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Geriatric Depression

Back Pain Management

Rituals in Death and Dying: Modern Medical Technologies Enter the Fray

Teaser: 

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

Abstract

In the absence of immortality, the human species has over the millennia developed rites and rituals to help in the passing of life to honor the person who is dying or has died or in some way demonstrate their "courage" and perseverance as well as duty even in the face of almost certain death. The centuries old traditions of the gathering of loved ones, the chanting of prayers, the ritual religious blessings are in the process of being replaced by the "miracles" of modern medical technology.

Key Words: Cross-cultural death, death, dying, rituals.

Related Terms: Dementia, Cross-cultural death, death, dying, rituals

A Pain in the Neck

Image Description
Teaser: 

Dr. Hamilton Hall, MD, FRCSC,1 Greg McIntosh, MSc,2 Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,3 Dr. Pierre Côté, DC, PhD,4

1Professor, Department of Surgery, University of Toronto. Medical Director, CBI Health Group, Executive Director of the Canadian Spine Society, Toronto, ON.
2Masters in Epidemiology, University of Toronto, Faculty of Medicine. Director of Clinical Research for CBI Health Group and research consultant to the Canadian Spine Society.
3Family Physician practising Sport and Exercise Medicine, Toronto Rehabilitation Institute, University Health Network. Appointed at the University of Toronto, Department of Family and Community Medicine, Associate Clinical Professor.
4Canada Research Chair in Disability Prevention and Rehabilitation; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT); Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation.

CLINICAL TOOLS

Abstract: Neck pain is common and disabling. Associated with poor posture, sedentary work and stress it is long lasting and recurrent. Most neck pain is mechanical from the structural elements within the cervical spine and can be referred to a number of remote locations. Radicular arm dominant pain is infrequent. Neck pain is diagnosed on history and confirmed with the physical examination. Routine imaging is inappropriate and the Canadian C-spine rules are recommended. Management focuses on education, range of movement exercises with associated postural improvement and strengthening exercises; neck braces should not be used.
Key Words: cervical spine, neck pain, Canadian C-spine rules, range of movement, exercise.

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www.cfpc.ca/Mainpro_M2

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Pre-test CME Quiz Post-test CME Quiz
Most neck pain is benign mechanical pain and serious pathology is uncommon.
Neck pain is longer lasting and more disabling than generally recognized.
Referred neck pain can be felt on top the shoulders, between the shoulder blades, along the jaw, in the front of the chest and as a headache.
Nerve root involvement is unusual but when it occurs typically affects C5, C6 or C7.
Routine imaging is unproductive.
Management is based on education, range of movement exercises and strengthening.
A careful history to locate the site of the dominant symptoms and a physical examination to assess posture and rule out radiculopathy will identify common mechanical neck pain.
The need for an x-ray should be based on the Canadian C spine rules.
Improving mechanical neck pain starts with educating the patient about the favourable prognosis and increasing the range of neck movement: a cervical collar is contraindicated.
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Related Terms: Back Health, cervical spine, neck pain, Canadian C-spine rules, range of movement, exercise