Point-of-Care Guides

These guides offer evidence-based tools to assist family physicians in improving their decision-making at the point of care.

Jun 15, 2017 Issue
Nonalcoholic Fatty Liver Disease: Identifying Patients at Risk of Inflammation or Fibrosis
NAFLD is defined as hepatic steatosis on imaging or histology in the absence of other etiologies for secondary fat accumulation. It is usually identified during the evaluation of elevated transaminase levels in a patient without heavy alcohol intake, or found incidentally on imaging studies.

May 1, 2017 Issue
Estimating Cardiovascular Risk
The primary prevention of cardiovascular disease (CVD) depends on accurate estimation of cardiovascular risk. However, a recent systematic review identified 363 prediction models.

Dec 15, 2016 Issue
Prognosis Following Mild Head Injury in Children
Concussion, also referred to as mild traumatic brain injury, is a common injury in children. It is defined as a transient disturbance in mental status following head trauma, and it can cause a variety of physical, cognitive, and emotional sequelae. Symptoms continuing for more than 28 days after the initial trauma are referred to as persistent postconcussion symptoms and affect approximately one-third of children with concussion.

Sep 15, 2016 Issue
Clinical Diagnosis of Gout Without Joint Aspirate
Gout is ideally diagnosed through identification of characteristic negatively birefringent crystals under polarized light microscopy in fluid aspirated from end-organ deposits, typically from a joint. However, fewer than 10% of patients with gout see a rheumatologist, and most cases of gout are diagnosed in the primary care setting based on signs, symptoms, and serum uric acid level. But how accurate is a clinical diagnosis, and can it be done better?

Aug 15, 2016 Issue
Predicting Hospital Readmission
In 2007, the Medicare Payment Advisory Committee reported that 18% of hospital admissions resulted in a readmission, of which 76% were potentially avoidable.1 The development of a clinical decision rule to identify patients at risk of readmission could aid in directing interventions and resources, potentially improving cost-effectiveness of care and reducing postdischarge mortality.

Jun 15, 2016 Issue
Rapid Protocols to Rule out Myocardial Infarction
Cardiac troponin T and I are released into the bloodstream when cardiac muscle is damaged. Cardiac troponin tests have been available for decades and are the preferred biomarkers for the diagnosis of acute myocardial infarction (AMI). However, until recently, they lacked sensitivity in the first few hours following an acute myocardial injury.

Jun 15, 2014 Issue
Diagnosis of Streptococcal Pharyngitis
Sore throat was the chief symptom in 1.3% of all outpatient office visits in 2010, and is even more common in primary care practice. An Australian study found that among families with at least one child three to 12 years of age, the incidence of sore throat was 33 and 14 episodes per 100 person-years in children and their parents, respectively. These episodes were caused by GABHS bacteria in about 40% of children and 25% of adults.

Aug 1, 2012 Issue
Risk Stratification of Children with Bronchiolitis
Bronchiolitis is a common and sometimes serious viral lower respiratory tract infection in young children.

Jun 1, 2012 Issue
Risk Stratification of Patients Presenting with Syncope
A previous Point-of-Care Guide addressed risk stratification in patients with syncope and described two validated clinical decision rules. Shared variables between the two rules included abnormal findings on electrocardiography (ECG) and a history of congestive heart failure; other variables included decreased systolic blood pressure, shortness of breath, anemia, age older than 45 years, and history of arrhythmia.

Mar 1, 2011 Issue
Evaluation of Chest Pain in Primary Care Patients
Chest pain can be caused by conditions that range from benign and self-limited (e.g., chest wall pain) to serious (e.g., anxiety disorder) or life-threatening (e.g., unstable angina, aortic dissection, pulmonary embolism). Accurate identification of life-threatening and serious causes of chest pain must be accomplished without overtesting and overtreating patients with less serious causes.

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