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JCCC 2017 Issue 7

Table of Contents

JCCC 2017 Issue 5

Table of Contents

Choosing Wisely Canada and Low Back Imaging: The view from Alberta

Teaser: 

Dr. Ted Findlay, D.O., CCFP,

is a Clinical Assistant Professor in the Department of Medicine at the University of Calgary and he is on the Medical Staff at Alberta Health Services, Calgary Zone in Calgary, Alberta.

CLINICAL TOOLS

Abstract: The Choosing Wisely Canada (CWC) initiative is a partner in a global effort to increase the efficiency and effectiveness of medical care by stimulating conversations between patients and care givers about the benefits and risks of commonly done tests and treatments. One of the earliest and broadly publicized recommendations was to stop routine lumbar spine imaging in the absence of clinical red flags. The rationale for discouraging this practice, including the quantification of associated harm, is not as widely known. The CWC initiative includes "Toolkits" for a number of clinical conditions, which extend the conversation beyond what should be avoided to include recommendations for appropriate care. The Alberta CWC partners have developed a Toolkit for low back pain for use by individual clinicians, physician groups, and at the systems level.
Key Words: Low back pain, imaging, overuse, red flags.

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
In the absence of red flags and/or significant chronicity don't order x-rays or advanced imaging for low back pain.
Be cautious about attributing any findings from imaging as the "cause" of low back pain in a particular patient; recognize normal age related changes.
Low back imaging is required in the presence of clinical Red Flags for which invasive intervention is planned. Clinical correlation of the images is mandatory.
The indications for specific interventional treatments either surgical or image guided must be determined by history and physical examination.
Most low back pain patients need treating, not testing.
Patients presenting with low back pain are often anxious and worried that they may have a serious underlying anatomical cause. This anxiety is not relieved by discussions of abnormalities found on routine imaging.
Patients respond to a treatment plan that is supported by pertinent handouts and clear explanations including discussions about when imaging could be considered and when a referral might be the correct course.
Treatment for low back pain should not be delayed until the cause has been "established" by investigation; appropriate treatment can be determined by the history and physical examination and supported by the anticipated positive clinical response.
A successful back school educates the patient about the benign nature of back pain and provides the tools to transfer knowledge about back hygiene into practice in the patient's life.
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, low back pain, imaging, overuse, red flags
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Finding Respite in the Stitch

Teaser: 

It was a small storefront, wedged next to a marvelous looking Greek meat shop and bakery.

...

Related Terms: Medical Narratives
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Clinical Images: Cercarial Dermatitis

Clinical Images: Cercarial Dermatitis

Teaser: 

Kerry Gardner, MD,1 Joseph M. Lam, MD, FRCPC,2

1Resident, Department of Dermatology and Skin Science, University of British Columbia, BC.
2Clinical Assistant Professor, Department of Pediatrics and Dermatology, University of British Columbia, BC.

CLINICAL TOOLS

Abstract: Cercarial dermatitis (swimmers' itch) consists of urticarial papules that form when the larvae of avian parasitic flatworms penetrate the skin. Cercarial dermatitis is common in the summer months where heaviest recreational swimming occurs, and when the temperature is ideal for amplified schistosome development.
Key Words: cercarial dermatitis (swimmers' itch), non-communicable, water-borne disease.
Cercarial dermatitis usually occurs with exposure to fresh water, but can occur with shallow salt water exposure as well.
The eruption typically occurs on uncovered skin 12-24 hours (up to 8 days) after exposure.
The eruption is self-limited, lasting 4-10 days (up to 20 days).
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, cercarial dermatitis (swimmers' itch), non-communicable, water-borne disease
Disclaimer: 
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