Top resources and tools for physician management of chronic pain in the Canadian Armed Forces

LAY SUMMARY Diagnosis and management of chronic pain in Canada by primary care clinicians is a challenging and changing field with new approaches, evidence, and tools emerging in the past few years. For a busy clinician, it is vital to integrate and become aware of new tools that can improve the care delivered to patients. This article summarizes new evidence-based tools, key guidelines and research, algorithms, and simplified prescription practices, in addition to continuous medical education resources that will allow busy clinicians to rapidly be brought up to speed on the latest in chronic pain management in the Canadian military context.

Five Features to Look for in Early-Phase Clinical Intervention Studies

Neurorehabilitation relies on core principles of neuroplasticity to activate and engage latent neural connections, promote detour circuits, and reverse impairments. Clinical interventions incorporating these principles have been shown to promote recovery and demote compensation. However, many clinicians struggle to find interventions centered on these principles in our nascent, rapidly growing body of literature. Not to mention the immense pressure from regulatory bodies and organizational balance sheets that further discourage time-intensive recovery-promoting interventions, incentivizing clinicians to prioritize practical constraints over sound clinical decision making. Modern neurorehabilitation practices that result from these pressures favor strategies that encourage compensation over those that promote recovery. To narrow the gap between the busy clinician and the cutting-edge motor recovery literature, we distilled 5 features found in early-phase clinical intervention studies—ones that value the more enduring biological recovery processes over the more immediate compensatory remedies. Filtering emerging literature through this lens and routinely integrating promising research into daily practice can break down practical barriers for effective clinical translation and ultimately promote durable long-term outcomes. This perspective is meant to serve a new generation of mechanistically minded and caring clinicians, students, activists, and research trainees, who are poised to not only advance rehabilitation science, but also erect evidence-based policy changes to accelerate recovery-based stroke care.

Sustained Support for a Dissertation Will Facilitate Postgraduate Research Publication: An Experience From South India

Background: Though India’s position in research is notable, it is poor in medical research, barring four centers of excellence. Where the priority for the Government is providing universal health care and for a postgraduate (PG) is becoming a busy clinician, the research remains a low priority. Getting published is an incentive for researchers, and its experience during the training period will be valuable. Research by practitioners in the field is a need in low-and middle-income (LAMI) countries to find workable solutions to local problems. Objectives: The objectives of this study were to develop a system for sustained support and evaluation of the dissertation and to examine its impact on getting published by PG students. Methods: In this prospective study, all 27 PG students of 2015 Batch were given support throughout their six-semester course. Participants were PG students registered for the course in 2015. This included orientation for guides, research methodology (RM) for students and pre-submission (synopsis) external review in the first semester; mid second-year review in the fourth semester and pre-submission (final dissertation), and selection for award and workshop for paper submission in the fifth semester. Results: Before appearing for the final examination in 2018, all 27 students prepared papers out of their dissertations and submitted them to the journals. From April 2019, 19 papers were published, and eight were in various stages of publication. Conclusions: Given sustained guidance and support from the institution, students perform very well, leading to improved publication status.

How to Evaluate Clinically Relevant Literature: Five Simple Rules for the Practicing Clinician in Stroke Neurorehabilitation

Neurorehabilitation relies on core principles of neuroplasticity to activate and engage latent neural connections, promote detour circuits, and reverse impairments. Clinical interventions incorporating these principles have been shown to promote recovery while demoting compensation. However, many clinicians struggle to find evidence for these principles in our growing but nascent body of literature. Regulatory bodies and organizational balance sheets further discourage evidence-based, methodical, time-intensive, and efficacious interventions because practical needs often outweigh and dominate clinical decision making. Modern neurorehabilitation practices that result from these pressures favor strategies that encourage compensation over those that promote recovery. With a focus on helping the busy clinician evaluate the rapidly growing literature, we put forth five simple rules that direct clinicians toward intervention studies that value more enduring but slower biological recovery processes over the more alluring practical and immediate “recovery” mantra. Filtering emerging literature through this critical lens has the potential to change practice and lead to more durable long-term outcomes. This perspective is meant to serve a new generation of mechanistically minded clinicians, students, and trainees poised to not only advance our field but to also erect policy changes that promote recovery-based care of stroke survivors.

Genetic testing for Parkinson disease

Purpose of reviewWith the advent of precision medicine and demand for genomic testing information, we may question whether it is time to offer genetic testing to our patients with Parkinson disease (PD). This review updates the current genetic landscape of PD, describes what genetic testing may offer, provides strategies for evaluating whom to test, and provides resources for the busy clinician.Recent findingsPatients with PD and their relatives, in various settings, have expressed an interest in learning their PD genetic status; however, physicians may be hesitant to widely offer testing due to the perceived low clinical utility of PD genetic test results. The rise of clinical trials available for patients with gene-specific PD and emerging information on genotype-phenotype correlations are starting to shift this discussion about testing.SummaryBy learning more about the various genetic testing options for PD and utility of results for patients and their care, clinicians may become more comfortable with widespread PD genetic testing in the research and clinical setting.