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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.

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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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Tales from the Uber Scene

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For the 6 months that I have not been able to drive because of medical reasons I have become a regular user of Uber. I find Uber more flexible and convenient than standard taxis. As regular users of Uber services know, many of the drivers are originally from elsewhere, by which I mean overseas and came as immigrants or refugees.

To anyone that knows me well, my interest in people and their stories plays a prominent role in my modus operendi. Also following many years of travelling overseas as part of my work as an academic geriatric medical specialist, I have learned that there are many interesting stories and points of view to be gleaned from taxi drivers. So it has come to pass with my multiple Uber trips. The point of initiation of engagement is if I recognize an accent and ask the driver from where he came. They often ask me to guess, but I have already had a hint by the Uber app which provides the name of the driver. If it is one of the typical names and the accent fits I may venture to say something like, "the Middle East or Former Soviet Union or Ireland". If I am close or correct I am usually complemented on my guess, with a question such as "do you know my country" which if positive opens the door to the conversation.

Because I have travelled a good deal during my medical school education in Scotland which at the time afforded me may months of free time to travel, sometimes combined with a medical elective experience in the country I was visiting, but also a chance to pick up some of the language, friendships with local residents and a travel experience—which often resulted in friendships some of which are still operative. I also witnessed historical moments like the coup in Greece during the 1960s, the build up to the Six-Day War in Israel and the vote that ousted the regime in Argentina that replaced the prime minister with Carlos Menem who shook the economy with economic reforms. I was in Argentina with my teenage son for a geriatric conference during the time of the election that brought Menem to power and we witnessed the hundreds of police officers patrolling the streets of Buenos Aries, with a favorite hangout of the blue uniformed police being the McDonalds in the Centre of the city on the Avenue de Mayo.

The driver answered, "Turkey-Istanbul, do you know it?" To which I replied with unbridled enthusiasm, "Yes I do, have been there and loved it." He turned towards me in the passenger seat and smiled. "It is a beautiful city". I followed with the question, "do you know the movie Kedi" He turned toward me with a huge grin, "it means cats" to which I acknowledged, "I love cats, we have three Abyssinians in the house and a number of feral cats in our backyard—three consisting of a mother and two of her litter that have adopted us or maybe allowed themselves to be adopted by my wife who diligently feeds and speaks to them. The bond is so close that we have purchased a number of cat shelters for them to increase their comfort which is helped by straw we bought from one of my wife's students who comes from a rural community outside of Toronto. Besides dry cat food many of her friends give her wet food that they have accumulated from their own cat adventures—we try to get them neutered and receive their vaccinations with the clipped ear being evidence that they were caught for this purpose before being released back to their feral home.

The driver and I talked about the wonderment of cats and how they are part of Istanbul life. To observe the seven cats and their litters featured in the movie was a real joy, with the film starting with a picture of kittens waiting for their mamma to return with breakfast—their tiny heads peering through the railing surrounding the birth site. The clips of the cat who ventures to the fish market every morning where the local fishmonger prepares the remnants of the carved fish for the dependable visitor as if it were a guest coming for dinner. Among the most moving scenes were that of people whose lives were either impacted or even saved by their feline companion who through the special sense that cats have of responding to human need.

One moving clip was of a fisherman whose adopted cat helped the small fishing boat captain deal with depression and loneliness, would roam the boat as it churned through the Bosphorus, acting like the queen of the sea as the captain beckons it for a pat. More devotion from an animal towards a human cannot be found—it is unfair to categorize the cat as a pet, it is more like a friend, companion and loved one.

We reached my destination, but not before sharing our common bond in the love of cats and their deserved place in the hearts of mankind—the Turks of Istanbul have done it, we should be able to emulate their devotion and bring the feline joy to our communities and individual families.

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

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

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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The Resuscitative Power of Stories: The Importance of Narrative Medicine in Training, Practice and Patient Centered Health Systems—Part 1

Teaser: 

Dr. Zahra Bardai BSc MD CCFP (COE) MHSc FCFP 200hRYT,

Lecturer, Department of Family and Community Medicine, University of Toronto, Staff Physician, Brock CHC Primary Health Care Program, Cannington ON.

CLINICAL TOOLS

Abstract: Stories have the capacity to move us by evoking strong powerful emotions and unlocking potent insights. The narratives that convey the lived experience in medicine bring a sense of meaning and compassion to the science of the discipline. This article is an introduction in a series that depicts stories in medicine and the influence they have on patient care, medical education and physician well being.
Key Words: narratives, patient care, medical education, physician well being.
The art and science of medicine as seen through a narrative based lens is interwoven in the telling and retelling of the patient and provider's experience.
Narrative based medicine involves honing skills of listening, exploring, deciphering and reflecting in order to understand and improve the humanitarian practice of medicine.
The practice of narrative medicine involves bearing witness and holding space through attentive mindful listening during a clinical encounter.
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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