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Planning for the Future: Expected and Unexpected

Author(s)
Michael Gordon
Deck
For those of us who are planners, it seems perfectly natural to anticipate the possibilities of the future...
Thumbnail Image
Teaser

My late father, an engineer whose expertise was motor vehicles, drummed into me the importance of timely oil changes—which I do to this day: it is an almost obsession with me.

For those of us who are planners, it seems perfectly natural to anticipate the possibilities of the future and try to take steps to either avoid bad outcomes or implement steps to mitigate deleterious outcomes. My late father, an engineer whose expertise was motor vehicles, drummed into me the importance of timely oil changes—which I do to this day: it is an almost obsession with me.

Topic
Law and Ethics
Section
Blogs

Sharon A. Chung, PhD1and Colin M. Shapiro, MBBCh, PhD, MRCPsych, FRCP(C)1-3

1Youthdale Treatment Centres, Toronto, Ontario, Canada. 2International Sleep Clinic, Parry Sound, Canada and the 3University of Toronto, Department of Psychiatry, Canada.

CLINICAL TOOLS

Abstract: Obstructive Sleep Apnea (OSA), where patients stop breathing numerous times during sleep, is a disorder linked to serious medical, socioeconomic, and psychological morbidity, yet most patients with OSA remain undetected. Physicians should consider symptoms of frequent/loud snoring, complaints of daytime sleepiness or fatigue, high blood pressure and obesity or excessive body fat distribution in the neck or upper chest area as possible indications of untreated OSA.
Key Words: obstructive sleep apnea, screening, management.
Untreated OSA is associated with significant morbidity and mortality and results in increased healthcare utilization.
OSA is more prevalent in individuals with a chronic medical illness.
Almost 90% of individuals with OSA remain undiagnosed.
Treatment of OSA improves medical outcome; this is particularly relevant in medically ill patients.
Evidence-based medicine supports screening for OSA as part of routine clinical care.
Newer technology allows doctors to 'skip the waiting line' and obtain quick and accurate sleep testing for their patients.
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: obstructive sleep apnea, screening, management
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Editor's Note, Volume 7 Issue 5

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

Related Terms:
Disclaimer at the end of each page

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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