Latest Updates

Complementary and Alternative Medicine: Is It Alternative or Mainstream for Managing Low Back Pain?

    • Complementary and alternative medicine therapies are now an important part of the management of chronic low back pain in patients.
    • Physical modalities such as yoga and tai chi aim for a mind-body connection effect to help treat chronic low back pain.
    • Acupuncture has been shown in some medical studies to be of benefit with chronic pain when combined with conventional treatments.
    • Herbal medicines are increasingly being used by patients to treat back pain. Regulation of this industry is required to ensure the safety and reliability of these agents.
    • Medical marijuana is being advocated by many for chronic low back pain; at present, research is not conclusive on the benefit of this herbal. Further research is required prior to universal recommendation. 

Renovascular Hypertension and Stenosis

    • Clinical trials demonstrate renal artery stenting offers no benefit over medical therapy among patients with renal artery stenosis and hypertension or chronic kidney disease.
    • Stenting should be reserved for patients who fail medical therapy.
    • Optimizing outcomes for renal artery stenting requires an understanding of clinical predictors that portend a higher probability of improved blood pressure or renal function with stenting.

Renovascular Hypertension and Stenosis

    • Clinical trials demonstrate renal artery stenting offers no benefit over medical therapy among patients with renal artery stenosis and hypertension or chronic kidney disease.
    • Stenting should be reserved for patients who fail medical therapy.
    • Optimizing outcomes for renal artery stenting requires an understanding of clinical predictors that portend a higher probability of improved blood pressure or renal function with stenting.

Management of Shock in Infants and Children

    • Extracorporeal membrane oxygenation (ECMO) is a modified method of cardiopulmonary bypass that is used as a last resort modality for support of the pediatric patient in cardiac and/or respiratory failure. 
    • VADs are a newer, alternative method of mechanical circulatory support for children in refractory heart failure or cardiogenic shock who are awaiting transplantation. VAD use in adults is well established, and its use in children has been steadily increasing over the last decade.
    • Lactate is a by-product of anaerobic metabolism and is often used to diagnose and monitor the progression of shock. Although lactate is less frequently elevated in pediatric patients, an initial elevated lactate level has been found to be associated with increased risk of organ dysfunction in pediatric sepsis and can be followed as a marker of resuscitation.

Management of Chronic Kidney Disease and its Complications

    • 2024 KDIGO Practice Guidelines
    • Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada
    • Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update.

Primary and Metastatic Central Nervous System Malignancies

    • The main function of corticosteroids in CNS tumors is to control brain and spinal cord vasogenic edema and decrease intracranial pressure. Corticosteroids should be used with caution because of its significant side effects, such as insomnia, hyperglycemia, myopathy, psychiatric effects, and opportunistic infections. 
    • Maximal safe resection is recommended for all glioma grades and subtypes if the tumor is surgically accessible and there are no absolute medical contraindications to surgery. Nevertheless, even a macroscopic complete resection is almost never curative because grade II to IV gliomas infiltrate the normal brain.
    • The addition of WBRT to either surgical resection or radiosurgery decreases the risk of brain metastasis recurrence but does not improve survival in patients with one to three brain metastases.

Primary and Metastatic Central Nervous System Malignancies

    • The main function of corticosteroids in CNS tumors is to control brain and spinal cord vasogenic edema and decrease intracranial pressure. Corticosteroids should be used with caution because of its significant side effects, such as insomnia, hyperglycemia, myopathy, psychiatric effects, and opportunistic infections. 
    • Maximal safe resection is recommended for all glioma grades and subtypes if the tumor is surgically accessible and there are no absolute medical contraindications to surgery. Nevertheless, even a macroscopic complete resection is almost never curative because grade II to IV gliomas infiltrate the normal brain.
    • The addition of WBRT to either surgical resection or radiosurgery decreases the risk of brain metastasis recurrence but does not improve survival in patients with one to three brain metastases.

Intellectual Disability

    • Individuals with intellectual disability have high rates of medical and psychiatric comorbidity.
    • Healthcare providers lack education and training to provide health care to individuals with an intellectual disability.
    • Expert consensus guidelines recommend using the same medications and therapeutic doses for individuals with intellectual disability.
    • Polypharmacy and chronic medication use are common in individuals with an intellectual disability, despite lack of evidence on safety and effectiveness.
    • The DM-ID adapts the DSM criteria to individuals with intellectual disability.  The DM-ID is considered the gold standard for diagnosing psychiatric disorders in individuals with an intellectual disability
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