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Importance of Screening Children with Adenotonsillar Hypertrophy for Obstructive Sleep Apnea

Teaser: 

Madison O.L. Rays, Sharon Chung, PhD, Maya Capua, MD, Colin M. Shapiro, MBBCh, PhD, FRCPC,

Youthdale Child and Adolescent Sleep Centre and Youthdale Treatment Centres, Toronto, ON.

CLINICAL TOOLS

Abstract: Obstructive sleep apnea (OSA) is a disorder in which patients stop breathing repeatedly during sleep, and it is linked to a number of serious medical consequences. However, most patients with OSA remain undiagnosed. The consequences of OSA are particularly severe in children. Adenotonsillar hypertrophy (AT) is a major factor in the etiology of Obstructive Sleep Apnea (OSA) in children. Physicians should consider snoring, pauses in breathing while asleep, restless sleep, bizarre sleeping positions, paradoxical chest movements, cyanosis, bedwetting, hyperactivity, and disruptive behaviour in school as possible indications of untreated OSA in children. The presentation of OSA in children differs substantially from that in adults. For example, hyperactivity is often a primary symptom in children but is not a symptom typically found in adults.
Key Words: obstructive sleep apnea (OSA), children, adenotonsillar hypertrophy (AT), medical consequences.
The presentation of OSA in children is significantly different than that in adults; hyperactivity can be a primary symptom in children but is not typically found in adults.
Adenotonsillar hypertrophy is an indicator of undiagnosed OSA in children and merits a sleep study.
Untreated OSA in children can lead to medical and psychiatric issues.
Adenotonsillectomy, a common treatment for OSA in children with large tonsils, not only reduces or eliminates the OSA, but in most cases improves the associated behavioral problems.
Evidence-based medicine supports the need for children with adenotonsillar hypertrophy to be referred to a sleep specialist to be screened for OSA regardless of the degree of tonsillar enlargement.
The I'm Sleepy questionnaire allows doctors to quickly and easily identify children with a high risk of having OSA.
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Related Terms: Men’s Health, Women’s Health, obstructive sleep apnea, children, adenotonsillar hypertrophy, medical consequences
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JCCC 2018 Issue 4

Table of Contents

Exercise Prescription for Back Pain

Teaser: 

Eugene K. Wai, MD, MSc, CIP, FRCSC1
R. Michael Galbraith, DO, CCFP (SEM), Dip Sport Med2
Denise C. Lawrence Wai BScPT3
Susan Yungblut, PT, MBA4
Ted Findlay, DO, CCFP, FCFP5

1 is an orthopedic surgeon who specializes in the care of adult spinal disorders. He is also an Associate Professor in the Department of Surgery at the University of Ottawa. In addition he is the Research Chair for the Canadian Spine Society.
2Private practice Elite Sports Medicine in Lethbridge, AB.. Head Team Physician, Lethbridge Hurricanes (WHL). Clinical Lecturer, Dept of Family Medicine, University of Calgary School of Medicine.
3 is a Physical Therapist in Ottawa and a Research Assistant at The Ottawa Hospital.
4 Physiotherapist, Liquidgym, Ottawa; Nordic Walking Instructor and Urban Poling Master Trainer, OttawaNordicWalks; Past Director, Exercise is Medicine Canada
5 is a Clinical Assistant Professor in the Department of Medicine at the University of Calgary. He is also in a Private Family Medicine practice. In addition he is on Medical Staff at Alberta Health Services, Calgary Zone in Calgary, Alberta.

CLINICAL TOOLS

Abstract: Exercise is one of the most effective and simplest evidence-based recommendations to manage acute and chronic back pain. This paper discusses the physiology and evidence to support exercise as effective treatment. We will provide guidance on how to assess and prescribe exercise and offer methods to educate and encourage physical activity for patients with back pain.
Key Words: Back Pain, Physical Activity, Exercise Prescription, Motivational Interviewing.

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. Exercise is one of the most effective and simplest evidence-based recommendations to manage acute and chronic back pain.
2. For chronic back pain the most important exercise is the one the patient will actually do.
3. For acute back pain the exercise prescriptions should take into account the patient's directional preference of exercise (Pattern of Pain) and the patient's unique situation.
4. Exercise Prescriptions should include the F.I.T.T. principle (Frequency, Intensity, Time and Type).
Simply asking the patient about exercise has been shown to be effective in improving health outcomes. Consistent messaging about the positive role of physical activity is important.
Most forms of physical activity are usually beneficial. The exercise prescription should take in to account what the patient is actually prepared to do.
Patients often require reassurance that pain associated with exercising does not lead to physical harm.
Motivational interviewing is a structured, empathetic method to engage resistant patients.
Walking is free.
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, back pain, physical activity, Exercise Prescription, Motivational Interviewing
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Keep Your Head when Dealing with Concussion

Teaser: 

Dr. Aly Abdulla1
Adil Abdulla2
Neelam Charania3

1 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/
2 is a law student at the University of Toronto that has suffered 13 concussions.
3 is a Masters in Occupational Therapy from Boston University and involved in managing and rehabilitating patients with chronic concussion syndrome.

CLINICAL TOOLS

Abstract: Concussion or minimal traumatic brain injury is a confusing medical condition that is more common than previously appreciated. At the Berlin congress in 2016, 3 key tools and 11 key processes have been developed to clarify this condition and ensure good outcomes. This article summarizes those recommendations in an easy to use format.
Key Words: Concussion, minimal traumatic brain injury (mTBI), symptoms, protocol.
Do the SCAT5 or cSCAT5 on everyone with a mTBI.
When thinking of concussion also consider cervical spine or neck injury and vestibular injury. Learn to differentiate them. Treat accordingly.
The patient should rest for 24–48 hours after the injury, then can be encouraged to become gradually and progressively more active while staying below their cognitive and physical symptom-ex-acerbation thresholds
Any patients having persistent concussive symptoms (> 14 days for an adult or > 30 days in a child) should be referred to a specialist in mTBI and prescribed active rehabilitation.
Have a high rate of suspicion for mTBI
Most mTBI are managed well with Remove from play, Re-evaluate in office using SCAT5, and Rest
Repeat clinical testing is de rigeur for Return to Play
Learn to manage symptoms like poor sleep, mood changes, and deconditioning while patients recover.
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: Sports Medicine, concussion, minimal traumatic brain injury (mTBI), symptoms, protocol
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JCCC 2018 Issue 3

Table of Contents