Things to know up front before reading the article
Abbreviations
Presentation
Clinical: (history and exam)
Lab/imaging findings:
Pathophysiology
Diagnosis:
Criteria / approach
Differentials
Investigations:
Management:
Usual:
Special circumstances:
Natural history / prognosis:
Patient resources:
Factoids:
Quiz yourself:
Further Reading:
clinical guidelines
other sources
Authors:
Primary: list
Reviewers: list
Editor: list
Conflicts of interest
Other topic content specifics:
Not all topics will fit this general structure, and it is meant as a general scaffold. If you look at this article, you can see how the structure can be deviated (but the content remains comprehensive)
Pearls, tips, pitfalls, etc. should be intermixed throughout the topic -- ideally, the page is not just a solid mass of bullet points
Where possible, especially for more recent changes to guidelines, please include references. If a fact is obviously self-evident (ie. INCS is used to treat allergic rhinitis), it does not need a citation; however, a specific point-estimate should have one. This is somewhat subjective; confer with the editors and staff during the review period if questions arise
References should be in Vancouver format. If you are writing your rough draft in Google Docs, please use a citation manager -- having the correct numbers for in-text citations makes it MUCH easier to port the references to the website
If there are particular references that are very high yield, feel free to include a small blurb about them (it will show up in the reference icon, as such: 2)
If you need to list a specific prescription, format as "ExRx: Nasonex 2 sprays EN BID" (ExRx = Example Prescription)
If possible, you can also list a 'med-popup' linking to a relevant medication card. For example:
Rx
Bilastine
Brand Names:
Blexten
Routes:
10/20mg PO tab, 2.5mg/ml liquid (uncommon)
MoA:
2nd generation H1 receptor antagonist
Half-life:
~15 hours
Time to peak action:
~1h, rapid absorption
Doses:
CSU, AR: 20mg PO OD to QID (≥12 years old)
CSU, AR: 10mg PO OD to QID (4-11 years old)
Cost:
~$1.1 CAD / 20mg tab (ON)
Coverage:
ON (ODB)
Age Group:
≥4 years old
Pregnancy:
Avoid (not enough data)
Contraindications:
Hypersensitivity, QT prolongation or history of torsades
Common SEs:
QT prolongation (at 100mg ODx4, max mean increase 6ms); drowsiness (4%); headache (4%). For reference, drowisness/headache had a 2% incidence rate in placebo arm
Theoretically does not cross BBB; less sedating than other AHs
No renal adjustments needed; minimal data with hepatic impairment but not expected to cause issues
Going beyond OD is technically off-label
Take without food or juice otherwise absorption impaired
If possible for key management options, there should be a 'drop box' for a deeper dive into the evidence: specifically, any relevant point estimates that would be useful for patient counseling. For example:
DEEP-DIVE: Efficacy of INCS in CRSwNP
Here you would put the evidence behind a study (ideally a systematic review or meta-analysis) that contains data relevant to patients2
What's the bottom line of the research?
What outcomes were studied, and population?
What are relevant concrete data points?
Is this evidence "strong"? This is a very nuanced point (and there are frameworks such as GRADE for this). You shouldn't spend a LOT of time on this up-front; while interpretation of complex research is crucial, it's not the main point of this project
Macros
Macros exist at the top of the topic page. While not all topics need a macro, most will. It has 2 sections:
relevant HPI
Family doctor focused blurb about the condition (ie. pathophys, prognosis), investigations, management recommendations
Example:
nasal congestion/fullness
facial pain/pressure/fullness
anterior or posterior nasal drainage (?purulent)
hypo/anosmia
change in voice
cough
headache
fatigue/disruption of sleep
halitosis/dental pain
ear pain/fullness
duration
CT/ENT before? Known nasal polyps?
? asthma/COPD, AR, CF, NERD/ASA sensitivity, recurrent infect, EtOH induced worsening of upper airway disease, impaired cilia(CF, PCD), smoking, pollution, occupational exposure, nasal anatomic variations, vasculitis
Treatment trials
SNOT-22 Score
# Chronic rhinosinusitis (CRS) wNP sNP AFRS
Their clinical picture is suggestive of CRS, an inflammatory syndrome defined by objective structural evidence of sinus inflammation and ≥2 cardinal symptoms (nasal congestion, facial pain/pressure, anterior/posterior nasal drainage, absent/reduced smell) ≥12 weeks. While chronic, regular pharmacotherapy can usually control symptoms well.
Recommendations:
- CT sinuses (non-contrast) vs ENT referral
- SPT for common aeroallergens
- Ad-hoc testing: ie. B-cell immunodeficiency workup in setting of suspicious symptoms / acute recurrent sinusitis
- High volume nasal saline rinses, avoidance of triggers
- INCS + treatment of any underlying causes
- Consider short course prednisone for symptom management (most evidence for CRSwNP or AFRS)
- Consider oral antibiotics for acute exacerbations (controversial)
- Consider biologics for CRSwNP if severe/failed first-line therapy
- Follow-up: ~3-4 months
Patient handouts/resources
If applicable, each topic should have an accompanying printable patient resource: see this example.
It should be written at a 6th grade level or lower
Use of tables, diagrams is highly encouraged
Often, use of LLMs such as ChatGPT are quite helpful at this stage to reword with simpler language
Styling of topic pages
Don't just use plain-text
Within a topic page, there are many ways to customize the text: in particular, Markdown and Shortcodes.
Markdown
See this link for a great introduction to the Markdown format
For your purposes, you do not have to know Markdown itself very well -- it is more important you know that the website renders Markdown. This means that you are able to use italics, bolded words, strike-through-text, and links such as the one before. Lists and bullet points will also render as you expect. Different title headers can be achieved with # signs
Make good use of highlights as well
You can also make tables in Markdown, though they do not look the best and cannot be too complicated:
Name
Comment
Alice
Always involved in various communications
Bob
A good guy, who likes to communicate with Alice
Malroy
Not so nice guy. Tries to mess with the communication of Alice and Bob.
This doesn't mean we can't accommodate more complex tables (ie with nesting), but it does mean Josh/editors need to manually code it in
Shortcodes
Shortcodes are custom pieces of styled HTML (and sometimes JavaScript). You can use any of the shortcodes below as you like for a topic
Each can serve a different purpose, and helps break up plain-text into more manageable sections
You don't have to know how to implement them -- one of the editors who knows how to code will do it for you. Just indicate in your draft document what shortcode you want, and the information you need in it. If you're interested in the actual code, check out the GitHub
Admonitions
Admonitions are boxes that are intended to highlight an important fact for the reader. There are a variety of styles and icons that can be used. Options for type/icon: note, tip, info, warning, danger, and pearl. These can be mixed and matched. The title of each admonition can be changed to any text.
DANGER
This is a danger admonition with a danger icon, and the title DANGER.
WARNING
This is a warning admonition with a warning icon, and the title WARNING.
INFO
And so forth.
TIP
And so forth.
NOTE
And so forth.
PEARL
And so forth.
MIXUP
This is a note admonition with a question icon and the title MIXUP.
Question
Insert questions with hidden answers. Click the blurred section to reveal it.
QUESTION
A 27 year old female presents to clinic with complaints of frequent infections. She has had 3 episodes of pneumonia confirmed by XR over the past 3 years as well as 2 episodes of sinusitis requiring a short course of antibiotics. She has no relevant family history and no symptoms of asthma or SOB. What is the most appropriate test to consider?
a) Serum immunoglobulins b) Blood cultures
text_image
Sometimes you want to show an image and text to one side of it. You have two options:
Here is some text on the left.
QUESTION
Can you also add questions on the side?
test caption
Here is some text on the right.
You can add admonitions here too!
This is helpful if there's something you really want to call someone's attention too!
test caption
two_columns
Sometimes you want two columns to place text in.
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum
You can add admonitions here too!
This is helpful if there's something you really want to call someone's attention too!
A rare clinical pearl
Benadryl is not a fantastic antihistamine to use :)
references
References are embeddable! All you need to do it prepare references like you normally do with a bibliography in Vancouver style, and the editor will implement the rest. For example:
This sentence needs two references 1,2. Here is another sentence with one reference 3.
... rest of document
×
1. Netting MJ, Campbell DE, Koplin JJ, et al. An Australian Consensus on Infant Feeding Guidelines to Prevent Food Allergy: Outcomes From the Australian Infant Feeding Summit. Journal of Allergy and Clinical Immunology: In Practice. 2017;5(6):1617-1624. doi:10.1016/j.jaip.2017.03.013.
Link.
2. Khan DA, Banerji A, Blumenthal KG, et al. Drug allergy: A 2022 practice parameter update. Journal of Allergy and Clinical Immunology. 2022;150(6):1333-1393. doi:10.1016/j.jaci.2022.08.028.
Link.
3. Another reference here with its own details..
Link.
custom_macro
You can create custom copy-paste macros if you need to.
Here is a custom macro copy paste section
load_macro
You can also load any macros from the offical macro 'repo' here
nasal congestion/fullness
facial pain/pressure/fullness
anterior or posterior nasal drainage (?purulent)
hypo/anosmia
change in voice
cough
headache
fatigue/disruption of sleep
halitosis/dental pain
ear pain/fullness
duration
CT/ENT before? Known nasal polyps?
? asthma/COPD, AR, CF, NERD/ASA sensitivity, recurrent infect, EtOH induced worsening of upper airway disease, impaired cilia(CF, PCD), smoking, pollution, occupational exposure, nasal anatomic variations, vasculitis
Treatment trials
SNOT-22 Score
# Chronic rhinosinusitis (CRS) wNP sNP AFRS
Their clinical picture is suggestive of CRS, an inflammatory syndrome defined by objective structural evidence of sinus inflammation and ≥2 cardinal symptoms (nasal congestion, facial pain/pressure, anterior/posterior nasal drainage, absent/reduced smell) ≥12 weeks. While chronic, regular pharmacotherapy can usually control symptoms well.
Recommendations:
- CT sinuses (non-contrast) vs ENT referral
- SPT for common aeroallergens
- Ad-hoc testing: ie. B-cell immunodeficiency workup in setting of suspicious symptoms / acute recurrent sinusitis
- High volume nasal saline rinses, avoidance of triggers
- INCS + treatment of any underlying causes
- Consider short course prednisone for symptom management (most evidence for CRSwNP or AFRS)
- Consider oral antibiotics for acute exacerbations (controversial)
- Consider biologics for CRSwNP if severe/failed first-line therapy
- Follow-up: ~3-4 months
contributors
A small cut-out for contributors. This may be removed in the future.
Authors:Alice Smith,
Bob Johnson
Editor:Charlie Brown
Staff Reviewer:David Lee
timeline
Lorem Ipsum Event
Lorem Ipsum is simply dummy text of the printing and typesetting industry.
Lorem Ipsum event 2
Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged.
dropdown
Dropdowns are useful if you want to host information in more depth without taking up more space. For example, deep dives into the evidence behind a management option, listing the detailed options for a particular class of medication, etc.
this is what the user will click on to get more info
mermaid diagrams are interesting to use but not mandatory. If you want to explore and use these, check out their documentation.
{% mermaid() %}
sequenceDiagram
Alice ->> Bob: Hello Bob, how are you?
Bob-->>John: How about you John?
Bob--x Alice: I am good thanks!
Bob-x John: I am good thanks!
Note right of John: Bob thinks a long<br/>long time, so long<br/>that the text does<br/>not fit on a row.
Bob-->Alice: Checking with John...
Alice->John: Yes... John, how are you?
{% end %}
sequenceDiagram
Alice ->> Bob: Hello Bob, how are you?
Bob-->>John: How about you John?
Bob--x Alice: I am good thanks!
Bob-x John: I am good thanks!
Note right of John: Bob thinks a long<br/>long time, so long<br/>that the text does<br/>not fit on a row.
Bob-->Alice: Checking with John...
Alice->John: Yes... John, how are you?