Canada

Background: Fragility fractures are a major health concern for older adults and can result in disability, admission to hospital and long-term care, and reduced quality of life. This Canadian Task Force on Preventive Health Care (task force) guideline provides evidence-based recommendations on screening to prevent fragility fractures in community-dwelling individuals aged 40 years and older who are not currently on preventive pharmacotherapy.

Methods: We commissioned systematic reviews on benefits and harms of screening, predictive accuracy of risk assessment tools, patient acceptability and benefits of treatment. We analyzed treatment harms via a rapid overview of reviews. We further examined patient values and preferences via focus groups and engaged stakeholders at key points throughout the project. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to determine the certainty of evidence for each outcome and strength of recommendations, and adhered to Appraisal of Guidelines for Research and Evaluation (AGREE), Guidelines International Network and Guidance for Reporting Involvement of Patients and the Public (GRIPP-2) reporting guidance.

Recommendations: We recommend "risk assessment-first" screening for prevention of fragility fractures in females aged 65 years and older, with initial application of the Canadian clinical Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD). The FRAX result should be used to facilitate shared decision-making about the possible benefits and harms of preventive pharmacotherapy. After this discussion, if preventive pharmacotherapy is being considered, clinicians should request BMD measurement using dual-energy x-ray absorptiometry (DXA) of the femoral neck, and re-estimate fracture risk by adding the BMD T-score into FRAX (conditional recommendation, low-certainty evidence). We recommend against screening females aged 40-64 years and males aged 40 years and older (strong recommendation, very low-certainty evidence). These recommendations apply to community-dwelling individuals who are not currently on pharmacotherapy to prevent fragility fractures.

Interpretation: Risk assessment-first screening for females aged 65 years and older facilitates shared decision-making and allows patients to consider preventive pharmacotherapy within their individual risk context (before BMD). Recommendations against screening males and younger females emphasize the importance of good clinical practice, where clinicians are alert to changes in health that may indicate the patient has experienced or is at higher risk of fragility fracture.

Author/s:

Thériault, G., Limburg, H., Klarenbach, S., Reynolds, D. L., Riva, J. J., Thombs, B. D., Tessier, L. A., Grad, R., Wilson, B. J., Canadian Task Force on Preventive Health Care

Lung cancer crash course

Aubrey Delammermore — Sat, 22 Apr 2023 05:00:00 +0000

Date Added:

April 22, 2023

Journal/Publication:

Canadian Family Physician

Publisher:

College of Family Physicians of Canada

Publication Date:

April 1, 2023

Issue:

Volume:

Pages:

266-268

URL:

Lung cancer crash course

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.6904266

Keywords

liver

brain

Survival Rate

Small Cell Lung Carcinoma

Canada

PMID (1):

37072209

MeSH

Lung Neoplasms*

Carcinoma, Non-Small-Cell Lung

early detection of cancer

Carcinoma, Squamous Cell

A concise review of the diagnosis, classification, and treatment and treatment of lung cancer. James W. Mold, MD, MPH

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Lung cancer has the highest mortality rate of any cancer in Canada, causing 25.5% of all cancer deaths, with a 5-year survival rate of only 19%. More than half of lung cancers are metastatic at diagnosis, with common sites of metastases in the brain, bone, liver, and adrenal glands. Lung cancer is a heterogeneous group of cancers broadly separated into small cell lung cancer (SCLC)—approximately 15% of all lung cancer cases—and non–small cell lung cancer (NSCLC), which is further divided into predominantly adenocarcinoma and squamous cell carcinoma subtypes. More than 80% of lung cancer cases are related to smoking, meaning smoking cessation remains the cornerstone of lung cancer prevention. Low-dose computed tomography is a valuable screening tool for lung cancer that can identify lung cancers at an earlier stage and reduce lung cancer–specific mortality and all-cause mortality. Although lung cancer screening is recommended by the Canadian Task Force on Preventive Health Care, it is currently available in only a few Canadian provinces.

Author/s:

Wilkinson, A. N.

Pre-exposure prophylaxis for HIV: effective and underused

Aubrey Delammermore — Sat, 10 Sep 2022 05:00:00 +0000

Date Added:

September 10, 2022

Journal/Publication:

CMAJ

Publisher:

CMA Impact Inc

Publication Date:

September 6, 2022

Issue:

Volume:

194

Pages:

E1164-E1170

URL:

Pre-exposure prophylaxis for HIV: effective and underused

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.220645

Keywords

Follow-Up Studies

Substance Abuse, intravenous

Canada

sexually transmitted diseases

Drug users

MeSH

Pre-Exposure Prophylaxis

Sexual and Gender Minorities

HIV infections

Tenofovir

fumarates

Pre-exposure prophylaxis should be offered to those at high risk for HIV. James W. Mold, MD, MPH

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Pre-exposure prophylaxis (PrEP) is a highly effective modality for HIV prevention that can be prescribed by generalists.

Pre-exposure prophylaxis should be offered to patients who are at high risk of HIV exposure, including gay, bisexual and other men who have sex with men (GBM), women reporting condomless intercourse with partners of confirmed or unknown transmissible HIV status and persons who inject drugs and share injection equipment.

Once daily PrEP (tenofovir disoproxil fumarate/emtricitabine [TDF/FTC] or tenofovir alafenamide fumarate/emtricitabine tablets) is approved by Health Canada.

On-demand TDF/FTC can be prescribed to gay, bisexual and other men who have sex with men and has similar efficacy.

The Canadian guideline details protocolized monitoring for PrEP follow-up including HIV screening, screening for sexually transmitted infection and renal monitoring.

Author/s:

Hempel, A., Biondi, M. J., Baril, J., Tan, D. H. S.