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Virtual Care for Low Back Pain Patients

Teaser: 

Ted Findlay, DO, CCFP, FCFP,1 Dr. Hamilton Hall, MD, FRCSC,2

1 is on Medical Staff with the Calgary Chronic Pain Centre at Alberta Health Services, Calgary Zone in Calgary, Alberta.
2 is 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:The COVID-19 global pandemic has had a rapid and massive impact on health care delivery worldwide. Two of the first public health measures applied in Canada and most other developed nations have been some variety of social distancing and "stay at home" orders, which limit the ability of patients to access non-urgent health care services. Patients with chronic pain including low back pain comprise some of the most disadvantaged populations where ongoing support from their family physician is an essential aspect of management. Virtual patient care has rapidly become one of the primary means to deliver of non-urgent management and is, in many ways, ideally suited for the support of chronic low back pain patients. It will continue to be used not only until face to face appointments are again permitted but may become a permanent feature of continuing care.
Key Words: COVID-19; virtual care; video appointments; low back pain; communication.

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

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1. Virtual patient care is not a new concept, but its use has been accelerated due to the COVID-19 pandemic.
2. Even pre-dating the COVID-19 pandemic, organized medicine in Canada has come out strongly in favor of the delivery of health care by virtual means.
3. There are many on-line resources that can be accessed by patients to help manage their low back pain during pandemic limitations on direct patient contact.
4. Positive patient identification and documentation of consent are requirements for virtual care delivery.
5. Both the physician and the patient have a role to play in ensuring appropriate privacy for the virtual visit.
Have your patient download and test any required communications software prior to their virtual appointment.
Commercial video communication software can be compliant with provincial personal privacy and information protection laws, check with your provincial medical association and/or provincial College of Physicians and Surgeons to be certain that approved software is being used.
Have the patient perform any required clinical measurements and list current medications and any required refills prior to the start of the virtual appointment.
Make sure that unidentified number call blocking does not prevent the virtual appointment from being completed.
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Osteoporosis Prevention: What can we tell patients?

Teaser: 

Dr. Marina Abdel Malak

is a Family Medicine Resident at the University of Toronto. She graduated and completed her Bachelor of Science in Nursing and went on to study Medicine. She has a passion for medical education, patient empowerment, and increasing awareness about the relationship between mental, emotional, and physical health.

CLINICAL TOOLS

Abstract:Osteoporosis (OP) is the leading cause of hip fractures in patients. Primary prevention focusses on engaging in strategies that prevent the development of osteoporosis. Physicians often provide health information to patients on how to optimize their overall wellness, and therefore, ought to educate patients on bone health as well. Offering advice on specific interventions that decrease the risk of developing OP is an effective way to engage patients in maintaining peak bone mass. Physicians should counsel patients on key points such as dietary modifications, physical activity, and decreasing the use of alcohol and smoking. Setting mutual goals with patients and ensuring that they understand the positive impact this will have on their health is critical.
Key Words: Osteoporosis, bone health, health promotion, primary prevention, education.

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.

1) Educating patients about methods to decrease the risk of osteoporosis is a critical role of the physician, as peak bone mass develops in early adulthood
2) CALCIUM (see figure 4) is a mnemonic that can help physicians recall what strategies they can address with patients: calcium/vitamin D intake, aerobic activities, limit alcohol, cut down on smoking, increase balance, use supplements if indicated, and maintain a healthy weight
3) Physicians should provide patients with resources and referrals if appropriate to ensure patients receive adequate information/support in promoting their bone health
Patients should be advised that a vitamin D supplement is required to obtain the 1000-2000 IU daily requirement
A calcium supplement is not always indicated if dietary intake is adequate
Both aerobic and weight-bearing activities are essential for OP prevention
Smoking cessation and limiting alcohol are also factors that impact bone health
Patients should be encouraged to mutually set goals around bone health with their physicians, as this increases the likelihood that their behaviour changes will be successful
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The Non-Operative Management of Scoliosis

Teaser: 

Brett Rocos, BSc (Hons), MB ChB, MD, FRCS (Tr & Orth),

Paediatric Spine Fellow, The Hospital for Sick Children, Toronto, ON.

CLINICAL TOOLS

Abstract:Scoliosis is a common condition that every primary care provider will encounter. There are many treatments available in its management, including observation, physical therapy, pain management strategies, casting, bracing and surgery. In this narrative review, the roles of each of the non-operative strategies in managing adult and paediatric scoliosis are explored, and the evidence supporting each is summarised. Scoliosis affects people at every stage of life, and an understanding of the treatments available will aid in counselling patients and making appropriate referrals.
Key Words: Scoliosis, conservative, paediatric, bracing, physiotherapy, alternative therapies, spine cast.

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

www.cfpc.ca/Mainpro_M2

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• Scoliosis is common
• Most patients require observation only
• Patient information is essential
• Casting and bracing have roles in the growing skeleton only
• Physical therapy has limited evidence in both adult and paediatric deformity
• Alternative therapies have no proven use in the management of scoliosis
The majority of patients with scoliosis can be observed
Reliable patient information is critical
There is limited evidence that physiotherapy is effective, and no evidence that alternative therapies are effective in treating scoliosis
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What is Athletic Heart Syndrome?

Teaser: 

Dr. Alykhan Abdulla, BSC, MD, LMCC, CCFPC, DipSportMed CASEM, FCFCP, CTH (ISTM), CCPE, Masters Cert Phys Leader, ICD.D

Assistant Professor University of Ottawa Faculty of Medicine, Academic Clinical Professor University of Ottawa Faculty of Nursing Medical Director The Kingsway Health Centre, The Kingsway Travel Clinic, The Kingsway Cosmetic Clinic, Beechwood Medical Cosmetic Physio Pharmacy, Editor in Chief/Author Journal of Current Clinical Care SPORTS MEDICINE, Vice Chair Section of General and Family Practice Ontario Medical Association, Board Director Eastern Ontario Regional Lab Association, Bruyere Foundation

CLINICAL TOOLS

Abstract: A common term for an enlarged heart that is associated with repeated strenuous exercise is athletic heart syndrome (AHS). This article reviews AHS, other serious conditions that appear similar to AHS, and how to identify a young athlete at risk for sudden cardiac death.
Key Words: athletic heart syndrome, enlarged heart, strenuous exercise, sudden cardiac death.
The changes in heart structure and function seen in athletic heart syndrome would suggest illness if seen in non-athletes.
When abnormalities in heart structure or function are detected in an athlete, it is important to ensure the abnormalities are indeed due solely to exercise conditioning, and not to a cardiac disorder.
Consider a clinical history of drug abuse, the use of anabolic steroids, recent viral infections and very tall athletes with arachnodactily or an arm span greater than their height.
Clinically suspicious athletes need to go for further testing.
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Navigating the COVID-19 Pandemic as a Healthcare Provider

Teaser: 

Dr. Marina Abdel Malak

is a Family Medicine Resident at the University of Toronto. She graduated and completed her Bachelor of Science in Nursing and went on to study Medicine. She has a passion for medical education, patient empowerment, and increasing awareness about the relationship between mental, emotional, and physical health.

CLINICAL TOOLS

Abstract: The COVID-19 pandemic is an unprecedented situation. Feelings of isolation, uncertainty, fatigue, and a loss of control have created stress among individuals across the world. Healthcare providers are in a position where they must balance their personal, familial, and work obligations during the pandemic. As frontline workers, healthcare providers are particularly vulnerable to the physical, mental, emotional, and social stressors encountered during crises. This can contribute to burn out, physical illnesses, and dissatisfaction. It is therefore essential that healthcare providers are supported in acknowledging and normalizing these feelings, and accessing resources to help them cope. To maintain social distancing and provide around-the-clock services, there are a variety of online resources available to support healthcare providers during this time. By utilizing various coping skills and seeking support, healthcare providers can protect their mental, emotional, physical, and social (MEPS) health during the COVID-19 situation.
Key Words: COVID-19, pandemic, wellness, physical health, resilience.
The COVID-19 pandemic has created a level of uncertainty, fear, and distress across the world. Feelings of isolation, anxiety, and stress are normal during this time.
Healthcare providers are, in particular, are faced with difficult decisions and situations in the COVID-19 crisis. Balancing personal, familial, and work obligations can be extremely challenging.
Mental, emotional, physical, and social health (MEPS) are equally important. As healthcare providers, we cannot take care of others if we do not care for ourselves first.
Various resources are available to help healthcare providers during the COVID-19 pandemic. Developing and utilizing a range of coping tools can promote MEPS health.
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Development and Implementation of a National Canadian Spine Surgery Registry

Teaser: 

1Greg McIntosh,2Dr. Michael Craig, 3Dr. Charles Fisher,

1Director of Research Operations, Canadian Spine Outcomes and Research Network.
2Neurosurgery Resident at Vancouver General Hospital, University of British Columbia. 3Professor and Head of the Division of Spine Surgery, Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia.

CLINICAL TOOLS

Abstract:The goal of the Canadian Spine Outcomes and Research Network (CSORN) is to develop a registry for Canadian orthopaedic and neurosurgical spine surgeons to participate in prospective multi-centre trials and retrospective reviews utilizing multivariable analyses. The design allows ongoing research and contains clinical details necessary for epidemiological assessment. Currently, 21 hospital sites, representing 9 provinces, participate CSORN. A total of 81 investigators have enrolled over 11,000 spine patients; 78% thoracolumbar and 22% cervical. Predictive models, effectiveness of surgical procedures, wait time issues and patient-surgeon expectations are some of the specific topics already published with CSORN data.
Key Words: registry, spine surgery, data quality, outcomes.

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.

Collection, feedback and publication of registry data is now a recognized way of informing clinical practice, driving quality improvement and improving patient outcomes.
The Canadian Spine Outcomes and Research Network (CSORN) is a multicentre national initiative that prospectively enrols consecutive patients with spinal pathology requiring surgical treatment.
The CSORN registry is designed to assess the value of operative techniques on patient outcomes.
Both patients and providers can feel powerless to enact any real change over the healthcare system. Patient participation in a properly designed registry gives them the opportunity to contribute to improving healthcare delivery.
The need for documentation of clinical outcomes is as important in spinal surgery as it is in other medical specialties.
If the value of spine surgery is not well established, then the cheapest options, rather than potentially better ones, are more likely to be endorsed.
Registries require fewer resources and often avoid the constraints of randomized clinical trials; as a result, registry findings usually have strong external validity and generalizability.
Collecting quality of life and patient-reported outcome measures data are essential for treatment evaluation.
Patients (and their physicians) should not fear participation in well-designed registries.
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Percutaneous Vertebral Augmentation for the Treatment of Pathological Fractures of the Spine

Teaser: 

Ayoub Dakson, MBChB, MSc, FRCSC,1 Sean Christie, MD, FRCSC,2

1Clinical Fellow, Department of Surgery (Neurosurgery) QEII Health Sciences Centre, Halifax, Nova Scotia.2Professor, Department of Surgery (Neurosurgery), QEII Health Sciences Centre, Halifax, Nova Scotia.

CLINICAL TOOLS

Abstract:Pathological vertebral fractures (PVFs) occur commonly due to osteoporosis or a metastatic lesion to the spine, and present with acute back pain and loss of independent ambulation. Appropriate clinical assessment and radiographic evaluation are required to ensure optimal patient selection for a percutaneous vertebral augmentation procedure (PVA). This review explores the pathogenesis of PVFs and the efficacy of PVA in improving pain-related outcomes as well as health-related quality of life scores in both osteoporotic and metastatic PVFs.
Key Words: Osteoporosis; pathological vertebral fractures; vertebroplasty; kyphoplasty.

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.

Pathological vertebral fractures occur commonly due to osteoporosis and metastatic disease to the spine.
Percutaneous vertebral augmentation procedures consist of vertebroplasty or balloon-kyphoplasty with the goals of increasing the strength of fractured vertebral body and restoring its height in order to alleviate back pain and increase ambulation.
Balloon-kyphoplasty has been shown to improve back pain associated with PVFs and health-related quality of life scores.
Appropriate consideration of ''red flag'' features in the clinical history and neurologic examination of a patient with back pain is crucial in screening for a potential sinister underlying etiology (i.e. malignant pathological vertebral fractures with spinal cord compression, infection, etc.).
MRI imaging (STIR) may provide useful information in deciding if the fracture has already healed.
Loss of the integrity of the dorsal wall of the fractured vertebral body increases the risk of leakage of the injected cement into the spinal canal, potentially causing spinal cord compression.
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How to Understand and Prevent Knee Injuries in the Female Athlete

Teaser: 

Dr. Aly Abdulla, MD, CCFP, FCFP, DipSportMed CASEM, CTH, CCPE, McPL,

is a family doctor with specialties in sports medicine, palliative care, and cosmetic medicine. He can be found on Twitter, LinkedIn and https://ihopeyoufindthishumerusblog.wordpress.com/

CLINICAL TOOLS

Abstract: Knee injuries in female athletes is more common than in male athletes. There are many theories. Using these theories, prevention strategies are provided to ensure the incidence of such injuries decrease over time.
Key Words: knee injuries, athletes, prevention, exercise.
The incidence of significant knee injury among females is five times higher per player hour than for males.
Investigation shows that a large proportion of female knee injuries are non-contact.
Poor eating habits and eating disorders are more common in females so review this in prevention.
It is best to wear low heels to reduce weakening calf muscles and hamstrings.
Consider strength training to aerobic training at 50/50 and doing stretching after strength training.
Practice proper landing techniques with pliometrics, deceleration training and proprioceptive techniques.
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Caregivers Creating a Safe Home for Those with Dementia

Teaser: 

Holly Clark, Holly Clark is a freelance writer and works as a content manager for various international brands. When Holly is not researching and writing she loves nothing more than heading out into the country for some downtime. Holly is currently writing for Be in Health at https://www.beinhealth.com/

Caring for someone with dementia is never easy. In fact, many people often ask for support from other individuals who are also taking care of dementia patients. The first thing you should do is make some modifications in your home. People with dementia often see the world as a new and confusing place. Things can be scary every day. Therefore, it helps to adjust the environment to suit their needs and make them feel as comfortable as possible. Here is a guide on how individuals can create a danger-free home for those with dementia.

Ask for Guidance from Local Aging Agency

Often, these professionals have experience in taking care of people with Alzheimer's or other diseases related to dementia. They can recommend certified aging experts to come inspect your house and advise accordingly on safety issues in your home. It, therefore, helps to give them a call before modifying your house.

Inspect Areas of Your House That May be Unsafe
Check out areas in your house that you suspect may compromise the safety of your loved one. And when doing that, it helps to inspect them from the patient's point of view. So you have to remember that this condition affects one's balance, cognitive abilities, memory as well as perception. According to Jane Byrne, Project Coordinator at FirstCare nursing home Wicklow, "Someone with this condition has a difficult time interpreting and remembering information as well as making sound decisions." It, therefore, helps to modify your house in a way that will give them an easy time. And when doing that, you also should be careful. Redecorating or redesigning your home and other significant changes can be unsettling. On the other hand, simple moves like furniture rearrangement can also be alarming. Therefore, be cautious and give them time to adjust.

Follow the AARP Checklist for Home Safety
For those who don't have any idea on where to start, having this list will be useful. It outlines all the safety measures caregivers should take in order to make a home danger-free for loved ones with dementia. This list will serve as a guide on how to create a safe environment. Some of the things homeowners are advised to do, include:
Decluttering the walkway of any substance. Even if there is ice, snow, or debris, individuals should make sure it is removed. It's essential that you move bikes, chalks, lawn ornaments, or jump ropes to other rooms.

Marking Step Edges Using Neon Glow in the Dark Tape

Providing sufficient lighting, both indoors and outdoors. Sometimes people with dementia may perceive shadows as demons or burglars. Placing bright outdoor lighting, therefore, helps reduce falls, fear, as well as anxiety.

Repairing uneven bricks or cracked pavements as they serve as tripping points.

Designate a Danger Zone
Dementia people forget how things are used quickly. They can even drink wiper juice or touch a hot grill with bare hands. Therefore, individuals should convert one room, either the garage or outdoor shed, into storing substances such as sharp knives, as well as cutters, bleach, washing products, paint, insecticides, and other substances that might be confused. It also helps to have a combination of locks on rooms that contain hazardous items.

Creating a safe home for seniors with dementia is about identifying areas in your house that may pose dangers and modifying them so that they're safe. It also helps that individuals do a pantry patrol regularly since patients may eat spoiled or moldy foods.

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An Evidence-Based Approach to the Neck Assessment

Teaser: 

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH1 Pierre Côté, DC, PhD2 Dr. Hamilton Hall, MD, FRCSC3

1is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor. 2Professor and Canada Research Chair in Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT); Director, UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC). 3 is 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:Neck pain is a common musculoskeletal condition that frequently resolves spontaneously or with conservative treatment and only occasionally requires surgical intervention. The purpose of the neck examination is to determine if the etiology is neurological or mechanical pain, which determines treatment planning, and then to rule out red flags. There is good evidence that on examination clinicians cannot reliably differentiate specific anatomical structures but they should still perform a focused clinical examination to locate typical pain on movement and establish the neurological status. Base treatment on exercise, activity management and pain control.
Key Words: neck, examination, treatment, differential diagnosis.

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

www.cfpc.ca/Mainpro_M2

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If your patient is presenting with symptoms of systemic disease, deteriorating neurological status or focal severe pain, initiate further investigations and or referral.
Once red flags have been ruled out, neck pain will fall into two categories: neurological or mechanical pain.
Range of Motion testing should be done in 3 specific planes; flexion-extension, lateral flexion and rotation. Moving the neck in circles does not provide useful clinical information.
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