Canada

Sources of information: A literature search was conducted in PubMed and Google Scholar using relevant key words and subject headings. Recommendations were categorized based on clinical evidence and expert opinion using a 3-level classification system.

Main message: A mallet finger injury commonly occurs after an axial load, resulting in avulsion of the extensor tendon from the distal phalanx. This may occur with or without an avulsion fracture. Diagnosis is made clinically, with x-ray scans used to assess for an associated fracture and joint alignment. Nonsurgical management with continuous splinting for 6 to 8 weeks is the standard of care and achieves excellent outcomes even in cases of delayed presentation. Surgery referral may be considered for avulsion fractures resulting in joint subluxation, open injuries, and failure of conservative management. Untreated mallet finger injuries can lead to chronic swan-neck deformities, which may limit function.

Conclusion: Mallet finger injuries may be easily recognized and managed in the primary care settings, resulting in excellent patient outcomes without the need for specialist referral. This review should equip primary care physicians with confidence in diagnosing a mallet finger injury, initiating appropriate splinting, providing patient education, and recognizing indications for surgical referral.

Author/s:

Vincent Dinh, Marisa Market, Kevin Cheung

Open Access Canadian guideline on HIV pre- and postexposure prophylaxis: 2025 update

Megan George — Tue, 02 Dec 2025 16:04:24 +0000

Date Added:

December 2, 2025

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

December 1, 2025

URL:

Open Access Canadian guideline on HIV pre- and postexposure prophylaxis: 2025 update

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1503/cmaj.250511

Keywords

HIV

Anti-HIV Agents

Post-Exposure Prophylaxis

Pre-Exposure Prophylaxis

Tenofovir

PMID (1):

41326046

MeSH

Anti-HIV Agents* / administration & dosage

Anti-HIV Agents* / therapeutic use

Canada

Emtricitabine / therapeutic use

HIV Infections* / prevention & control

Humans

Post-Exposure Prophylaxis* / methods

Post-Exposure Prophylaxis* / standards

Pre-Exposure Prophylaxis* / standards

Pre-Exposure Prophylaxis* / methods

Tenofovir / therapeutic use

Updated Canadian Guideline for pre- and post-exposure prophylaxis for HIV infection. James W. Mold, MD, MPH.

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Background: New HIV infections occur annually in Canada, highlighting the need for pre- and postexposure prophylaxis (PrEP and PEP). Through the Canadian Institutes of Health Research (CIHR) Pan-Canadian Network for HIV/AIDS and STBBI (sexually transmitted and blood-borne infections) Clinical Trials Research, we have updated the 2017 guideline on clinical indications and drug regimens for PrEP and PEP in Canada.

Methods: Drawing on meetings with community-based organizations representing key populations affected by HIV in Canada, along with evidence from 3 systematic reviews on PrEP, PEP, and HIV risk assessment tools (searches to June 2024), our diverse panel of 19 experts formulated recommendations on PrEP and PEP. We used a formal evidence-to-decision-making framework and the Grading of Recommendations, Assessment, Development, and Evaluation system. We followed the Guidelines International Network principles for managing competing interests. Our guideline development and reporting adhere with Appraisal of Guidelines for Research and Evaluation II.

Recommendations: This guideline contains 31 recommendations and 10 good practice statements. Although it is appropriate to prescribe PrEP to adults and adolescents who request it, clinicians are also encouraged to assess HIV risk during routine health visits to identify people who would benefit from PrEP. Clinicians should elicit information about patients' anatomy and sexual partners in a culturally sensitive and affirming manner to determine which PrEP regimens - daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC), on-demand TDF/FTC, daily oral tenofovir alafenamide/emtricitabine, or long-acting injectable cabotegravir - are suitable options. When assessing whether PEP is needed, clinicians should consider the likelihood that the source person has transmissible HIV, as well as the biological risk of HIV transmission based on exposure type. Preferred PEP regimens are dolutegravir plus TDF/FTC, or bictegravir/tenofovir alafenamide/emtricitabine.

Interpretation: Multiple safe, effective PrEP and PEP regimens are now available in Canada, making it increasingly possible to find suitable options for all who could benefit. Implementation of this guideline should expand access to biomedical HIV prevention interventions for those at risk and decrease the incidence of HIV in Canada.

Author/s:

Darrell H.S. Tan, Mark W. Hull, Stanley O. Onyegbule, Wale Ajiboye, Camille Arkell, Jean-Guy Baril, Joseph Cox, Marianne Harris, Debbie Kelly, Michael Kwag, Gilles Lambert, Patrick O’Byrne, Shannon O’Donnell, Caley B. Shukalek, Ameeta Singh, Tatiana Sotindjo, Jaris Swidrovichv, Cécile Tremblay, Deborah Yoong

Parkinson disease primer, part 1: diagnosis

Aubrey Delammermore — Sat, 28 Jan 2023 06:00:00 +0000

Date Added:

January 28, 2023

Journal/Publication:

Canadian Family Physician

Publisher:

College of Family Physicians of Canada

Publication Date:

January 1, 2023

Issue:

Volume:

Pages:

20-24

URL:

Parkinson disease primer, part 1: diagnosis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.690120

Keywords

PMID (1):

36693741

MeSH

Canada

Levodopa

Parkinson Disease* / diagnosis

Parkinsonian Disorders*

patients

A review of how to identify patients with Parkinson's Disease. James W. Mold, MPH

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Objective To provide family physicians an updated approach to the diagnosis of Parkinson disease (PD).

Sources of information Published guidelines on the diagnosis and management of PD were reviewed. Database searches were conducted to retrieve relevant research articles published between 2011 and 2021. Evidence levels ranged from I to III.

Main message Diagnosis of PD is predominantly clinical. Family physicians should evaluate patients for specific features of parkinsonism, then determine whether symptoms are attributable to PD. Levodopa trials can be used to help confirm the diagnosis and alleviate motor symptoms of PD. “Red flag” features and absence of response to levodopa may point to other causes of parkinsonism and prompt more urgent referral.

Conclusion Access to neurologists and specialized clinics varies, and Canadian family physicians can be important players in facilitating early and accurate diagnosis of PD. Applying an organized approach to diagnosis and considering motor and nonmotor symptoms can greatly benefit patients with PD. Part 2 in this series will review management of PD.

Parkinson disease (PD) is the fastest growing neurodegenerative condition, with prevalence predicted to double from more than 6 million globally in 2015 to more than 12 million by 2040.1 Recognizing parkinsonism and having knowledge of the presentation, diagnosis, and management of motor and nonmotor symptoms of PD are increasingly important, particularly as access to neurologists and specialized clinics is limited in many parts of Canada.2 Family physicians are well placed to identify symptoms, participate in diagnosis, and collaborate with specialty clinics in management of patients through the course of the disease.

Author/s:

Frank, C., Chiu, R., Lee, J.

Individualized antidepressant therapy in patients with major depressive disorder: Novel evidence-informed decision support tool

Aubrey Delammermore — Sun, 11 Dec 2022 06:00:00 +0000

Date Added:

December 11, 2022

Journal/Publication:

Canadian Family Physician

Publisher:

The College of Family Physicians of Canada

Publication Date:

November 1, 2022

Issue:

Volume:

Pages:

807-814

URL:

Individualized antidepressant therapy in patients with major depressive disorder: Novel evidence-informed decision support tool

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi.org/10.46747/cfp.6811807

Keywords

Systematic Reviews as Topic

antidepressive agents

Serotonin Uptake Inhibitors

Major Depressive Disorder

SSRI

PMID (1):

36376052

MeSH

Antidepressive Agents / therapeutic use

Canada

Selective Serotonin Reuptake Inhibitors / adverse effects

quality of life

Depressive Disorder, Major* / drug therapy

Figures 1A and 1B provide an algorithm to help decide which of the many available antidepressants might be best for a particular patient. James W. Mold, MD, MPH.

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Objective: To introduce a visual clinical decision support tool to assist with individualizing first-line antidepressant pharmacotherapy for adults with major depressive disorder (MDD) in a Canadian context.

Sources of information: A literature review was conducted with Google Scholar, PubMed, the Cochrane Database of Systematic Reviews, and Trip Pro using the MeSH headings depression, antidepressive agents, primary care, practice patterns, medication adherence, and decision making, shared.

Main message: Major depressive disorder affects about 4.7% of Canadians annually and is a prevalent condition encountered and diagnosed in primary care. Untreated depression is associated with decreased quality of life, increased risk of suicide, and worsening physical health outcomes when depression co-occurs with other chronic medical conditions. In a network meta-analysis, antidepressant medications (such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, bupropion, and vortioxetine) reduced depressive symptoms by 50% or more when compared with placebo in acute treatment of adults with moderate to severe MDD. Poor treatment adherence and high discontinuation rates limit MDD treatment success. Factors such as strong therapeutic alliances between patients and prescribers, collaborative care, patient education, and supportive self-management have been shown to enhance treatment adherence. The most recent Canadian Network for Mood and Anxiety Treatments depression treatment guidelines (published in 2016) suggest 15 different first-line antidepressant medication options for the treatment of MDD. There is a need for evidence-informed decision support aids to individualize antidepressant therapy to treat patients diagnosed with MDD.

Conclusion: Recent studies on antidepressants have indicated no single antidepressant is superior to others in treating patients with MDD. This suggests there may be opportunities to enhance treatment adherence and success by tailoring antidepressant therapy to align with each patient's preferences. The Antidepressant Decision Support Tool was developed to help prescribers and adult patients engage in shared decision making to select an individualized and optimal first-line antidepressant for the treatment of acute MDD.

Author/s:

Chin, T., Huyghebaert, T., Svrcek, C., Oluboka, O.

Obesity in adults: a clinical practice guideline

Brian Desmarais — Mon, 10 Aug 2020 17:50:10 +0000

Date Added:

August 10, 2020

Journal/Publication:

Canadian medical Association Journal

Publication Date:

August 4, 2020

Issue:

Volume:

192

Pages:

E875-E891

URL:

Obesity in adults: a clinical practice guideline

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.191707

MeSH

Updated Canadian guideline for management of patients with obesity. Not sure I agree with medicalizing it as they have, but important information. James W. Mold, MD, MPH

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Author/s:

Wharton, S., Lau, D.C.W, Vallis, M., Sharma, A.M.

Canadian practice guidelines for the treatment of children and adolescents with eating disorders

Brian Desmarais — Tue, 10 Mar 2020 16:04:09 +0000

Date Added:

March 10, 2020

Journal/Publication:

Journal of Eating Disorders

Publication Date:

February 8, 2020

Volume:

URL:

Canadian practice guidelines for the treatment of children and adolescents with eating disorders

Type:

Practice Management Reviews and Guidelines

Format:

Article

DOI (1):

10.1186/s40337-020-0277-8

Keywords

Anorexia nervosa

Avoidant/restrictive food intake disorder

Bulimia nervosa

guidelines

MeSH

Feeding and Eating Disorders

This is a 2020 evidence-based guideline from Canada on management of eating disorders in children and adolescents. It is long and comprehensive. (Potentially useful as a reference when you have a child with an apparent eating disorder.) James W. Mold, MD, MPH

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Abstract
Objectives: Eating disorders are common and serious conditions affecting up to 4% of the population. The
mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no
Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to
which treatment they should use. Our objective was to produce such a guideline.
Methods: Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation
(GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high
quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders.
Results: Strong recommendations were supported specifically in favour of Family-Based Treatment, and more
generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family
Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical
antipsychotics were confirmed.
Conclusions: Several gaps for future work were identified including enhanced research efforts on new primary and
adjunctive treatments in order to address severe eating disorders and complex co-morbidities.
Keywords: Guidelines, Adolescent, Anorexia nervosa, Bulimia nervosa, Avoidant/restrictive food intake disorder

Author/s:

Couturier, J., Isserlin, L., Norris, M., Spettigue, W., Brouwers, M., Kimber, M., McVey, G., Webb, C., Findlay, S., Bhatnagar, N., Snelgrove, N., Ritsma, A., Preskow, W.

Preoperative Cardiac Risk Assessment

John Bayhi — Thu, 27 Feb 2020 15:22:21 +0000

Date Added:

February 27, 2020

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Elsevier B.V. / Mayo Foundation for Medical Education and Research

Publication Date:

February 24, 2020

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2019.08.013

Keywords

cardiac

preoperative assessment

MeSH

acute coronary syndrome

Cost-Benefit Analysis

This is a review of the latest recommendations regarding the cardiac assessment of patients needing surgery. James W. Mold, MD, MPH

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Major adverse cardiac events are common causes of perioperative mortality and major morbidity. Preventing these complications requires thorough preoperative risk assessment and postoperative monitoring of at-risk patients. Major guidelines recommend assessment based on a validated risk calculator that incorporates patient- and procedure-specific factors. American and European guidelines define when stress testing is needed on the basis of functional capacity assessment. Favoring cost-effectiveness, Canadian guidelines instead recommend obtaining brain natriuretic peptide or N-terminal prohormone of brain natriuretic peptide levels to guide postoperative screening for myocardial injury or infarction. When conditions such as acute coronary syndrome, severe pulmonary hypertension, and decompensated heart failure are identified, nonemergent surgery should be postponed until the condition is appropriately managed. There is an evolving role of biomarkers and myocardial injury after noncardiac surgery to enhance risk stratification, but the effect of interventions guided by these strategies is unclear.

Author/s:

Raslau, D, Bierle, DM, Stephenson, CR, Mikhail, MA, Kebede, EB, Mauck, KF

Practice: Five things to know about edible cannabis

Brian Desmarais — Tue, 18 Feb 2020 17:01:51 +0000

Date Added:

February 18, 2020

Journal/Publication:

Canadian Medical Association Journal

Issue:

Volume:

197

Pages:

e162

URL:

Practice: Five things to know about edible cannabis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.191305

Keywords

MeSH

Important clinical points about edible cannabis products. James W. Mold, MD, MPH

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Author/s:

Zipursky, J.S., Bogler, O.D., Stall, N.M.

Canadian guideline for Parkinson disease

Brian Desmarais — Mon, 03 Feb 2020 17:28:55 +0000

Date Added:

February 3, 2020

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

September 9, 2019

Issue:

Volume:

191

Pages:

E989-E1004

URL:

Canadian guideline for Parkinson disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.181504

MeSH

Hospice and Palliative Care Nursing

Parkinsonian Disorders

decision making

communication

Canada

Updated Canadian guidelines for management of Parkinson’s Disease. James W. Mold, MD, MPH

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KEY POINTS

This guideline update reflects substantial changes in the literature on diagnosis and treatment of Parkinson disease, and adds information on palliative care.
Impulse control disorders can develop in a person with Parkinson disease who is on any dopaminergic therapy at any stage in the disease course, especially for those taking dopamine agonists.
Advanced therapies like deep brain stimulation and intrajejunal levodopa-carbidopa gel infusion are now routinely used in Parkinson disease to manage motor symptoms and fluctuations.
Evidence exists to support early institution of exercise at the time of diagnosis of Parkinson disease, in addition to the clear benefit now shown in those with well-established disease.
Palliative care requirements of people with Parkinson disease should be considered throughout all phases of the disease, which includes an option of medical assistance in dying.

Author/s:

Grimes,D., Fitzpatrick, M., Gordon, J., Miyasaki, J., Fon, E.A., Schlossmacher, M., Suchowersky, O., Rajput, A., Lafontaine, A.L, Mestre, T., Appel-Cresswell, S., Kalia, S., Schoffer, K., Zurowski, M., Postuma, R.B., Udow, S., Fox, S., Barbeau, P., Hutton, B.

Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability

John Bayhi — Wed, 04 Dec 2019 18:30:19 +0000

Date Added:

December 4, 2019

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

November 28, 2019

Issue:

Volume:

381

Pages:

2125-2134

URL:

Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa1909159

Keywords

pulmonary embolism

d-dimer

computed tomography

PMID (1):

31774957

MeSH

Humans

prospective studies

retrospective studies

Venous Thromboembolism

Computed Tomography Angiography

anticoagulants

Angiography

Though the full article is not freely available, I thought the abstract was worth sharing. In primary care patients with low or moderate probability of a pulmonary embolus, PE can essentially be ruled out with D-dimer testing. James W. Mold, MD, MPH

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BACKGROUND:

Retrospective analyses suggest that pulmonary embolism is ruled out by a d-dimer level of less than 1000 ng per milliliter in patients with a low clinical pretest probability (C-PTP) and by a d-dimer level of less than 500 ng per milliliter in patients with a moderate C-PTP.

METHODS:

We performed a prospective study in which pulmonary embolism was considered to be ruled out without further testing in outpatients with a low C-PTP and a d-dimer level of less than 1000 ng per milliliter or with a moderate C-PTP and a d-dimer level of less than 500 ng per milliliter. All other patients underwent chest imaging (usually computed tomographic pulmonary angiography). If pulmonary embolism was not diagnosed, patients did not receive anticoagulant therapy. All patients were followed for 3 months to detect venous thromboembolism.

RESULTS:

A total of 2017 patients were enrolled and evaluated, of whom 7.4% had pulmonary embolism on initial diagnostic testing. Of the 1325 patients who had a low C-PTP (1285 patients) or moderate C-PTP (40 patients) and a negative d-dimer test (i.e., <1000 or <500 ng per milliliter, respectively), none had venous thromboembolism during follow-up (95% confidence interval [CI], 0.00 to 0.29%). These included 315 patients who had a low C-PTP and a d-dimer level of 500 to 999 ng per milliliter (95% CI, 0.00 to 1.20%). Of all 1863 patients who did not receive a diagnosis of pulmonary embolism initially and did not receive anticoagulant therapy, 1 patient (0.05%; 95% CI, 0.01 to 0.30) had venous thromboembolism. Our diagnostic strategy resulted in the use of chest imaging in 34.3% of patients, whereas a strategy in which pulmonary embolism is considered to be ruled out with a low C-PTP and a d-dimer level of less than 500 ng per milliliter would result in the use of chest imaging in 51.9% (difference, -17.6 percentage points; 95% CI, -19.2 to -15.9).

CONCLUSIONS:

A combination of a low C-PTP and a d-dimer level of less than 1000 ng per milliliter identified a group of patients at low risk for pulmonary embolism during follow-up. (Funded by the Canadian Institutes of Health Research and others; PEGeD ClinicalTrials.gov number, NCT02483442.).

Author/s:

Kearon, C, de Wit, K, Parpia, S, Schulman, S, Afilalo, M, Hirsch, A, Spencer, FA, Sharma, S, D'Aragon, F, Deshaies, JF, Le Gal, G, Lazo-Langer, A, Wu, C, Rudd-Scott, L, Bates, SM, Julian, JA, PEGeD Study Investigators