Canadian Family Physician最新文献

Objective: To understand the possible association between media coverage and changes in the dispensation of doxylamine-pyridoxine in Canada.

Design: Cross-sectional time-series analysis using data from the IQVIA CompuScript database.

Setting: Ten Canadian provinces.

Participants: Family physicians, general practitioners, and obstetrician-gynecologists.

Main outcome measures: Data on the estimated total volume of doxylamine-pyridoxine prescriptions dispensed by retail pharmacists in Ontario and across Canada between July 2016 and May 2022 were used for a time-series analysis. Birth data obtained from Statistics Canada were used to adjust for pregnancy rates. Finally, the possible impact of media coverage in January 2018 on doxylamine-pyridoxine use was assessed with interventional autoregressive integrated moving average modelling, and dispensation rates of doxylamine-pyridoxine were reported overall and by prescriber specialty.

Results: Doxylamine-pyridoxine dispensation decreased by 1.2% (P=.015) overall in Ontario but did not change significantly (P=.064) across the rest of Canada. Out of 619,720 total doxylamine-pyridoxine prescriptions dispensed, 391,722 (63.2%) prescriptions were written by family physicians or general practitioners in Ontario, and there was a decline of 2.4% (P=.010) in the dispensation of doxylamine-pyridoxine based on prescriptions written by this group that lasted for 6 months before returning to previous dispensation rates. There was no significant change in the dispensation of doxylamine-pyridoxine based on prescriptions written by obstetrician-gynecologists (decline of 0.5%, P=.235) in Ontario.

Conclusion: Despite nationwide media attention questioning the efficacy of doxylamine-pyridoxine in early 2018, trends in dispensation rates of doxylamine-pyridoxine were only modestly affected and only in Ontario. Within Ontario, a small but significant reduction in doxylamine-pyridoxine dispensations was noted based on prescriptions from family physicians or general practitioners but not based on those written by obstetrician-gynecologists. Factors associated with the ongoing use of doxylamine-pyridoxine despite evidence of lack of benefit require further research.

Objective: To provide primary care physicians with a review of common oral white lesions and a practical management algorithm.

Sources of information: Between January and April 2024 relevant literature and clinical guidelines were searched for using the PubMed MEDLINE database with no date limitation.

Main message: A broad differential diagnosis exists for white lesions of the oral cavity. Fungal infections; human papillomavirus-related proliferations; reactive lesions secondary to physical, thermal, or chemical injuries; and premalignant or malignant clinical entities can all present as white lesions. Prompt recognition and proper management are therefore important. In certain instances, short-term follow-up of nonsuspicious lesions may be considered to assess for regression, persistence, or progression. Other lesions require timely investigations and treatment. Furthermore, providing patients with adequate counselling for lifestyle risk factors, including tobacco and alcohol use, is of utmost importance.

Conclusion: White lesions of the oral cavity are prevalent and may be encountered routinely in primary care settings. Recognizing the most common conditions and becoming proficient in their clinical management enhances patient care. Primary care physicians can play a crucial role in early detection of oral pathology. Proper triage of suspicious lesions can subsequently help decrease the wait time to see a specialist and avoid unnecessary medical visits for patients.