NP Current

A Primer on Combined Oral Contraceptives Across the Reproductive Lifespan

2026-08-23T04:41:11+00:00

Canadian women may use combined oral contraceptives for many indications: contraception, dysmenorrhea, management of heavy menstrual bleeding, management of polycystic ovarian syndrome… the list goes on. A recent study showed that of Canadian women age 19-49 who used hormonal contraception, over half were using an oral contraceptive.1 Most of those oral contraceptives were combined hormonal pills. Combined oral contraceptives are an appropriate choice for many women throughout their reproductive lives. This primer will address the use of combined oral contraceptives (COCs) across the reproductive years with comments on common clinical challenges during adolescence, peak reproductive years, and perimenopause.

Fraser Health Authority Nurse Practitioner Gastrointestinal Prophylaxis Audit in Acute Care

2024-07-26T20:41:28+00:00

Each year, the Fraser Health Authority (FHA) Regional Department Medical Quality Committee (RDMQC) of the Department of Nurse Practitioners (NP) conducts a clinical chart audit that focuses on a specific disease or condition. Due to increased interest as well as questions regarding the correct use of this practice in acute care, for the 2022 and 2023 FHA clinical chart audit, GI prophylaxis was the selected topic for acute care nurse practitioners. The aim of the FHA NP GI prophylaxis audit in acute care was to understand the practice patterns of NPs prescribing gastroprotective agents in the FHA acute care population, indications for prescribing, and criteria used to identify those at risk for GI bleeds. Once the 2022 audit was completed and analyzed, an educational tool was developed and distributed to all acute care NPs in an effort to improve GI prophylaxis practice. In 2023 NPs were asked to complete the GI prophylaxis chart audit for a second time. Following the delivery of the GI prophylaxis educational tool, there is a reported increased awareness amongst acute care FHA NPs on the topic of GI prophylaxis, and improved prescribing practices. When compared to the 2022 chart audit, the 2023 chart audit data revealed that more often than previously, NPs have critically evaluated patients' need for GI prophylaxis, used risk assessment tools to identify high risk patients for GI bleed, provided teaching to patients about GI prophylaxis and assessed indications of prescribing and deprescribing GI prophylaxis.

Bridging Medicine and Reconciliation

2025-11-04T16:43:14+00:00

ABSTRACT: Obesity is one of the most pressing health challenges in Canada, driving the rise of type 2 diabetes, cardiovascular disease, cancer, and premature mortality. While lifestyle interventions remain the cornerstone of obesity management, many individuals require pharmacotherapy and/or bariatric surgery to achieve sustained benefits. Among recent advances, glucagon-like peptide-1 (GLP-1) and dual glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide (GLP-1/GIP) receptor agonists have demonstrated unprecedented efficacy in weight reduction and cardiometabolic risk improvement.

For Indigenous peoples in Canada, the burden of obesity is not only medical but deeply rooted in colonial legacies. Systemic inequities, intergenerational trauma, disrupted food systems, and racism in healthcare have contributed to disproportionately high rates of obesity and related chronic illnesses. The authors evaluate the efficacy of GLP-1 pharmacotherapy, analyze policy and systemic barriers that constrain access, and highlight the essential role of primary care providers in delivering culturally safe, trauma-informed, and community-centred care. By situating biomedical advances within the context of reconciliation, the authors argue that equitable access and culturally grounded approaches are essential to achieving meaningful improvements in obesity care for Indigenous peoples in British Columbia (BC) and across Canada.

This policy review employed a multi-faceted approach to examine the intersection of obesity management and health equity among Indigenous populations in Canada. The objectives were to identify available and publicly funded obesity treatments in BC and to explore the root causes of obesity and related health inequities among Indigenous peoples. First, an environmental scan of the BC health landscape was conducted, including an analysis of the BC Guidelines for Obesity Management and coverage available under the Medical Services Plan (MSP) and PharmaCare. Second, a literature review synthesized findings from scoping reviews and white papers addressing Indigenous health disparities. Finally, a focused literature review evaluated the clinical outcomes of GLP-1 pharmacotherapy for weight management in non-diabetic populations, with the specific search strategies and methods outlined within this paper.

Key Themes

The authors found several key themes in review of the literature, including: the enduring legacy of colonization and its impact on Indigenous health outcomes, systemic barriers to GLP-1/GIP access for Indigenous populations, culturally safe and trauma-informed approaches to obesity care, and recommendations for equitable access and culturally safe care. The authors conclude with a call to action to change policies on GLP-1/GIP medication coverages for First Nations that align with the social determinants of health.

POCUS in the Rapid Diagnosis of Aortic Dissection in the Emergency Department: Case Report

2025-08-29T05:34:08+00:00

Background: Aortic dissection is a life-threatening condition that requires timely diagnosis and intervention. However, its variable presentation often leads to delayed recognition in the emergency department (ED). Point-of-care ultrasound (POCUS), when performed by a nurse practitioner, can serve as a valuable bedside tool for the rapid assessment of patients with suspected aortic dissection, particularly in cases with atypical presentations.

Case Presentation: We describe the case of a 91-year-old male presenting to the ED for syncope. Initial assessment was challenging due to the patient’s altered mental status and atypical presentation. POCUS, performed during the initial clinical evaluation, revealed a dilated aortic root and an intimal flap, raising suspicion for an acute aortic dissection. This prompted urgent confirmatory imaging with computed tomography angiography (CTA), which confirmed a Stanford Type A aortic dissection extending into the great vessels.

Discussion: This case highlights the role of POCUS in the early detection of aortic dissection, particularly when clinical presentation is nonspecific. While CTA remains the gold standard for diagnosis, POCUS offers a rapid, non-invasive means of identifying key findings such as aortic dilation, pericardial effusion and intimal flaps, facilitating early decision-making in critical patients.

Conclusion: POCUS is a valuable adjunct in the evaluation of suspected aortic dissection, allowing for timely diagnosis and intervention. Increased awareness and training in its application may enhance ED clinicians’ ability to recognize and manage this life-threatening condition more effectively.

Building Confidence and Excellence: A Novel Fellowship for Nurse Practitioners in Cardiovascular Surgery

2026-08-23T05:05:51+00:00

For a newly graduated nurse practitioner (NP), few first jobs are more daunting than stepping onto a post-operative cardiovascular surgery ward. The pace is relentless; the decisions are high-stakes; and the role is unusually autonomous. At St. Michael’s Hospital in Toronto, the cardiovascular surgery team has built a pragmatic answer to that reality: a year-long, post-hire fellowship-style onboarding that blends protected academic learning, interprofessional rotations, and mentored practice on the ward.