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#43: The Future of Medicine, Part 5

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.

  Back to Pills, Pearls & Patients (3P)

Welcome to the next episode in our series of what the Future of Medicine holds.

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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.

Symptomatic Lumbar Canal Stenosis—A Review and Primer on Surgical Decision Making

Teaser: 

Sager Hanna MB, BCh, BAO, 1 Perry Dhaliwal MD, MPH, FRCSC,2

1Section of Neurosurgery and Section of Orthopedic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba.
2Assistant Professor of Neurosurgery, Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba.

CLINICAL TOOLS

Abstract: Lumbar canal stenosis is an anatomical term used to describe narrowing of the spinal canal either congenitally or from age-related degenerative changes. It refers to a structural finding that may or may not be symptomatic. A decrease in canal diameter can lead to compression of the neural components, causing a constellation of symptoms. Family physicians should familiarize themselves with the various presentations of canal narrowing and the available diagnostic and treatment options.
Key Words: lumbar spinal stenosis, neurogenic claudication, back pain, radiculopathy.

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. Lumbar spinal stenosis is commonly caused by age-related degenerative changes involving the intervertebral discs, ligamentum flavum and facet joints.
2. Patients with lumbar spinal stenosis may present with neurogenic claudication or radiculopathy.
3. The primary care provider needs to distinguish between symptomatic lumbar spinal stenosis and other common mimics.
4. Surgical treatment is principally decompression of the neural elements with the possible addition of fusion of the affected levels.
1. Degenerative changes in the lumbar spine can lead to various symptoms such as low back pain, lumbar radiculopathy, neurogenic claudication, and cauda equina syndrome.
2. Imaging of the lumbar spine should be ordered when there is a high clinical suspicion of lumbar spinal canal stenosis based on the history and physical examination.
3. Initial management of patients presenting with lumbar canal stenosis involves non-operative modalities like pharmacological therapy, physiotherapy, lifestyle modifications, patient education and image-guided injections.
4. Surgical decompression for symptomatic lumbar spinal stenosis, with or without fusion, is generally indicated when symptoms significantly interfere with daily activity and non-operative treatment has failed after 3-6 months.
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, lumbar spinal stenosis, neurogenic claudication, back pain, radiculopathy

#11: Stroke Imaging in Primary Care

Welcome to Inside Radiology: A Primary Care Perspective where we explore the world of radiology and its applications in primary care.

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.

  Inside Radiology: A Primary Care Perspective

Hello and welcome to Inside Radiology: A Primary Care podcast. I'm your host, Dr. D'Arcy Little and today we're going to be reviewing a topic regarding Stroke Imaging in Primary Care.

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Welcome to Inside Radiology: A Primary Care Perspective podcast! I'm Dr. D'Arcy Little, your host. As a community radiologist and former family physician, I'm passionate about empowering primary care doctors with the knowledge and insights they need. With my unique perspective, I aim to bridge the gap between primary care and radiology, presenting the complexities of radiology in a way that resonates with you. My goal is to equip you with tools to enhance patient care and decision-making. Join me on this educational journey as we explore the world of radiology, tailored for primary care physicians like you. Together, let's elevate primary care radiology.

#42: The Future of Medicine, Part 4

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.

  Back to Pills, Pearls & Patients (3P)

Welcome to the next episode of our series on what the Future of Medicine holds. Today I want to talk about how quality improvement and research has changed over time in medicine.

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No applauses yet

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.

Collodion Baby

Teaser: 

Dylan Hollman,1Ou Jia (Emilie) Wang,2 Joseph M. Lam, MD, FRCPC,3

1Faculty of Medicine, University of Alberta.2 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
3Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

CLINICAL TOOLS

Abstract: Collodion baby, estimated to occur in 1 in 100,000 newborns, is a visually striking clinical presentation seen in neonates that is often a sign of an underlying autosomal recessive congenital ichthyosis. The baby is wrapped in a taut, translucent membrane, which is often compared to plastic wrap, saran wrap, a cocoon, or armour. A formal clinical diagnosis is often not reached until shedding of the membrane reveals the underlying phenotype. This can be isolated or associated with other structural and systemic congenital abnormalities. Patients may require ongoing monitoring and sometimes surgical intervention. Collodion baby is a rare and challenging condition that requires multimodal management including dermatologic care, infection prevention, nutritional support, developmental monitoring, and procedural interventions, if needed.
Key Words: Collodion baby, ichthyosis, neonate, newborn, pediatrics, dermatology.

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
Collodion baby is both a diagnosis and a clinical manifestation in newborns who commonly have autosomal recessive congenital ichthyosis.
A highly compromised skin barrier puts the patient at a high risk of both hypo-/hyperthermia, dehydration, poor growth, infection and several other organ-specific complications. Due to these increased risks, admission to the neonatal intensive care unit is necessary to facilitate close monitoring and access to a highly humidified incubator.
The collodion membrane (CM) is shed within 3 to 4 weeks, revealing the underlying ichthyosis. Special investigations can be undertaken before the membrane sheds such as a skin biopsy or blood work. These investigations can provide clinical clues to an earlier diagnosis. If the patient is stable, it is reasonable to wait for the membrane shedding to reveal an underlying diagnosis.
Petroleum-based moisturizers can protect the skin as the membrane peels off.
The most common underlying diagnoses of collodion baby are congenital ichthyosiform erythroderma and lamellar ichthyosis. However, an estimated 10% of patients will have near normal-appearing skin, referred to as self-improving collodion ichthyosis.
Skin barrier dysfunction can lead to significantly higher transepidermal water loss and poor temperature regulation. A highly humidified incubator (minimum 60%) can help reduce water loss and assist in adequate temperature regulation.
Other keys to management include close observation for signs of infection, dehydration, electrolyte imbalance and/or poor feeding/decreased growth velocity.
Topical petroleum-based lubricants should be applied multiple times per day while medicated ointments should be avoided due to risk of systemic toxicity.
Complications involving the lungs (chest constriction or respiratory distress), eyes (ectropion or keratitis) and ears (obstruction, conductive and sensorineural hearing loss) may also be seen. In these instances, consultations with pulmonology, ophthalmology or otorhinolaryngology may be necessary for comprehensive care.
Skin biopsy prior to membrane shedding is generally unhelpful but may provide disease-specific histological findings if done after the collodion sheds.
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, Collodion baby, ichthyosis, neonate, newborn, pediatrics, dermatology
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