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Post Bariatric Care and Obesity Management

Project ECHO® OBN
Update Your Knowledge on Post Bariatric Care and Obesity Management

The Ontario Bariatric Network (OBN) is launching an exciting new initiative Project ECHO™ OBN that partners primary care providers with a multi-disciplinary team of specialists from the Bariatric Centres of Excellence (BCOE) to share best practices on bariatric care and obesity management.

This series of 6 sessions hosted by The Ottawa Hospital begin on October 2, 2019 and is open to physicians, residents and medical students, nurse practitioners and allied health professionals working in primary care.  There is no cost to attend.

Learn about:

  • Changing practices in the surgical and medical management of patients with obesity
  • BCOE and primary care collaboration to implement the Shared Care Model
  • Obesity-related co-morbidities and treatment options
  • Evidence-based approaches to effectively manage patient complications

Managing the care of post-bariatric surgery patients can be complex.  Register soon to take advantage of this no-cost learning opportunity!

For more information on session dates, curriculum details and to register, please visit https://obn.echoontario.ca

Click to view PDF with details: ECHO Flyer with curriculum Aug 2019

 

 

New Event: OntarioMD Every Step Conference

Register to attend the OntarioMD EMR: Every Step Conference on September 26, 2019 in Toronto.

If you register before Friday, July 5, you can take advantage of the Super Early Bird Rate of just $160 for a full day of learning, networking and CME credits!

Register now at https://lnkd.in/eRVcQbm

 

The EMR: Every Step Conference is for physicians, nurse practitioners, allied health professionals and administrative staff.

This conference will be accredited for CME pending approval from the Ontario College of Family Physicians.

learn more

FIT Implementation – Are you ready?

In preparation for the June 2019 roll-out of Fecal Immunochemical Testing in June 2019, the Champlain Regional Cancer Program invites you to attend: “FIT Implementation – Are you ready?” part of the Continuing Professional Development Series.

When: Wednesday, May 29, 2019
5:30pm – 8:00pm

You can attend in person or by webcast or OTN.

In person at:
The Ottawa Hospital, General Campus, Critical Care Wing
Room CCW 5225
501 Smyth Road
Ottawa

For webcast or OTN, details are available at www.cancerprimarycare.eventbrite.ca

Registration for this event can be made directly on our event registration site: www.cancerprimarycare.eventbrite.ca

Please feel free to forward this email and information to your colleagues.

This Group Learning program has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 2 Mainpro+ credits.

Health Report Manager & EMR Practice Enhancement Program

Health Report Manager – Health Report Manager (HRM) is a digital health solution that enables clinicians using an OntarioMD-certified EMR to securely receive patient reports electronically from over 250 participating hospitals and specialty clinics, including over 30 in Champlain LHIN.

HRM electronically delivers text-based Medical Record reports, (e.g. Discharge Summary), and transcribed Diagnostic Imaging (excluding image) reports from sending facilities directly into patients’ chart, within your EMR. Once you are connected to HRM, you will also receive eNotifications, a useful digital health tool that lets you know sooner than the arrival of the discharge summaries that your patients were in the hospital.

Learn more about HRM. To sign up, please contact your local OntarioMD Practice Advisor or support@ontariomd.com.

 

EMR Practice Enhancement Program – The EMR Practice Enhancement Program (EPEP) is a complimentary provincial service designed to take an in-depth look at how you use your EMR to help you enhance your EMR skills and efficiency.

EPEP offers a current analysis of your EMR use, practice workflow and data quality to help you move beyond data capture and use information to improve patient care and practice efficiency. It provides hands-on support from Practice Advisors and Peer Leaders, who are expert EMR users, to create an enhancement plan that reflects your unique practice priorities, leading to improved workflow, efficiency and patient care.

 

Get started with EPEP today, or contact support@ontariomd.com to connect with a Practice Advisor.

Project ECHO Ontario Skin and Wound

ECHO stands for Extensions for Community Healthcare Outcomes.

The ECHO model™ links specialist/ resource team (Hub) with primary care community-based partners (Spokes) to form the Hub and Spokesmodel.  It uses a combination of live online sessions and in-person skills training to build health care capacity. The online sessions are live 2 hours weekly and include a short educational lecture, followed by case-based learning from the participants’ own patients.

The resource team (Hub) puts together the content of the ECHO educational lectures. Participants present de-identified cases of their own patients during the live online sessions. Participants also contribute to case discussions and evaluation surveys. They also receive continuing education/ continuous professional development credits (CE/ CPD).

Through the ECHO model™, community providers and specialists learn from each other, acquire knowledge, skills, increase competency and build a strong community of practice. Participants become part of a supportive community of practice and an inter-professional team.

See: Q&A’s – ECHO Ontario Wound and Skin

We’re launching in May. Sign up below if you’re interested in no cost interprofessional skin and wound care learning surveymonkey.com/r/FM6T99B #onhealth #wounds #dermatology

What Is It?

  • FREE case-based learning on: wound bed preparation, pressure injuries (ulcers), diabetic foot ulcers, venous leg ulcers, interprofessional team building and other topics
  • No cost mentorship on skin and wound care best practices
  • Access to physicians, nurses and allied health providers who will offer you guidance on your patients with complex skin and wound care needs.

Who Should Join?

  • Health care providers based in Ontario who have an interest in skin and wound care, including nurses, physicians, and allied health providers.

Benefits for Participants

  • Enhanced care for patients with skin and wound care issues
  • Certificate of Attendance, if a regular participant
  • Continuing Medical Education (CME) Credits awarded by Queen’s University
    • Being part of an interprofessional community of practice

Details

  • Weekly 2-hour sessions: 15-minute didactic lecture, based on International Interprofessional Wound Care Course (IIWCC) curriculum, followed by a discussion of real clinical cases submitted by participants
  • Topics discussed: diabetic foot ulcers, leg ulcers, pressure injuries, wound bed prep, infection, malignant, post-surgical wounds, traumatic injuries, peristomal, lymphedema, acute infection and other wound and skin care issues
  • Hands-on learning at semi-annual boot camp sessions held across Ontario

Interested? Here’s What You’ll Need

  1. Internet connection and webcam-enabled device like a laptop or smartphone
  2. Minimum two hours per week of committed time
  3. Willingness to present your patient cases for group discussion

To Express Interest in Joining

Email:       info@echowoundskin.com

For More Information:

Visit:        https://www.echoontario.ca/Echo-Clinic/Wound.aspx

Follow on Twitter:    @ECHOWound

Important Concussion Resources

In Ontario, over 150,000 people are diagnosed annually with concussion in emergency departments and by primary care physicians. In 2016 there were 15,736 concussions diagnosed in the Champlain LHIN. It remains evident that both healthcare providers and patients feel ill-prepared to effectively navigate the healthcare system with respect to concussion care and management of persistent concussion symptoms.

The Ontario Neurotrauma Foundation,ONF has been working to provide clarity and evidence-informed direction with respect to post-concussion care for healthcare providers and patients by releasing the Standards of Post-Concussion Care and the  3rd Edition Guideline for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms for Adults over 18 Years of Age. Providers can use the resources to learn about up-to-date evidence-informed practices and recommendations. ONF’s goal is to streamline visits with healthcare providers and provide direction to patients and families to increase confidence about how, what and when care should be provided.

Breast Imaging Update 2019

The Champlain Regional Cancer Program invites you to attend its’ annual Breast Imaging Update 2019, part of the Continuing Professional Development Series. Please find details below. You can attend in person or by OTN. Please feel free to forward to your colleagues. 

 

Champlain Lung Health Intake and Referral

The Champlain Lung Health – Intake and Referral program is your access point to community lung health education and support in Champlain if you are living with COPD.

For healthcare providers, this program offers one referral form that allows your adult clients living with COPD access to effective community lung health services in Champlain.

The lung health programs provide an evidence-based approach that improves the health and quality of life of people living with COPD.

http://champlainlunghealth.ca/

“Since joining your program my breathing and general overall health has been greatly improved …Your program is a hidden gem and should have more exposure so others may experience what I have been given”

– Lung Health Program Participant

“When I started 4 years ago, I was barely able to walk due to my shortness of breath; today I am able to walk for over a half an hour. I love this program for what is has helped me accomplish.”

– Lung Health Program Participant

The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness

Jerrold Petrofsky, Lee Berk, Gurinder Bains, Iman Akef Khowailed, Haneul Lee, Michael Laymon

Clinical Journal of Sport Medicine, Volume 27, No. 4, July 2017

Delayed-onset muscle soreness (DOMS) is a relatively common phenomenon experienced by people who are new to exercise, or essentially anyone who exceeds their normal workout intensity. DOMS can range from mild irritation to severe pain that can form a significant barrier inhibiting performance, or exercise participation altogether. Furthermore, previous research has shown that DOMS is greater in intensity and duration in older individuals and individuals with diabetes, which is a particularly important patient population within family medicine. This cross-sectional repeated measure design study was performed to assess the impact on DOMS of heat applied for 8 hours immediately or 24 hours after exercise.

60 subjects aged 20-40 who were physically inactive for 6 weeks and had BMI’s less than 40 were divided randomly into 3 groups (control, ThermaCare heat wraps applied immediately after exercise, and ThermaCare heat wraps applied 24 hours after exercise). To provoke DOMS, the subjects completed squats in 3, 5-minute bouts with 3 minutes of rest in-between each bout.  Visual analog pain scales, blood myoglobin, muscle strength, range of motion, and stiffness of the quads were the main outcome measures of the study.

The results revealed a significant reduction in soreness in the group that had the heap wraps applied immediately after exercise (P<0.01). This was corroborated by blood myoglobin, algometer and muscle stiffness data. In addition, there was some benefit to applying the heat 24 hours after exercise when compared to control.

In summary, low-level continuous heat wraps left for 8 hours after heavy exercise can reduce the effects of DOMS (assessed by both subjective and objective measures). Although cold therapy is commonly used after heavy exercise to reduce soreness, heat seems to have the added benefit of increasing flexibility of tissue and tissue blood flow. The authors note that for the purposes of reducing joint swelling, it is still probably better to use cold therapy.

 

Sean Mindra MD, CCFP

PGY3 – Sport and Exercise Medicine, University of Ottawa

Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport & Exercise Medicine

The Noisy Knee

Song, S. J., Park, C. H., Liang, H., & Kim, S. J. (2018). Noise around the Knee. Clinics in orthopedic surgery, 10(1), 1-8.

A common MSK question patients ask is “is it normal that my knee makes this sound?” While this review focuses on the knee, the approach can be generalized to any shoulder. Noise in the knee is common, and often patients are worried the noise is pathological.

Noise around the knee can be separated into physiologic and pathologic causes. This is defined by whether the sound is associated with pain, swelling, and abnormal range of motion. There are also many different types of sounds which are more likely to describe one cause than another. Crepitus is a vague descriptor used to represent a sound during a joint’s range of movement. Popping is a sudden explosive and well perceived sound, usually associated with injury such as meniscal, cruciate, or collateral ligament tears. Clunking is a loud singular noise due to release against resistance, often suggestive of something that was subluxed and now relocated. Clicking is a tiny, singular noise that occurs during one cycle of knee extension and flexion, this can be associated with various causes. Grinding and grating are used to describe continuous scratching sounds and are more associated with degenerative OA and patellofemoral pain syndrome.

Physiologic Sounds:

Not associated with any history of trauma, swelling, or pain.

Tend to be sporadic in nature

No aggravation of sounds and combined symptoms

Causes include:

  • build up or bursting of tiny bubbles in the synovial fluid
  • snapping of ligaments
  • catching of the synovium or physiological plica
  • hypermobile or discoid meniscus.

One way to distinguish between these causes is whether the joint sound occurs repeated during range of motion. If it happens repeatedly, it is usually due to anatomic structures rubbing against each other, such as ligaments/tendons or plica over a bony prominence. One common is the bicep femoris tendon at the lateral aspect of the knee. If the crack has a refractory period, it is likely due to air build up in the joint, and subsequent changes in joint pressure during range of motion cause cavity formation which creates a popping sound.

Management of physiologic noise involves reassurance and stretching and strengthening of affected musculotendinous structures.

Pathologic Sounds:

Can have history of trauma or injury

Tend to be higher pitch/frequency

observed consistently, has gradual aggravation

Causes:

  • Degenerative changes
    • Structural cause such as bony spurs and cysts, meniscal tears…etc
  • Pathologic plica
    • If a plica gets irritated, it can cause synovitis and pain
  • Patellofemoral instability
    • Due to hypermobility of patella or subluxation of patella
  • Post-surgical
  • Pathologic snapping knee syndrome
    • Any extra or intra-articular structure that causes painful sounds, which can include ganglion cysts, lipoma, synovial nodules, fabella, osteochondromas, osteophytes

Management of these pathologic noises depends on the underlying cause.

Overall, noise around the knee is a common phenomenon, with one study suggesting 38.1% of women and 17.1% of men over 40. With this approach, careful evaluation of the noise can help prevent unnecessary diagnostic interventions and provide appropriate guidance for healthy patients experiencing physiologic noise.

 

Jim Niu MD, CCFP

Sport and Exercise Medicine Fellow, University of Ottawa

Advisor Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport Med