Why a Section on Ethics?
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At the time of my medical training, the term medical ethics was hardly used when discussing complex issues related to patients and families.
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At the time of my medical training, the term medical ethics was hardly used when discussing complex issues related to patients and families.
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Editor's Note, Volume 5 Issue 6
D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET
Spine and Sport: Are Athlete's Back Injuries Different?
Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,
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.
CLINICAL TOOLS
| Abstract: Athletes participating in training and competition for an average of 8 hours a week have a one year prevalence for spine injuries as high as 68%; an average increase of 18-31% compared to non-athletes. Except for young growing athletes at risk for structural deformity, most spine injuries are soft tissue and self-limiting. Risk factors include a sudden increase in training hours, transition in strength and coordination related to growth, sustained back flexion, reduced dynamic core stability and repetitive trunk rotation and hyper extension. Decreased training levels following back injury lead to deconditioning and muscle imbalance increasing the risk of recurrence and prolonging recovery. Core stability testing can identify patients for targeted exercise. |
| Key Words: Sport-related, spine, hypermobility, core stability, overuse. |
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| Frequent repetition and sustained postures in rotation, hyperextension and full flexion require advanced levels of strength and flexibility for the athlete to remain injury-free. |
| The two most common risk factors for low back pain in training athletes is overuse strain and excessive spinal movements. |
| Treatment consists of both reducing the demands on the paraspinal muscles and increasing the amount of core stability. |
| It is important to screen for generalized joint hypermobility syndrome (JHS) affecting all joints using the Beighton Score, as this condition may require investigation and can be an indication of other medical syndromes. |
| The most specific test with high inter-rater reliability to determine core stability is the single leg standing balance stork test. The patient stands on one leg and raises the other knee to 90 degrees then maintains balance for a minimum of 25 seconds. |
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Discussions with your Doctor about your Future Wishes
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There are days in my clinic where I seem to be having the same conversation over and over…
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There are days in my clinic where I seem to be having the same conversation over and over—but with a different patient and different family. I have often thought that a model of care I once heard a presentation about might be worth doing—having the equivalent of a group therapy, but with a number of my patients and their families to discuss the common problems in aging and cognitive function.
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TINNITUS is an "Aura Symptom" in Need of a Multidisciplinary Approach to Facilitate Diagnosis and Treatment
Dr. Pradeep Shenoy, MD, FRCS, FACS, DLO,1 Dr. Eric Deschenes, Au. D.2
1Otolaryngolost , Campbellton, NB, Canada.
2Audiologist, Campbellton, NB. Canada.
CLINICAL TOOLS
| Abstract: Tinnitus is a perception of sound in the absence of sound stimulation (Figure 1). Various reasons are blamed for the causes of the tinnitus. Very rarely, tinnitus is seen in normal-hearing children where no obvious cause is detected. In these instances, tinnitus does not persist for long. In some people it may occur spontaneously as in old age, and in some individuals it is induced by noise exposure, ototoxic drug use, stress, smoking, or excessive coffee consumption (Figure 2). In some, tinnitus may be associated with other symptoms like vertigo and deafness. Such symptoms can be correlated with congenital sensorineural hearing loss, wax accumulation, serous otitis media, Meniere's disease, vestibular neuronitis, acoustic neuroma, vascular causes like a/v malformation or fistulae, and also in some patients, temperomandibular dysfunction. Tinnitus can cause anxiety, depression and sleep disorders, and in some individuals, extreme anxiety can lead to suicidal tendencies. Conventional medical treatment uses medication, sound therapy and relaxation. Management using electromagnetic stimulation and low intensity laser is also reported in the literature. |
| Key Words: Tinnitus counselling, sound therapy, hyperacusis, ototoxic drugs, presbyacusis, noise induced deafness (acoustic trauma), electromagnetic therapy, relaxation exercises. |
| Tinnitus is the perception of sound without external acoustic stimuli and is often described as ringing, whistling, buzzing, gushing of water, or a pulsatile noise. |
| Most researchers theorize that tinnitus is caused by initial damage to the outer hair cells in the cochlea, followed by impairment of the inner hair cells. |
| Tinnitus can cause anxiety, depression, sleep disorders, and in some cases, extreme anxiety that can lead to suicidal tendencies. |
| There is no method to eliminate tinnitus entirely; the goal with patients suffering from tinnitus is to provide the tools necessary to effectively manage their reaction to tinnitus symptoms. |
| Tinnitus can be attributed to a wide variety of causes, and it is difficult to study and treat tinnitus because of the lack of objective diagnostic tools. |
| To help manage tinnitus symptoms, sound therapy (tinnitus masking and tinnitus retraining) can be used in conjunction with alternative therapies like relaxation exercises, breathing exercises, hypnosis, vitamins and herbs, low level laser treatment, and electromagnetic treatment. |
| 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. |
