A physician-physiotherapist collaborative model in a family medicine teaching clinic.

Persons with musculoskeletal disorders frequently seek care in family medicine clinics. However, musculoskeletal education provided in medical schools is often considered insufficient. The implementation of a collaborative model that integrates physiotherapists into teaching clinics may benefit the musculoskeletal training of medical residents. This paper describes a model developed in a family medicine teaching clinic by examining the interprofessional educational and collaborative activities implemented in this model. The model allowed to provide physiotherapy services, involve the physiotherapist in the training of family medicine residents and enhance interprofessional collaboration, particularly for the management of persons with musculoskeletal disorders.

Les personnes ayant des troubles musculosquelettiques consultent fréquemment en cliniques de médecine de famille. Cependant, l'enseignement musculosquelettique dispensé dans les programmes de médecine est souvent considéré comme insuffisant. L'implantation d'un modèle de collaboration qui intègre les physiothérapeutes aux cliniques d'enseignement pourrait améliorer la formation des médecins résidents. Cet article décrit un modèle développé dans une clinique d'enseignement en médecine familiale en examinant les activités interprofessionnelles d'éducation et de collaboration implantées dans ce modèle. Le modèle a permis d'offrir des services de physiothérapie, d'impliquer le physiothérapeute dans la formation des médecins résidents et d'améliorer la collaboration interprofessionnelle, particulièrement pour la prise en charge des personnes ayant des troubles musculosquelettiques.

Vaccine hesitancy: an overview.

Despite being recognized as one of the most successful public health measures, vaccination is perceived as unsafe and unnecessary by a growing number of individuals. Lack of confidence in vaccines is now considered a threat to the success of vaccination programs. Vaccine hesitancy is believed to be responsible for decreasing vaccine coverage and an increasing risk of vaccine-preventable disease outbreaks and epidemics. This review provides an overview of the phenomenon of vaccine hesitancy. First, we will characterize vaccine hesitancy and suggest the possible causes of the apparent increase in vaccine hesitancy in the developed world. Then we will look at determinants of individual decision-making about vaccination.

Physiolysis for correction of clinodactyly in children.

Congenital clinodactyly is a lateral deviation of a finger frequently caused by an abnormal middle phalanx (trapezoidal or triangular delta phalanx). The physis extends longitudinally on the short side of the middle phalanx. Resection of the abnormal longitudinal physis and fat graft interposition (physiolysis) has been reported to correct the lateral finger deviation in growing children. We reviewed 35 fingers that had a physiolysis procedure. The age at surgery varied from 2.9 to 10.9 years (mean, 6.6 y), the preoperative angulation was 20 degrees to 29 degrees in 9 fingers, 30 degrees to 39 degrees in 16 fingers, and 40 degrees or more in 10 fingers. Thirty-one fingers presented a trapezoidal phalanx and 4 fingers a triangular phalanx. Ten fingers had a second surgery using the same procedure. Follow-up time ranged from 1.2 to 5.3 years (mean, 3.2 y). After 1 procedure the degree of correction varied from 0 degrees to 30 degrees (mean, 11.1 degrees). The residual angulation was <15 degrees in 8 fingers, 15 degrees to 19 degrees in 4 fingers, 20 degrees to 29 degrees in 15 fingers, 30 degrees to 39 degrees in 6 fingers, and > or =40 degrees in 2 fingers. Correction obtained in the trapezoidal phalanges was better (mean 12.5 degrees) than in the triangular phalanges (mean, 2.8 degrees). The fingers presenting a more severe preoperative deformity (angulation > or =40 degrees) had a better correction (mean, 20 degrees) compared with fingers with a lesser deformity (mean, 7.5 degrees). The correction was also better in children who had surgery before 6 years of age (mean, 17.9 degrees) compared with older children (mean, 6.5 degrees). A second physiolysis procedure was not beneficial in 8 of 10 fingers reoperated and 2 premature fusions of the proximal transverse physis were found among these 10 fingers. There were no other complications. The physiolysis procedure is simple and effective, particularly in children presenting with a trapezoidal phalanx who have surgery before 6 years of age.