Canadian Family Physician最新文献

Objective: To clarify who generalist physicians are and what characterizes their practice.

Data sources: MEDLINE, PsycInfo, SocINDEX, Embase, Ovid HealthSTAR, Scopus, and Web of Science.

Study selection: Empirical studies (quantitative, qualitative, mixed methods) that described the attributes of generalist physicians across various disciplines in the clinical literature.

Synthesis: A total of 262 studies from 25 countries met inclusion criteria. Forty-seven percent of studies lacked essential participant information. The remaining studies primarily framed generalism in terms of an absence of specialist training, reflecting a "deficit model" of care. We identified 4 archetypes of generalist practice: broad-based knowledge, generalism as adaptive expertise, generalism as integrative expertise, and generalism as interpretive expertise.

Conclusion: Generalism lacks a consistent meaning across clinical disciplines in medicine. Four archetypes of practice are proposed to promote cross-disciplinary dialogue and guide the design of future health care systems and professional roles.

Objective: To provide primary care physicians with up-to-date information on obstructive sleep apnea (OSA) and current management options.

Sources of information: Reviews of relevant literature retrieved via the PubMed and MEDLINE databases with no date limitations. Searches for the impact on OSA of dentures with implant oral restoration.

Main message: A narrowing of the upper airway axial surface due to fat deposition or hypertrophic tonsils and upper airway neuromuscular pathology can cause OSA. OSA can be asymptomatic, but most patients develop a variety of symptoms, including nocturnal awakenings, nocturia, unrefreshing sleep, daytime sleepiness and fatigue, impaired concentration, and chronic morning headaches. Several screening tools exist, including the Berlin Questionnaire. Laboratory polysomnography (level 1) is the accepted standard for the evaluation of sleep-disordered breathing. Addressing modifiable risk factors can help control OSA. Obesity and overweight status in the adult population, which can be addressed with behavioural interventions, are associated with severity of OSA. Medical options include positive airway pressure (PAP) therapy. Mandibular advancement devices are an alternative for patients with mild or moderate OSA or those who cannot tolerate PAP therapy. Surgical options can address both the biomechanical aspects of OSA and patients' overweight status.

Conclusion: Careful history-taking and understanding of the underlying biomechanical pathophysiology can orient physicians to consider OSA. Personalized and interdisciplinary approaches should be considered when prescribing OSA treatment and during follow-up assessments.

Objective: To review a selection of new resources and updated recommendations from the third update of the Greig Health Record (GHR).

Sources of information: Pediatric preventive care literature was reviewed using PubMed and Google Scholar databases. Systematic reviews of subtopics were evaluated where available. Guidance and supporting evidence were reviewed from the Canadian Paediatric Society, the American Academy of Pediatrics, the Canadian Task Force on Preventive Health Care, the United States Preventive Services Task Force, the National Advisory Committee on Immunization, and the Centers for Disease Control and Prevention.

Main message: In this 2025 update the following topics have been added or revised: confidentiality, capacity, and consent in pediatric patients; developmental assessment; poverty screening; sexual health and consent; menstrual health history; contraception; guidance for detection and prevention of sexually transmitted infections; radon as an environmental hazard; updated ferritin standards; vaccine hesitancy; and updated dosing for human papillomavirus vaccination.

Conclusion: The third update of the GHR provides recent evidence-based recommendations and detailed guidance for clinicians providing pediatric preventive care.