A Primary Care Provider's Guide to Spasticity Management in Spinal Cord Injury.

Muscle spasticity is a common sequela of spinal cord injury (SCI) that may impact daily function. Spasticity dynamically varies and is an important physiologic response to illness or other stressors. The challenge for the general practitioner is in recognizing, treating, and developing an effective plan focused on the patient's individual goals.

A Primary Care Provider's Guide to Sexual Health for Individuals With Spinal Cord Injury.

The collaboration with individuals regarding their sexual health is an important component of patient-centered health care. However, talking about sexual health in primary care settings is an area not fully addressed as a result of time limitations, medical task prioritization, awareness or knowledge deficit, and discomfort with the topic of sexuality. A critical shift in professional focus from disease and medical illness to the promotion of health and wellness is a prerequisite to address sexual health in the primary care setting.

A Primary Care Provider's Guide to Pain After Spinal Cord Injury: Screening and Management.

Individuals with spinal cord injury (SCI) often experience chronic pain as a secondary complication. It can significantly impair mental health, sleep, mood, and overall quality of life. It is important for providers within a primary care setting to recognize the different types of pain such as nociceptive and neuropathic.

Enabling Advance Care Planning in Dementia Care: A Primary Care Approach.

Background: Lack of tools to support advance care planning (ACP) has been identified as a significant barrier to implementing these discussions.

Aim: We pilot tested an ACP framework tool for use with persons living with dementia (PLWD) in primary care-based memory clinics and an Adult Day Program; this study describes user and recipient experiences with this framework.

Methods: We used a mixed methods approach.

Controlled substances in hospices after patient death: a cross-sectional survey of Ontario hospices.

Background Practices related to the handling of controlled substances (CS) in Ontario hospices have not been previously published and therefore, are unknown. Objective The objective of this study was to determine current practices, and policies, standard operating procedures (SOPs) and guidelines related to handling and disposal of CS at hospices across Ontario. Setting This study was a cross-sectional survey of hospices in Ontario.

The C5-75 Program: Meeting the Need for Efficient, Pragmatic Frailty Screening and Management in Primary Care.

Case-Finding for Complex Chronic Conditions in Seniors 75+ (C5-75) is a systematic approach to identify frailty using gait speed and hand-grip strength and to screen for co-morbid conditions. We identified the C5-75 features offering the highest yield for identifying frailty and to streamline the screening program. Analyses included 1,948 C5-75 assessments completed from 2013 to 2018.

Spinal cord injury/dysfunction and medication management: a qualitative study exploring the experiences of community-dwelling adults in Ontario, Canada.

Purpose: To explore the attitudes, beliefs and experiences pertaining to the management of prescribed and unprescribed medications among community-dwelling adults with spinal cord injury/dysfunction (SCI/D) in Ontario, Canada.

Materials And Methods: In-depth semi-structured interviews were conducted by telephone. Each interview was audio-recorded, transcribed verbatim and analyzed using inductive thematic analysis.

A Prospective Study of Usability and Workload of Electronic Medication Adherence Products by Older Adults, Caregivers, and Health Care Providers.

Background: A decreased capacity to self-manage medications results in nonadherence, medication errors, and drug-related problems in older adults. Previous research identified 80 electronic medication adherence products available to assist patients with self-management of medications. Unfortunately, the usability and workload of these products are unknown.

Pharmacist interventions for persons with intellectual disabilities: A scoping review.

Introduction: Persons with intellectual disabilities (ID) often have complex health needs due to the development of multiple comorbidities. Given the higher associated use of problematic medications, such as antipsychotics, and polypharmacy, persons with ID may be particularly vulnerable to adverse side effects. With their medication expertise, pharmacists have the potential to address medication related challenges experienced by this population.

A Decade of Dementia Care Training: Learning Needs of Primary Care Clinicians.

Introduction: Limited knowledge of dementia among health professionals is a well-documented barrier to optimal care. This study examined the self-perceived challenges with dementia care and learning needs among primary care clinicians and assessed whether these were associated with years of practice and perceived preparedness for dementia care.

Methods: Participants were multi-disciplinary clinicians attending a 5-day team-based dementia education program and physicians attending a similar condensed continuing medical education workshop.

Exploring the perspectives on medication self-management among persons with spinal cord injury/dysfunction and providers.

Rationale: Spinal cord injury/dysfunction (SCI/D) is an exemplar condition with a high prevalence of secondary complications, chronic conditions and use of multiple medications (polypharmacy). Optimizing medication self-management is important for persons with SCI/D to improve outcomes; however, there is a lack of research on how healthcare/service providers and persons with SCI/D experience medication self-management.

Objective: To explore attitudes and experiences of medication self-management from the perspectives of persons with SCI/D and providers, and to explore the extent to which the Taxonomy of Everyday Self-management Strategies (TEDSS) framework captured participants' experiences with medication self-management.

The Value in Mental Health Screening for Individuals With Spinal Cord Injury: What Patients Tell Us.

Objective: To gather consumer perspectives of a mental health screening protocol and to identify the incidence of previously unrecognized mental health concerns (case finding).

Design: Pilot study using mixed methods: quantitative (survey) and qualitative (interviews).

Setting: Primary care health team in Kitchener, Ontario, Canada.

Epilepsy and lifestyle behaviors related to bone health.

Objective: Adults aged 50 years and older with epilepsy face an increased risk of fracture associated both with age and with the use of antiepileptic drugs. Lifestyle behaviors, such as physical activity and calcium and vitamin D intake, have been found to be beneficial to bone health. The aim of this study is to investigate these osteoprotective behaviors in people aged 50 years and older with and without epilepsy.

An approach to interprofessional management of complex patients: a case report.

Introduction: Complex patients are frequently high-users of health care resources. Case management has been demonstrated to be an effective and efficient approach for this demographic.

Case Presentation: A 36-year old, medically complex male patient was referred to an interprofessional primary care team to optimize health status.

Partnerships for improving dementia care in primary care: Extending access to primary care-based memory clinics in Ontario, Canada.

In Ontario, Canada, the Primary Care Collaborative Memory Clinic (PCCMC) model of dementia care provides a team-based assessment and management service that has demonstrated increased capacity for dementia care at the primary care level. PCCMCs are established following completion of a multi-faceted memory clinic training programme. Evidence of the success of this care model has been demonstrated primarily in practice settings with integrated interprofessional healthcare providers (HCPs).

Situational cues surrounding family physicians seeking external resources while self-monitoring in practice.

Many models of safe and effective clinical decision making in medical practice emphasize the importance of recognizing moments of uncertainty and seeking help accordingly. This is not always done effectively, but we know little about what cues prompt health professionals to call on resources beyond their own knowledge or skill set. Such information would offer guidance regarding how systems might be designed to offer better individual support.

Frailty Screening and Case-Finding for Complex Chronic Conditions in Older Adults in Primary Care.

With the aging population, escalating demand for seniors' care and limited specialist resources, new care delivery models are needed to improve capacity for primary health care for older adults. This paper describes the "C5-75" (Case-finding for Complex Chronic Conditions in Seniors 75+) program, an innovative care model aimed at identifying frailty and commonly associated geriatric conditions among older adults within a Canadian family practice setting and targeting interventions for identified conditions using a feasible, systematic, evidence-informed multi-disciplinary approach. We screen annually for frailty using gait speed and handgrip strength, screen for previously undiagnosed comorbid conditions, and offer frail older adults multi-faceted interventions that identify and address unrecognized medical and psychosocial needs.

Specialist and family physician collaboration: Insights from primary care-based memory clinics.

Given limited available geriatric specialists and complexity of dementia care, there is a need for greater collaboration between primary care and specialists to better meet the needs of persons with dementia. Meaningful family physician-specialist collaboration has the potential to improve health outcomes, timely access to care and more appropriate healthcare resource utilisation. Primary Care Collaborative Memory Clinics (PCCMCs), which include specialist support, provide a significant opportunity for studying the family physician-specialist interface.

Advancing primary and community care for persons with spinal cord injury: Key findings from a Canadian summit.

Persons with spinal cord injury (SCI) experience significant challenges when they access primary care and community services.: A provincial summit was held to direct research, education, and innovation for primary and community care for SCI. Toronto, Ontario, Canada.

Advanced Care Planning for Persons With Dementia in Primary Care: Attitudes and Barriers Among Health-Care Professionals.

Background: Advance care planning (ACP) provides clarity on goals and preferences for future health-care decisions, the timeliness of which is critical for persons with dementia.

Aim: This study assessed Primary Care Collaborative Memory Clinic (PCCMC) health-care practitioners' desire for more education on ACP, capacity for and attitudes toward ACP, and current ACP practices in their regular family practice and in their PCCMC.

Methods: Primary Care Collaborative Memory Clinic health-care professionals completed a questionnaire in which they rated their interest in learning various ACP-related topics (5-point scale: not at all to very much so), attitudes toward ACP, and the importance of and perceived degree of responsibility for ACP (5-point scale: not at all to extremely).

Persons with dementia and care partners' perspectives on memory clinics in primary care.

Aims: To understand persons with dementia (PWD) and care partners' experiences with the Primary Care Collaborative Memory Clinic (PCCMC) care model.

Methods: Interviews were conducted with a purposeful sample of PWD (n = 12) and care partners (N = 16) to identify their perspectives of care received in the clinic and suggestions for improvement.

Results: PWD and care partners were satisfied with care received within the PCCMC, had positive interactions with and perceived a strong sense of support from team members and felt listened to; the necessity of cognitive testing was recognized but disliked.

Self-management of pain and depression in adults with spinal cord injury: A scoping review.

Pain and depression are two prevalent secondary complications associated with spinal cord injury (SCI) that negatively impact health and well-being. Self-management strategies are growing in popularity for helping people with SCI to cope with their pain and depression. However, there is still a lack of research on which approaches are best suited for this population.

Demystifying serotonin syndrome (or ).

Objective: To review the symptoms of serotonin toxicity (commonly referred to as ) and the causative drugs and their mechanisms of action, and to equip primary care providers with practical strategies to prevent and identify serotonin toxicity.

Quality Of Evidence: PubMed and Google Scholar were searched for relevant articles on serotonin toxicity, the causes, and the differential diagnosis using search terms related to serotonin toxicity (), causes (individual names of drug classes, individual drug names), and diagnosis (). Experts in psychiatric medicine, psychiatric pharmacy, clinical pharmacology, and medical toxicology were consulted.

Melanoma in situ: a case report from the patient's perspective.

Introduction: Melanoma can be a fatal form of skin cancer. The prognosis rapidly deteriorates from the in situ stage (stage 0) to stage 4. As such, early detection and treatment are key.