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1.  Gastrointestinal adverse effects of varenicline at maintenance dose: a meta-analysis 
Background
Tobacco smoking remains the leading modifiable health hazard and varenicline is amongst the most popular pharmacological options for smoking cessation. The purpose of this study is to critically evaluate the extent of gastrointestinal adverse effects of varenicline when used at maintenance dose (1 mg twice a day) for smoking cessation.
Methods
We conducted a meta-analysis of randomised controlled trials published in PUBMED and EMBASE according to the PRISMA guidelines. Selected studies satisfied the following criteria: (i) duration of at least 6 weeks, (ii) titrated dose of varenicline for 7 days then a maintenance dose of 1 mg twice-per-day, (iii) randomized placebo-controlled design, (iv) extractable data on adverse event - nausea, constipation or flatulence. Data was synthesized into pooled odd ratios (OR) basing on random effects model. Quality of studies was also rated as per Cochrane risk-of-bias assessment. Number need to harm (NNH) was calculated for each adverse effect.
Results
98 potentially relevant studies were identified, 12 of which met the final inclusion criteria (n = 5114). All 12 studies reported adverse events on nausea, which led to an OR of 4.45 (95% CI = 3.79-5.23, p < 0.001; I2 = 0.06%, CI = 0%-58.34%) and a NNH of 5. Eight studies (n = 3539) contain data on constipation pooled into an OR of 2.45 (95% CI = 1.61-3.72, p < 0.001; I2 = 34.09%, CI = 0%-70.81%) with a NNH of 24. Finally, five studies (n = 2516) reported adverse events of flatulence, which pooled an OR of 1.74 (95% CI = 1.23-2.48, p = 0.002; I2 = 0%, CI = 0%- 79.2%) with a NNH of 35.
Conclusions
Use of varenicline at maintenance dose of 1 mg twice a day for longer than 6 weeks is associated with adverse gastrointestinal effects. In realistic terms, for every 5 treated subjects, there will be an event of nausea, and for every 24 and 35 treated subjects, we will expect an event of constipation and flatulence respectively. Family physicians should counsel patients of such risks accordingly during their maintenance therapy with varenicline.
doi:10.1186/1472-6904-11-15
PMCID: PMC3192741  PMID: 21955317
2.  Update on pharmacologic and nonpharmacologic therapies for smoking cessation 
Canadian Family Physician  2008;54(7):994-999.
ABSTRACT
OBJECTIVE
To review the evidence on the efficacy and safety of pharmacologic and nonpharmacologic therapies for smoking cessation.
QUALITY OF EVIDENCE
MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched for randomized controlled trials, meta-analyses, and systematic reviews (level I evidence) pertinent to pharmacologic and nonpharmacologic smoking cessation therapies.
MAIN MESSAGE
Pharmacologic smoking cessation aids are recommended for all smokers trying to quit, unless contraindicated. A new pharmacologic smoking cessation aid, varenicline, is now available in Canada. Level I evidence at 1-year follow-up indicates that it is effective for smoking cessation. Adverse effects include nausea, insomnia, and abnormal dreaming. Nausea is mild or moderate and decreases over time. Varenicline is more effective than placebo or bupropion. Counseling also increases the likelihood of achieving cessation.
CONCLUSION
Preliminary data indicate that varenicline is more effective than other available pharmacologic smoking cessation aids. Pharmacologic therapy should be combined with nonpharmacologic therapy.
PMCID: PMC2464816  PMID: 18625823
3.  Educating physicians to reduce benzodiazepine use by elderly patients: a randomized controlled trial 
Background
Benzodiazepine use by elderly patients is associated with adverse outcomes including increased risk of falls and fractures, motor vehicle accidents and cognitive impairment. Recent studies suggest that individualized feedback and education to physicians may improve drug prescribing. In this study, we evaluated an intervention to address the inappropriate prescribing of benzodiazepines for elderly patients.
Methods
We identified 1624 primary care physicians who wrote at least 10 prescriptions for the target drugs in a 2-month period and randomly assigned these physicians to the intervention group or the control group. We obtained data from the Ontario Drug Benefit claims database, which covers all Ontario residents aged 65 years and over for drugs selected from a minimally restrictive formulary. Every 2 months for 6 months, confidential profiles of benzodiazepine prescription use coupled with evidence-based educational bulletins were mailed to the intervention group. The control group received feedback and educational bulletins about first-line antihypertension drug prescribing for elderly patients. Our main outcome measures were reductions in the proportion of each physician's total benzodiazepine prescriptions for long-acting agents, combinations of benzodiazepines with other psychoactive medications (including other benzodiazepines) and long-term benzodiazepine therapy.
Results
After randomization, 168 physicians agreed to be in the intervention group and 206 in the control group. Their demographic and prescribing characteristics were similar. Although the proportion of long-acting benzodiazepine prescriptions decreased by 0.7% in the intervention group between the baseline period and the end of the intervention period (from 20.3%, or a mean of 29.5 prescriptions, to 19.6%, or a mean of 27.7 prescriptions) and increased by 1.1% in the control group (from 19.8%, or a mean of 26.4 prescriptions, to 20.9%, or a mean of 27.7 prescriptions) (p = 0.036), this difference was not clinically significant. There was no significant difference over the study period in either combination prescribing of benzodiazepines or in prescriptions for long-term benzodiazepine therapy.
Interpretation
We did not find that a program of confidential feedback and educational material offered to Ontario primary care physicians had a clinically significant impact on their benzodiazepine prescribing.
PMCID: PMC151988  PMID: 12668540
5.  Argument for blended funding. 
Canadian Family Physician  2002;48:236-249.
PMCID: PMC2213973  PMID: 11889878
7.  Five Weekend National Family Medicine Fellowship 
Canadian Family Physician  1997;43:2151-2157.
PROBLEM ADDRESSED
Many faculty development programs are thought time-consuming and inaccessible to academic family physicians or physicians wanting to move into academic positions. This is largely due to difficulty in leaving their practices for extended periods. Canadian family medicine needs trained leaders who can work in teams and are well grounded in the principles of their discipline as they relate to education, management, research, and policy making.
OBJECTIVE OF PROGRAM
To develop a team of leaders in family medicine.
MAIN COMPONENTS OF PROGRAM
The Five Weekend National Family Medicine Fellowship Program focuses on the essentials of education, management, communication, critical appraisal skills, and the principles of family medicine to develop leadership and team-building skills for faculty and community-based family physicians entering academic careers. This unique 1-year program combines intensive weekend seminars with small-group projects between weekends. It emphasizes a broader set of skills than just teaching, has regional representation, and focuses on leadership and teamwork using a time-efficient format.
CONCLUSION
The program has graduated 34 Fellows over the last 3 years. More than 90% of the 35 projects developed through course work have been presented in national or provincial peer-reviewed settings. Quantitative ratings of program structure, course content, and course outcomes have been positive.
PMCID: PMC2255090  PMID: 9426934
9.  Concern over litigation 
Canadian Family Physician  1991;37:1347-1522.
PMCID: PMC2145390  PMID: 21229033
10.  Who Will Deliver Canada's Babies in the 1990s? 
Canadian Family Physician  1989;35:2419-2424.
Family physicians and obstetricians are rapidly discontinuing obstetric practice. Infringement on lifestyle and threat of litigation are the two most important reasons for both family physicians' and obstetricians' withdrawing from obstetric practice. Only 4% of each medical school graduating class will enter practice as fully trained obstetricians. The most likely way to avoid future gaps in obstetric care is to attract more students and family medicine trainees to obstetrics. Strategies to stimulate undergraduate interest in low-risk obstetrics, to attract family medicine residents to pre-natal and intrapartum care, and to retain more of the family physicians and obstetricians now involved in delivering babies urgently require attention.
PMCID: PMC2280168  PMID: 20469502
education; family medicine; low-risk obstetrics; obstetrics
12.  Update from ASPN 
Canadian Family Physician  1989;35:843-846.
Patients suffering from common illnesses seek assistance from their family physicians and are referred to tertiary care specialists only if unusual complications develop. Tertiary care specialists have performed the bulk of training and research for primary care physicians. The result is that research and education are inappropriate for the illnesses most often encountered in family practice. The Ambulatory Sentinel Practice Network (ASPN) was formed to gather information about the disorders encountered in general practice that form the greatest part of human suffering and to disseminate that information among primary care practitioners.
PMCID: PMC2280821  PMID: 21249031
Ambulatory Sentinel Practice Network; clinicians; family medicine; medical research
13.  Response 
PMCID: PMC2146357
14.  Response 
PMCID: PMC2379650
16.  Mitral Valve Prolapse 
Canadian Family Physician  1992;38:599-605.
The author discusses the pathophysiology of mitral valve prolapse and provides guidelines to identify and treat low-to high-risk mitral valve prolapse. An approach to diagnosing bacterial endocarditis and its prophylaxis are also discussed. The author reviews mitral valve prolapse syndrome and the risk of sudden death.
PMCID: PMC2146069
17.  Medicolegal Liability for Ontario Physicians 
Canadian Family Physician  1991;37:1390-1394.
Family physicians and general practitioners in Ontario have responded more dramatically to the threat of medicolegal suits than physicians in other parts of the country. The authors identified geographic differences in responses to a national survey and suggest some explanations of these differences, some effects of the more defensive practice of medicine in Ontario on the province's health care system, and changes that might reduce physician concern.
PMCID: PMC2145398  PMID: 21229034

Results 1-21 (21)