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Unknown Origins of Syncope

Teaser: 

Dr. M.S. Alam, MD, MBBS, CCFP, FCFP

Clinical Lecturer, Cumming School of Medicine, Calgary, University of Calgary, Family Medicine Department, Calgary, AB.

CLINICAL TOOLS

Abstract: Syncope is generally categorized by such known causes as vasovagal syncope, situational syncope, postural syncope, neurologic syncope, postural-orthostatic tachycardia syndrome, and unknown causes. The unknown causes of syncope can be challenging to diagnose and treat since possible causes can range from benign to life-threatening. This article will focus on unknown cases with no evident cause.
Key Words: syncope, unknown causes, diagnosis, treatment.
Incidents of syncope with unknown origin can be challenging to diagnose and treat since possible causes can range from benign to life-threatening.
One of the challenges associated with diagnosing and treating syncope is the plethora of possible causes.
Concrete guidelines for syncope risk assessment would prove to be an invaluable tool in urgent and emergent care environments as well as in family medicine clinics. A standardized approach to syncope cases with unknown origin will improve patient care immeasurably.
No matter whether an incident involving syncope is benign or potentially high risk, any injury sustained should be addressed according to ATLS, ACLS, and PALS guidelines.
The ability to flag patients who are at high risk for morbidity and mortality, judicial use of diagnostic tools.
In 50 % of patients, the cause of a syncope incident will not be evident; a risk stratification (scoring) system ranging from low to intermediate to high would be beneficial.
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Related Terms: Cardio-Cerebrovascular, syncope, diagnosis, treatment, unknown causes
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JCCC 2019 Issue 5

Table of Contents

Cannabinoids and Low Back Pain

Teaser: 

Ted Findlay, DO, CCFP, FCFP

is on Medical Staff with the Calgary Chronic Pain Centre at Alberta Health Services, Calgary Zone in Calgary, Alberta.

CLINICAL TOOLS

Abstract:There is a great deal of interest in the use of cannabis-based products including medically authorized marijuana for the treatment of almost any pain condition including low back pain. There are many anecdotal reports of patients who found it an effective treatment for chronic low back pain, one that has allowed them in some cases to discontinue other treatments such as continuing opioid therapy. There is now easy legal access to cannabis-based preparations in Canada with or without medical authorization. However, with some notable exceptions, the evidence that would allow physicians to have a high degree of confidence in selecting this treatment modality is lacking.
Key Words: cannabis; chronic pain; low back pain; evidence.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. Compared to medically authorized cannabis, street sourced products are at high risk of contamination including insect remains, fungi, chemical fertilizers and herbicides.
2. Unlike most plant-sourced medications, the active ingredients are located on the cannabis leaf, which raises the risk of contaminant exposure.
3. Cannabis leaves by themselves are inert until heated in a process known as decarboxylation.
4. While inhaled cannabis has a rapid onset of action, ingested products have a delayed onset producing a risk of overdose if continuing to consume while waiting for an expected effect.
5. Little is yet known about potential drug interactions with cannabis use.
Cannabis authorizing physicians will often recommend a higher THC:CBD ratio product for evening or bedtime use, and a higher CBD:THC ratio or pure CBD for daytime use.
As is true for any potential intoxicant, patients need to be cautioned about the risks of operating a motor vehicle or any machinery while under the influence of cannabinoids, especially higher THC ratio products.
Because it is a lipid soluble chemical, urine, blood, or hair tests can detect THC for many days after use. Standardized tools and principles exist for the appraisal of credible eHealth resources.
Physicians in Canada provide medical "authorization" for cannabis use, verifying that the patient has a medical condition for which cannabis could be a valid therapeutic option. This authorization then allows the patient to purchase from a licensed producer up to a recommended quantity in grams per day. Although the basic patient demographics and birthday are required, unlike a prescription, the exact component percentage and potency, method of ingestion, and frequency are not components of the authorization.
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.
Related Terms: Back Health, Cannabis, chronic pain, low back pain, evidence
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JCCC 2019 Issue 4

Table of Contents

Electronic Health (eHealth) Solutions for Low Back Pain—The Present and The Future

Teaser: 

Dr. Eugene Wai 1 Dr. Pavel Andreev2 Alexander Chung3 Greg McIntosh, MSc4 Dr. Hamilton Hall, MD, FRCSC,5

1 is an associate professor in the Division of Orthopaedic Surgery at the University of Ottawa and is cross- appointed to the School of Epidemiology and Public Health. He is head of the University's Adult Spinal Surgery Program and is the medical lead for the region's ISAEC program. His research interests involve regional and systems-based strategies to improve physical activity in back pain.
2is an associate professor at the Telfer School of Management. His doctoral studies centered on the impact of information and communication technologies on activities such as telemedicine and e-learning. His current research program is developing methodologies that enhance healthcare practitioners care delivery.
3 is a PhD candidate at the Telfer School of Management. His research focuses on the use of behaviour change theories to anchor the design of digital technologies. Specifically, he is interested in designing systems to facilitate habit formation for users.4 completed his Masters in Epidemiology from the University of Toronto's Faculty of Medicine. He is currently the Director of Research Operations for the Canadian Spine Outcomes and Research Network.5is a Professor in the Department of Surgery at the University of Toronto. He is the Medical Director, CBI Health Group and Executive Director of the Canadian Spine Society in Toronto, Ontario.

CLINICAL TOOLS

Abstract:Electronic Health (eHealth) technologies for back pain care, including websites and mobile apps, are rapidly growing. Unfortunately, the clear majority are unregulated and not considered credible. Given this growth, clinicians require the tools to help their patients navigate through the "wild west" of options towards more trustworthy platforms. Artificial Intelligence and digital technologies anchored in behaviour change theories have the potential to further transform these eHealth platforms.
Key Words: Electronic Health (eHealth) technologies, back pain care, websites, mobile apps, artificial intelligence.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
The Canadian Agency for Drugs and Technologies in Health (CADTH) has published a summary for users entitled "Can you trust Dr. Google," and it recommends that users look at the Author, Date (current), Objectivity, Purpose, Transparency and Usability.
Clinicians should become familiar with several credible eHealth resources to recommend to patients when assisting with their self-management of back pain.
Electronic Health platforms have the potential to engage patients in the self-management of their back pain.
Most available eHealth options for back pain are considered unreliable and not credible; however, several government and professional societies are beginning to publish reliable and useful content for patients.
Standardized tools and principles exist for the appraisal of credible eHealth resources.
Artificial Intelligence and anchoring mobile health solutions in behaviour change theories may further improve eHealth platforms.
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.
Related Terms: Back Health, Electronic Health (eHealth) technologies, back pain care, websites, mobile apps, artificial intelligence
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Readdressing Recalcitrant Rashes: Alternate Approaches to Atopic Dermatitis

Teaser: 

Linda Yang, BSc,1Joseph M. Lam, MD, FRCPC,2

1 Faculty of Medicine, University of British Columbia, Vancouver, BC.
2Clinical Associate Professor, Department of Pediatrics, Associate Member, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC.

CLINICAL TOOLS

Abstract: Atopic dermatitis is a common pediatric disease with a chronic relapsing-remitting course, causing distress to patients and family. In patients who remain recalcitrant following treatment with topical steroids, adjunctive therapies including bleach baths, wet wraps and phototherapy as well as systemic immunosuppressants may be considered. Many novel therapies are in development and act on various aspects of the immunologic cascades involved in atopic dermatitis. The following review briefly summarizes up-to-date evidence for the use of these therapies in the pediatric population.
Key Words: atopic dermatitis, pediatric disease, therapies.
Topical corticosteroids, the first-line treatment for atopic dermatitis, can be optimized with usage of an appropriate amount and within a supportive, therapeutic alliance.
Those who fail to improve with topical corticosteroids may benefit from adjunctive treatment with wet wraps, bleach baths and phototherapy with narrowband UV therapy. These have been shown to be efficacious with a minimal side effect profile.
In those who remain recalcitrant, a brief course of immunosuppressants may be indicated. Methotrexate, azathioprine and cyclosporine have evidence in the pediatric population. Of these, methotrexate has been shown to have the most sustained duration of remission.
A recent explosion of novel immunomodulators and biologics may redefine atopic dermatitis treatment. Crisaborole is a topical PDE4 inhibitor, which has been approved for used in children. Dupilumab is an injectable monoclonal antibody, which has recently been approved for the adult population and remains off-label in pediatrics.
Monotherapy when possible and regular check-ins with parents can improve adherence to topical steroid regimens, particularly within the first 3 days of treatment.
The American Academy of Dermatology recommends the use of bleach baths (1/2 cup of 6% household bleach in a 150L bathtub full of water) for 5 to 10-minute intervals 2-3 times weekly as an adjunct to topicals.
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.
Related Terms: Dermatology, atopic dermatitis, pediatric, therapy
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