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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

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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.

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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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Goal-setting in the Office: Tips for Success

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:Empowering patients to set health-directed goals can be a challenging process. The skilled clinician successfully supports patients in setting goals that are SMART (specific, measurable, achievable, realistic/relevant, and time-related). When goals are made in collaboration with patients, they are more likely to be long-lasting and impactful. This article will focus on how physicians can work with patients to identify, create, and work towards meaningful interventions that optimize health.
Key Words: motivation, behaviour changes, counselling, goals, treatment.

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.

Goal-setting should be a partnership between physicians and patients
Asking patients what THEY want—and can—change in their lives/health is the first step to eliciting what behaviours can be targeted
After goals are set, it is important for physicians to reassess patients' progress by asking them if goals were met, and why or why not. When success occurs, patients should be congratulated on their achievements. If the goals were not met, physicians should seek to understand why this occurred, and work with patients to create new goals that are more realistic or achievable
Physicians should motivate patients to set goals that are SMART (specific, measurable, achievable, realistic/relevant, and time-related)
Patients are more likely to adhere to behaviours, habits, or interventions if they feel understood, supported, and empowered
Supporting patients in achieving goals that optimize health can have significant impacts on patient wellness, self-esteem, functioning; and strengthens the physician-patient relationship
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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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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.

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.
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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.

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.
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