Welcome to 3P: Pills, Pearls, and Patients where we will discuss current events in medicine, stories from real patient-physician encounters, and gain insight into what it's like being a physician in today's society.
Please note that while the first episode is available to listen to without registration, accessing additional episodes will require you to subscribe and log in.
Hello and welcome to the next episode of 3P, Pills, Pearls and Patients. Today is Owning Osteoporosis: Part 2. So if you have not listened to Owning Osteoporosis: Part 1, I strongly recommend that you listen to that. As this is a follow-up to that episode.
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Dr. Marina Malak is a family physician in Mississauga, Ontario and a lecturer and faculty member at the University of Toronto. She is actively involved in medical advocacy, and is a board member of the Mississauga Primary Care Network. She is also a member of the National Committee of Continuing Professional Development at the College of Family Physicians of Ontario, and a member of the Research Ethics Board at Trillium Health Partners.
She is passionate about patient care; medical education; and promoting mental, physical, and emotional wellness. She enjoys reading, writing, public speaking, puzzles, doodling in her bullet journal, and creating drawings on Procreate.
is a Family Physician in Mississauga, Ontario. She has served on several committees and groups, including The Primary Care Network and Collaborative Mental Health Network. She has a passion for medical education, patient empowerment, and increasing awareness about the relationship between mental, emotional, and physical health. Dr. Abdel Malak is highly involved in quality improvement initiatives, and her research interests include strategies to support physician wellness, patient self-management, and optimizing physician education.
Abstract: Family physicians may work in walk-in clinics (WICs), or choose to follow their patients as a family practice, also known as primary care (PCP). In some cases, there are differences between the roles of both physicians: generally WICs are seen as being for urgent issues, whereas primary care is seen as dealing with chronic conditions. However, with the rise in patients without family physicians, many have had to rely solely on WICs for their ongoing care. This article explores the differences—and similarities—between both models, and suggests some strategies for navigating any disparities.
Key Words: walk-in physicians, primary care physicians.
WICs and PCPs both help patients with health concerns, but usually WICs are reserved (ideally) for urgent concerns
Patients should be encouraged to develop a relationship with a PCP so as to ensure long-term care and chronic conditions are managed
Strategic and focussed resource allocation will allow our family physicians to properly care for populations, regardless of what model they practice in
WICs are usually – and ideally – reserved for urgent care issues
Primary care is focussed on health promotion and illness prevention
Ideally, long-term relationships among physicians and patients should be established so as to maintain a high standard of care
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Hello and welcome to the Medical Narratives podcast with Dr. Michael Gordon. I'm Regina Starr. And in today's episode, we will continue our series on the top ten issues affecting the elderly. We are excited to present another informative episode on the topic of Forgetfulness and Mild Cognitive Impairment. This is a topic that affects many older adults and their families.
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RS: Hello and welcome to the Medical Narratives podcast with Dr. Michael Gordon. I'm Regina Starr. And in today's episode, we will continue our series on the top ten issues affecting the elderly. We are excited to present another informative episode on the topic of Forgetfulness and Mild Cognitive Impairment. This is a topic that affects many older adults and their families.
RS: As our population continues to age, it's becoming increasingly common for people to experience memory lapses and cognitive changes. According to the Alzheimer's Society of Canada, an estimated 10 to 15% of Canadians over the age of 65 have mild cognitive impairment. The prevalence of mild cognitive impairment increases with age, with studies suggesting that up to 25 to 50% of people over the age of 85 may also have it.
RS: It's worth noting that mild cognitive impairment can be difficult to diagnose, and some individuals may not seek medical attention for their symptoms. As a result, the true prevalence of mild cognitive impairment in the Canadian or North American population may be higher than reported. While forgetfulness can be a normal part of aging. It can also be a symptom of more serious conditions, such as mild cognitive impairment or even dementia.
RS: It's important for doctors to understand the nuances of forgetfulness and cognitive decline and to be able to provide patients with accurate information and effective interventions. Today, in my conversation with Dr. Gordon, he will shed light on this complex and often misunderstood topic. So let's get started. Hello, Michael. How are you?
MG: Good morning. I should say good afternoon. Fine, thank you.
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Dr. Michael Gordon recently retired after a fulfilling career as a geriatrician that spanned 56 years, 44 of which he spent working at the Baycrest Center in Toronto. He is Emeritus Professor of Medicine at the University of Toronto. Dr. Gordon is a recognized ethicist and a thought leader on all topics of care of the elderly and end-of-life decisions. Currently, Dr. Gordon provides part-time professional medical consulting mainly in the domain of cognition and memory loss.
Welcome to 3P: Pills, Pearls, and Patients where we will discuss current events in medicine, stories from real patient-physician encounters, and gain insight into what it's like being a physician in today's society.
Please note that while the first episode is available to listen to without registration, accessing additional episodes will require you to subscribe and log in.
Hello and welcome to the next episode of 3P, Pills, Pearls, and Patients. I'm your host, Dr. Marina Malak and today's episode is called Owning Osteoporosis. Osteoporosis can be an easy topic or a difficult topic, like all things in medicine.
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Dr. Marina Malak is a family physician in Mississauga, Ontario and a lecturer and faculty member at the University of Toronto. She is actively involved in medical advocacy, and is a board member of the Mississauga Primary Care Network. She is also a member of the National Committee of Continuing Professional Development at the College of Family Physicians of Ontario, and a member of the Research Ethics Board at Trillium Health Partners.
She is passionate about patient care; medical education; and promoting mental, physical, and emotional wellness. She enjoys reading, writing, public speaking, puzzles, doodling in her bullet journal, and creating drawings on Procreate.
1 Adult Spine Fellow, Division of Spine Surgery, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA. 2 Assistant Professor of Orthopaedic Surgery, Division of Spine Surgery, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
Abstract: Though they have significant morbidity and mortality, spine infections are a rare cause of back pain. Because they are uncommon, it is important to recognize the signs and symptoms of a spine infection, to establish the diagnosis, and to treat appropriately, guided by culture results, with antibiotic therapy. Surgical intervention is indicated in cases of significant neurologic deficit, significant spinal deformity, instability, and/or failed medical management.
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Patients with spine infections often present with back pain and may have radicular pain, neurologic deficits, or constitutional signs and symptoms of infection
Workup begins with laboratory studies including, CBC, CRP, and ESR
The gold standard for imaging is MRI
Definitive diagnosis may require CT-guided biopsy and culture
The mainstay of treatment is at least 6 weeks of antibiotic therapy guided by culture results
Surgical intervention is indicated in cases of progressive neurologic deficit or spinal deformity, instability, or failed medical management
Spinal infections can present insidiously
Refer early if patients present with back pain and unexplained fever
Prompt identification with MRI improves likelihood of recovery
Antibiotic treatment for 6 weeks is recommended
Surgery is useful for neurological deficit or instability
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
1Professor of Psychiatry (Emeritus), Queen's University, Canada.2Professor of Psychiatry and Ophthalmology (Emeritus) University of Toronto, Canada Director of the Youthdale Child & Adolescent Sleep Clinic and International Sleep Clinic Parry Sound Toronto, Canada. 3Clinical Psychologist, Sleep on the Bay, Toronto, Canada.
Abstract: There is increasing appreciation of the relevance of sleep to general well-being, especially for those with medical—including psychiatric—illnesses. This growing recognition of the relevance of sleep is reflected in the DSM-V guidelines. We endeavor to present a nuanced understanding and usage of sedative hypnotic medications in the management of insomnia. New medications that reduce wakefulness is also mapped out in this overview. In addition, we briefly discuss the intervention of cognitive behavior therapy for insomnia (CBT-I) as the mainstay of treatment for chronic insomnia.
Insomnia is a sleep disorder in its own right. It is no longer regarded as just a symptom. It calls for specific, targeted insomnia treatment, especially in situations where insomnia is comorbid with medical conditions.
Cognitive behavioural therapy for insomnia (CBT-I) produces moderate to large effects on insomnia measures when insomnia is comorbid with chronic medical conditions. It is the mainstay of treatment in most cases of chronic insomnia.
The use of hypnotics should be planned strategically. In general, short term hypnotic use should be the objective, but for many patients long term use may be necessary and appropriate.
The initial dose of sedative-hypnotics should be determined on an individual basis and titrated in accordance with the patients' needs. While too high dose is not desirable, too low a dose would result in under-treatment and is counter-productive.
Insomnia may become a chronic disorder and as such may necessitate long-term management. Prescribe carefully-chosen hypnotics for the requisite period and re-evaluate patients in follow up. Consider CBI-I as a treatment option, independently or in conjunction with pharmacotherapy.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
