Editor's Note, Volume 6 Issue 2
D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET
Volume 6, Number 2
Disclaimer: While every attempt is made to ensure that drug dosages provided within the text of this journal and the website are accurate, readers are urged to check drug package inserts before prescribing. Views and opinions in this publication and the website are not necessarily endorsed by or reflective of those of the publisher.
The Role of Nutraceuticals in Atopic Dermatitis
Jacky Lo, MD,1 Joseph M. Lam, MD, FRCSC,2
1 is a resident in the Family Medicine Residency at the University of British Columbia. He was previously a registered dietitian at the College of Dietitians in BC.
2is a pediatric dermatologist and a clinical assistant professor in the Departments of Pediatrics and Dermatology at the University of British Columbia.
CLINICAL TOOLS
| Abstract: Atopic dermatitis (AD) is a chronic relapsing and remitting dermatosis with no definitive cure. Because treatment often remains challenging, the use of nutraceuticals has been gaining popularity as an alternative therapy. |
| Key Words: Nutraceuticals, atopic dermatitis, prevention, treatment. |
| The use of prebiotics in formula fed infants may reduce the incidence of AD up until two years of life. |
| The use of prenatal and/or postnatal probiotics, especially with Lactobacillus rhamnosus and Bifidobacterium, has been shown to reduce the incidence of AD. However, the evidence for its long-term effects appears to be inconsistent. |
| There is conflicting evidence regarding the use of vitamin D alone and zinc in the treatment of AD. |
| Routine supplementation of vitamin E alone and selenium does not appear to be beneficial in the treatment of AD. |
| While the use of fish oil has not been shown to have any statistically significant benefit in the treatment of AD, its use has been associated with improved quality of life, reduction in area affected in a pooled analysis of two studies and pruritus in one study. |
| Education plays an important in the management of AD and emphasis should be made to explore patients' reasons for turning to alternative therapies. |
| 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. |
Navigating the Gender Spectrum: A General Overview of Transgender Health Care
Dr. Adam C. Millar, MD, MScCH, FRCPC,
Mount Sinai Hospital, Assistant Professor, Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON.
CLINICAL TOOLS
| Abstract:Transgenderism is common, with quoted prevalence rates of between 0.5-1% of the population.1,2,3 The term "transgender" reflects a broad spectrum of identities, including agender, pangender, genderqueer and genderfluid. Although there is increased public recognition of transgender issues, many physicians remain uncomfortable managing matters of transgender health. There is a paucity of high quality, long term randomized controlled trials on many transgender health topics, requiring physicians to rely largely on consensus guidelines. Integration of transgender-related subject matter into medical school curricula is one of the first steps towards enabling future physicians to increase their comfort in transgender health care. |
| Key Words: Transgender, trans, testosterone, estrogen, androgen blockade. |
Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.
www.cfpc.ca/Mainpro_M2You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.
| 1. Transgenderism is not limited to the binary gender constructs of male and female. The term "transgender" includes a broad spectrum of identities, including agender, pangender, genderfluid and genderqueer. |
| 2. Lack of physician comfort with medical management of the transgender patient has been linked to increased rates of refusal of medical care, as well as verbal harassment and in extreme cases physical assault. |
| 3. Due in part to a lack of large randomized controlled trials, many transgender guideline recommendations are based on expert opinion and relatively low quality evidence. |
| Rather than assume one's gender identity, it is advisable to ask the patient how they identify, and what pronouns are preferred. |
| There are no specific hormonal targets during transition therapy. Instead, treatment targets are defined by the patient's goals and overall sense of well-being. |
| 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. |
Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
Mainpro+® Overview
Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,1 Yoga Raja Rampersaud, MD, FRCSC,2 Jess Rogers3Dr. Hamilton Hall, MD, FRCSC,4
1 is 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.
2Associate Professor Department of Surgery, University of Toronto, Divisions of Orthopaedic and Neurosurgery, University Health Network Medical Director, Back and Neck Specialty Program, Altum Health, Past President Canadian Spine Society, Toronto, ON.
3 is the Director at the Centre for Effective Practice (CEP). Jess' role includes developing evidence-based clinical guidance for providers. Jess was the Project Lead in executing the primary care provider education component of Ontario's Low Back Pain initiative including the CORE Back Tool. CEP is pleased to have funded the update of the CORE Back Tool 2016 to continue supporting primary care providers.
4 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: Through the redesign of the already successful Clinically Organized Relevant Exam (CORE) Back Tool, primary care clinicians now have a more comprehensive, user-friendly approach to clinical decision making for patients presenting with low back pain. The key components of the tool include a high yield history connected to mechanical low back pain patterns, embedded key patient messages, clear listing of appropriate radiological indications, criteria for consultant referrals as well as a management matrix geared to office practice. A clinical case will be used to demonstrate the application of the tool to practice and instruct the reader on the key features. |
| Key Words: Low Back Pain, Tool, Primary Care Providers, Management. |
Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.
www.cfpc.ca/Mainpro_M2You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.
| 1. Mechanical Patterns are a logical way to conceptualize, assess and manage low back pain. |
| 2. If pain does not fit a mechanical pattern, the patient may have non-spine referred pain from organs or a chronic pain disorder. |
| 3. Radicular (nerve) pain will have a positive straight leg raise (SLR) with reproduction of the typical leg dominant pain and possible abnormal neurological signs. |
| Initial patient management should include goals of reducing pain and increasing activity. |
| 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. |
Any Reason to not Enjoy Sex if you are in a Nursing Home?
Deck
A while back there was a headline in the New York Times about a well-known retired politician…
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A while back there was a headline in the New York Times about a well-known retired politician who was charged with rape for allegedly having sexual relations with his wife. This would of course not have been a story were it not for the fact that his wife was at the time of the alleged event living in a nursing home and experiencing cognitive impairment to a significant degree.
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