, wheezing, chest tightness, cough, sputum volume, purulence, bronchodilator, bronchodilators, oral corticosteroid, oral corticosteroids, oral antibiotics Richard Birtwhistle, MD, MSc, FCFP Dr. Birtwhistle reviews the goals of treatment of COPD. There is a gap between evidence and practice in treating COPD. Practical clinical understanding is needed to optimize therapeutic approaches. There is a gap between evidence and practice in treating COPD. Practical clinical understanding is needed to optimize therapeutic approaches. http://www.capre.ca/podcast/capre_bestpractices.mp3 Mon, 20 October 2008 19:00:00 GMT 1:53 arthritis, osteoarthritis, diclofenac sodium, non-steroidal anti-inflammatory, NSAID, COX-2, celecoxib, ibuprofen, GI toxicity, gastrointestinal, dyspepsia, peptic, glucosamine, chondroitin, intra-articularChronic obstructive pulmonary disease, COPD, Canadian Thoracic Society, CTS, American Thoracic Society/European Respiratory Society, ATS/ERS, Global Initiative for Chronic Obstructive Lung Disease, GOLD, smoking cessation, bronchodilator, bronchodilators, oral corticosteroid, oral corticosteroids, oral antibiotics, inhaled corticosteroid, inhaled corticosteroids, anticholinergics, beta-2 agonists, methylxanthines Richard Birtwhistle, MD, MSc, FCFP Dr. Birtwhistle examines the factors affecting contraceptive adherence. Each contraceptive method has advantages and disadvantages. In addition many factors influence sexual behaviour and patient response to contraceptive choices. Each contraceptive method has advantages and disadvantages. In addition many factors influence sexual behaviour and patient response to contraceptive choices. http://www.capre.ca/podcast/capre_contraception.mp3 Tue, 21 October 2008 19:00:00 GMT 2:49 arthritis, osteoarthritis, diclofenac sodium, non-steroidal anti-inflammatory, NSAID, COX-2, celecoxib, ibuprofen, GI toxicity, gastrointestinal, dyspepsia, peptic, glucosamine, chondroitin, intra-articularContraception, oral contraceptives, vaginal ring, vaginal patch, progestin-only pill, injections, implants, IUDs, intrauterine devices, condoms, sterilization, Depo-Provera, side effects, adherence, pregnancy Walter W. Rosser, MD, CCFP, FCFP, MRCGP(UK) Dr. Rosser explains the benefits of statins among patients who have diabetes. Statin therapy for all patients with diabetes, whatever their history of cardiovascular disease and with a low-density lipoprotein cholesterol (LDL-C) level as low as 2.6 mmol/L, offers a significant reduction in both all-cause mortality and major vascular events. Statin therapy for all patients with diabetes, whatever their history of cardiovascular disease and with a low-density lipoprotein cholesterol (LDL-C) level as low as 2.6 mmol/L, offers a significant reduction in both all-cause mortality and major vascular events. http://www.capre.ca/podcast/capre_diabetes_statin.mp3/guid> Mon, 8 December 2008 19:00:00 GMT 2:25 Diabetes, statins, type 1 diabetes mellitus, type 2 diabetes mellitus, diabetes mellitus, type 1 diabetes, type 2 diabetes Walter W. Rosser, MD, CCFP, FCFP, MRCGP(UK) Dr. Rosser reviews the need for the prevention of neuropathy in patients with type 1 and type 2 diabetes. Patients with type 1 diabetes should receive intensive blood sugar control to prevent the onset and progression of neuropathy as well as other diabetic complications. Patients with type 2 diabetes are also at risk of developing neuropathy. For patients with type 2 diabetes who are overweight, the first choice of blood sugar control is increased exercise and a 10% weight reduction. Patients with type 1 diabetes should receive intensive blood sugar control to prevent the onset and progression of neuropathy as well as other diabetic complications. Patients with type 2 diabetes are also at risk of developing neuropathy. For patients with type 2 diabetes who are overweight, the first choice of blood sugar control is increased exercise and a 10% weight reduction. http://www.capre.ca/podcast/capre_diabetic_neuropathy.mp3 Tue, 9 December 2008 19:00:00 GMT 2:50 Diabetes, diabetic neuropathy, type 1 diabetes mellitus, type 2 diabetes mellitus, diabetes mellitus, type 1 diabetes, type 2 diabetes Walter W. Rosser, MD, CCFP, FCFP, MRCGP(UK) The treatment options for patients with type 2 diabetes are reviewed by Dr. Rosser. There is good evidence supporting a program of diet and exercise for three months after an above-normal fasting blood sugar is detected. If after three months the sugar remains elevated or the HgA1C is elevated, then there is good evidence supporting commencement of metformin as the drug of first choice in all those who have a body mass index (BMI) greater than 25. If after six months and use of maximum doses of metformin, sugar and HgA1C are not controlled then sulfonureas may be added. Insulin may also be used in combination with oral hypoglycemics. There is good evidence supporting a program of diet and exercise for three months after an above-normal fasting blood sugar is detected. If after three months the sugar remains elevated or the HgA1C is elevated, then there is good evidence supporting commencement of metformin as the drug of first choice in all those who have a body mass index (BMI) greater than 25. If after six months and use of maximum doses of metformin, sugar and HgA1C are not controlled then sulfonureas may be added. Insulin may also be used in combination with oral hypoglycemics. http://www.capre.ca/podcast/capre_diabetes_drugtreatment.mp3 Wed, 10 December 2008 19:00:00 GMT 2:31 Diabetes, type 1 diabetes mellitus, type 2 diabetes mellitus, diabetes mellitus, type 1 diabetes, type 2 diabetes, metformin, sulfonureas, insulin, oral hypoglycemics Walter W. Rosser, MD, CCFP, FCFP, MRCGP(UK) Dr. Rosser reviews the management strategy for ear infections in children. For children over two years with a fever and other general symptoms from acute middle ear infection but who are not very ill, there is evidence that treating the fever, pain and nasal congestion for the first 48 hours may be the best approach. If more serious symptoms develop or the fever, pain and other symptoms do not resolve within 48 hours, the use of antibiotics should be considered. Both the physician and parents must understand the rationale and evidence supporting the approach and be comfortable with it. For children over two years with a fever and other general symptoms from acute middle ear infection but who are not very ill, there is evidence that treating the fever, pain and nasal congestion for the first 48 hours may be the best approach. If more serious symptoms develop or the fever, pain and other symptoms do not resolve within 48 hours, the use of antibiotics should be considered. Both the physician and parents must understand the rationale and evidence supporting the approach and be comfortable with it. http://www.capre.ca/podcast/capre_earinfections.mp3 Thu, 11 December 2008 19:00:00 GMT 3:30 Ear infection, ear infections, cold, nasal congestion, eustation tube, acute otitis media, middle ear infection Walter W. Rosser, MD, CCFP, FCFP, MRCGP(UK) Dr. Rosser reviews how asthma should be diagnosed and managed. Objective measurements using pulmonary function studies are needed to confirm the diagnosis of asthma and assess its severity in all symptomatic patients. Inhaled glucocorticosteroids offer the best option for the initial anti-inflammatory treatment of asthma. Objective measurements using pulmonary function studies are needed to confirm the diagnosis of asthma and assess its severity in all symptomatic patients. Inhaled glucocorticosteroids offer the best option for the initial anti-inflammatory treatment of asthma. http://www.capre.ca/podcast/capre_asthma.mp3 Fri, 12 December 2008 19:00:00 GMT 2:29 Asthma, pulmonary function tests, inhaled glucocorticosteroids, beclomethasone, chlorofluorocarbon-beclomethasone dipropionate, CFC-BDP, hydrofluroalkane-134a, HFA-BDP, corticosteroid inhalers, salbutamol inhalers