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Canadian Clinician's Rheumatology Handbook
Excerpt

Preface

 

 

The first edition of the Canadian Clinician’s Rheumatology Handbook was entitled the Canadian Residents’ Rheumatology Handbook, and it was designed to enhance and support a national rheumatology curriculum for core internal medicine trainees in Canada. Over the years, the book has been a helpful resource to medical students, family physicians, allied health professionals, and others. Thus, this second edition is more broadly geared to all Canadian clinicians, both trainees and those in practice, to help provide a starting point in the approach to common presenting problems of patients with rheumatologic disease.

Introduction

The Canadian Clinician’s Rheumatology Handbook is designed to give the clinician a starting point in assessing the patient who presents with a particular rheumatologic syndrome. The Handbook provides a foundational approach and will help guide the user to identify where further reading in a standard textbook or current literature will optimize care of the patient. Chapters on the use of laboratory investigations and imaging provide a quick reference to enhance the ordering and interpretation of these tests. The “Selected Rheumatologic Emergencies” section will help the clinician to quickly get organized in the face of an acutely ill patient and will lay the groundwork for appropriate investigation and management. Finally, the sections on physical examination and joint injection techniques will serve as a refresher for some clinicians or as an introduction for others. Joint injection techniques, however, cannot simply be learned from a book, and the clinician should endeavor to have supervised practice before routinely doing these procedures. It is impossible to list every reference and additional resource in a small space, but many chapter authors have tried to provide some key references for further reading. Several excellent standard rheumatology textbooks can provide a structured and detailed approach to build on the learning in this book. Management of rheumatic diseases is a rapidly evolving area—searching the current literature is the best approach when more detail is required.

We hope that you enjoy using the Canadian Clinician’s Rheumatology Handbook and anticipate that it will enhance your comfort and proficiency with the approach to the presenting problems of patients with rheumatologic disorders.

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Managing Alcohol, Tobacco and other Drug Problems

Managing Alcohol, Tobacco and other Drug Problems

A Pocket Guide for Physicians and Nurses
edition:eBook
also available: Paperback
More Info
Lab Literacy for Doctors

Lab Literacy for Doctors

A Guide to Ordering the Right Tests for Better Patient Care
edition:Paperback
also available: eBook
More Info
Excerpt

 

Introduction: Why this guide?

 

 

Five years ago, new evidence about vitamin D alerted doctors to the impacts of vitamin D deficits on patient health. This drove a meteoric increase in vitamin D testing in labs across North America. At some clinics, vitamin D testing became one of the single biggest expenses in the budget for lab services.

For all those tests and all that money, you would expect that doctors were at least getting useful information from the results. But they weren’t.

Vitamin D levels are not good predictors of bone health—or other health outcomes for that matter. Patients have different underlying disease susceptibilities, and, depending on supplements, their serum vitamin D levels go up and down. So, knowing a patient’s current vitamin D level has dubious value.

Ample evidence, however, shows the benefits of vitamin D supplements for almost everyone, regardless of their baseline vitamin D level. Therefore, a strategy of “treat don’t test” makes eminent sense and saves valuable health-care resources for testing that actually has a clinical impact.

In the setting of finite health-care resources, tradeoffs such as this—between clinical utility and costs of testing—will become increasingly important.

As health practitioners, we share an ethical responsibility to provide good stewardship of limited health-care dollars and testing resources. Whether you are a primary-care physician or resident, a medical student, or a health professional in an allied field, you need to be lab literate: you need to know which tests have the highest yield for the clinical situations you typically encounter.

Many references help you interpret lab investigations, but they don’t tell you what investigations to do in the first place. This guide is about what lab investigations to do first. We outline the most efficient and cost-effective way for you to use laboratory investigations to support clinical diagnosis and management.

How to use this guide The main guide

The guide is organized the way clinicians think: by clinical presentation and by organ system. So, if you have a patient with a skin problem, go to the section on dermatology. If a patient presents with fatigue, go to the section on fatigue.

In addition to information on lab investigations, we provide, where useful, differential diagnoses, etiologies, and summaries of signs and symptoms. We also share some “pearls”—particular knowledge about lab investigations we have gathered as experts and clinicians in our fields.

Lab basics

Lab investigations are only as good as the specimens delivered for analysis, and lab results are only as useful as human slip-ups and margins of error allow.

Find advice and information here on lab errors, false positives and negatives, and blood and tissue collection.

Lab investigations index

This index describes the diagnostic purpose of the lab investigations discussed in the guide, plus other common lab tests.

If you need a quick check on what an investigation is for, look it up here.

What’s not in this guide

This guide focuses on laboratory investigations. It does not cover diagnostic imaging.

It covers typical disorders and clinical presentations. It does not cover every disorder and clinical presentation, and is not meant to replace sound clinical judgement.

A note about units

This guide gives laboratory values in both conventional units and SI units (the International System of Units). We give the conventional units first and the SI units second.

We did this to be thorough: US laboratories usually report test results in conventional units, but SI units are increasingly used in the United States.

For this reason, we felt it was important to provide laboratory values in both systems as a reference.

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Lab Literacy for Canadian Doctors

Lab Literacy for Canadian Doctors

A Guide to Ordering the Right Tests for Better Patient Care
edition:Paperback
also available: eBook
More Info
Excerpt

Introduction: Why this guide?

Five years ago, new evidence about vitamin D alerted doctors to the impacts of vitamin D deficits on patient health. This drove a meteoric increase in vitamin D testing in labs across North America. At some clinics, vitamin D testing became one of the single biggest expenses in the budget for lab services.

For all those tests and all that money, you would expect that doctors were at least getting useful information from the results. But they weren’t.

Vitamin D levels are not good predictors of bone health—or other health outcomes for that matter. Patients have different underlying disease susceptibilities, and, depending on supplements, their serum vitamin D levels go up and down. So, knowing a patient’s current vitamin D level has dubious value.

Ample evidence, however, shows the benefits of vitamin D supplements for almost everyone, regardless of their baseline vitamin D level. Therefore, a strategy of “treat don’t test” makes eminent sense and saves valuable health-care resources for testing that actually has a clinical impact.

In the setting of finite health-care resources, tradeoffs such as this—between clinical utility and costs of testing—will become increasingly important.

As health practitioners, we share an ethical responsibility to provide good stewardship of limited health-care dollars and testing resources. Whether you are a primary-care physician or resident, a medical student, or a health professional in an allied field, you need to be lab literate: you need to know which tests have the highest yield for the clinical situations you typically encounter.

Many references help you interpret lab investigations, but they don’t tell you what investigations to do in the first place.

This guide is about what lab investigations to do first. We outline the most efficient and cost-effective way for you to use laboratory investigations to support clinical diagnosis and management.

How to use this guide The main guide

The guide is organized the way clinicians think: by clinical presentation and by organ system. So, if you have a patient with a skin problem, go to the section on dermatology. If a patient presents with fatigue, go to the section on fatigue.

In addition to information on lab investigations, we provide, where useful, differential diagnoses, etiologies, and summaries of signs and symptoms. We also share some “pearls”—particular knowledge about lab investigations we have gathered as experts and clinicians in our fields.

Lab basics

Lab investigations are only as good as the specimens delivered for analysis, and lab results are only as useful as human slip-ups and margins of error allow.

Find advice and information here on lab errors, false positives and negatives, and blood and tissue collection.

Lab investigations index

This index describes the diagnostic purpose of the lab investigations discussed in the guide, plus other common lab tests.

If you need a quick check on what an investigation is for, look it up here.

What’s not in this guide

This guide focuses on laboratory investigations. It does not cover diagnostic imaging.

It covers typical disorders and clinical presentations. It does not cover every disorder and clinical presentation, and is not meant to replace sound clinical judgement.

A note about units

This guide gives laboratory values in both SI units (the International System of Units) and conventional units. We give the SI units first and the conventional units second.

We did this because Canadian laboratories generally, but not always, report test results in SI units. In addition, Canadian laboratories refer some esoteric tests to the United States, and laboratories in the United States generally, but again not always, report results in conventional units.

For these reasons, we felt it was important to provide laboratory values in both systems as a reference.

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Methadone Maintenance

Methadone Maintenance

A Physician’s Guide to Treatment
edition:Paperback
also available: Paperback
More Info
The Complete Doctor's Stress Solution

The Complete Doctor's Stress Solution

Understanding, Treating and Preventing Stress-Related Illnesses
edition:Paperback
also available: Hardcover
More Info

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