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The Canadian Journal of CME
2004 Back Issues

2001 • 2002 • 2003 • 2004 • 2005 • 2006 • 2007 • 2008 • 2009 • 2010 • 2011 • 2012

Jan • Feb • Mar • Apr • May • Jun
• Jul • Aug • Sept • Oct • Nov • Dec

CME Workshop

Tools to Treat Chronic Fatigue Syndrome, Fibromyalgia, and
Multiple Chemical Sensitivity
By Lynn M. Marshall, MD, FAAEM, FRSM; Alison Bested, MD, FRCPC; and
Riina I. Bray, BASc, MSc, MD, CCFP

The chronicity and complexity of chronic fatigue syndrome, fibromyalgia,
and multiple chemical sensitivity can often seem overwhelming to patients and physicians.

Feature 1
COPD: Complex Obstructive Pulmonary Disease
By Rick Hodder MD, FRCPC

By the year 2020, COPD is predicted to be the fifth leading cause of disability, and the third leading cause of death worldwide.


Feature 2
The Dish on Slimming Down
By Ronnie Aronson, MD, FRCPC, FACE; and Karri Koach, BSc, RD

The World Health Organization has declared the growing rate of obesity to be an epidemic in developed countries. In the U.S. and Canada, obesity rates are predicted to near-double within the next two decades.


Feature 3
Mapping Depression
By Roger McIntyre, MD, FRCP; and Jakub Z. Konarski, MSc, PhD candidate

Major depressive disorder (MDD) is a highly prevalent, heterogenous, and progressive disorder. Depression often coaggregates with other illnesses, such as anxiety and cardiovascular disease. Persons with depression and anxiety disorders are consistently identified as high users of primary care services.


Feature 4
Screening for Colorectal Cancer
By Andy Smith, MD, MSc, FRCSC

Colorectal cancer is the second biggest killer amongst cancers. Colonoscopy is the best method for assessment of the presence of adenomatous polyps or colorectal cancers in the colorectum.

Feature 5
How Do I Treat Venous Leg Ulcers?
By David H. Keast, MSc, MD, FCFP

The prevalence of active leg ulcers in western countries is estimated to be 1.1 to 3.0 per 1,000 adults. The incidence increases with age. By these estimates, the average family physician could expect to have two to 10 patients with a leg ulcer at any given time.


Feature 6
The Many Faces of Dementia
By Y.H. Nashed, MD, FRCPC

With the advance in medical technology, the aging population is on the rise. Baby boomers will reach the age of 85 between 2030 and 2050, with an alarming increase in the rate of dementia in every primary care practice.


Feature 7
The Truth Behind Allergies
By Peter Vadas, MD, PhD, FRCPC, FACP

While many people believe they may be allergic to specific foods, the term allergy tends to be used too loosely. Adverse reactions to foods may be true immunologic reactions, but most reactions are non-immunologic, due to various forms of food intolerance.


Feature 8
Complementary Medicine: What You Should Know
By Mel Borins, MD, FCFP, (M)GPP

Complementary medicine is controversial, yet the number of patients who use alternative approaches continues to increase.


University Briefs


DermCase — New!


Ask the Experts


PhotoClinic — New!
Presented by Benjamin Barankin, MD


You Asked About:
• Gouty arthritis and more tendonitis
• LBBB and hypertension


Cases in Endocrinology — New!
Presented by M. Usman Chaudhry, MD, FACE


CME Credit Quiz

Upcoming

Calendar
Upcoming events at the University of Toronto

CME Workshop
How Do I Define Capacity?
By Michele Doering MD, FRCPC; and Paul Wadden MD, FRCPC

Through three phone conversations, a family physician receives advice concerning a challenging situation, from a psychiatrist.

Feature 1
“Is it a Tumour?”
By Krishna Balachandra, MD; Aashish Goela, MD; Gwynedd Pickett, MD;
Sherry Krawitz, MD, BA, MA, BSc; and Raj Dhar, MD

A case involving a patient who presents with fatigue, depressed mood, sleep disturbance, poor appetite, poor concentration, decreased activity, and aches.


Feature 2
From Head to Toe: What to do About Somatoform Disorders
By Praful Chandarana, MD, FRCPC; and Joseph Pellizzari, PhD, CPsych

While somatoform disorders have a rich descriptive and empirical history in the annals of psychiatry, psychology, and general medicine, they continue to perplex and frustrate practitioners.


Feature 3
Shedding Light on Blackouts
By Andrew D. Krahn, MD, FRCPC, FACC

Syncope is defined as a sudden temporary loss of consciousness with spontaneous recovery. Syncope affects 12% to 48% of the population at some point during their lives (most people do not seek medical attention).


Feature 4
Psychiatric Comorbidity in Eating Disorders
By Jennifer Couturier, MD

Eating disorders are associated with one of the highest risks of premature death of all mental illnesses.


Feature 5
Stroke Prevention: What’s the Secret?
By J. David Spence MD, FRCPC

Because the risk of stroke increases steeply with age, and our population is aging quickly, a huge increase in stroke has been forecast by the Heart & Stroke Foundation.


Feature 6
Creepy Crawlies and Kids
By Michael J. Rieder, MD, PhD, FRCPC, FAAP, FRCP (Glasgow)

Scabies and lice are reasonably common problems for primary care practitioners.

Feature 7
Obsessive Compulsive Youth: The Matrix of Support
By Margaret M. Steele, HBSc, MD, FRCPC, MEd

Obsessive-compulsive disorder was once considered rare. Recent studies, however, indicate a prevalence of 1% to 2% in children and adolescents.


Feature 8
Hunting for Huntington’s
By Varinder Dua, MD, FRCPC

Huntington’s disease is a well-defined, inherited neurodegenerative disease which afflicts the human population regardless of gender, race, or ethnicity. It results in significant morbidity and mortality.


Feature 9
Psychosis in the Elderly: What Can I Do?
By Kiran Rabheru, MD, DABPN, CCFP, FRCPC

Psychotic disorders characterized in older adults, by loss of touch from reality, are common and challenging to manage in primary care.


Feature 10
Schizophrenia: Early Intervention
By Rahul Manchanda, MD, MRCPsych, FRCP(C); and Ross M. G. Norman, Ph.D., C.Psych

Early intervention includes placing a focus on the nature and content of treatment.


Editorial
By Jatinder Takhar, MD, FRCPC; and Jason Eadie, BSc, MBA

University Briefs

DermCase — New!


Ask the Experts


PhotoClinic
Presented by Catherine McCuaig, MD, FRCPC, DABD


You Asked About:
• What’s the link between testosterone and prednisone?
• Bisphosphonates and osteoporosis: When and how?
• Are there dangers in continuing with the pill?
Cases in Endocrinology
Presented by M. Usman Chaudhry, MD, FACE


CME Credit Quiz


Upcoming


Calendar
Upcoming events at the University of Western Ontario

Feature 1
Endometriosis 101
Catherine Allaire, MDCM, FRCSC

There is an apparent increase in the prevalence of endometriosis over the last few decades. Dr. Allaire gives us a primer on its diagnosis and treatment.


Feature 2
What’s New in Cardiac Testing?
Payam Dehghani, MD, FRCPC; Dobri Hazarbasanov, MD; and
Andrew Ignaszewski, MD, FRCPC

Cardiac risk factors fail to predict the development of coronary artery disease in many cases (25-50%). These authors explain the updates in cardiac testing using two case studies.


Feature 3
Dealing with Menopause: 4 Case Studies
Chui Kin Yuen, MD, FACOG, FSOGC, FRCSC

All four women are 54 years old and began menopause at 51. They each have issues with osteoporosis and other concerns. What would you do in each case?

Feature 4
What to do About the Child with Headaches
Sheikh Nigel Basheer, MB; and Kevin Farrell, M

Migraine is the most common cause of recurrent headache in children, and occurs in up to 15% of adolescent girls. Migraine can nearly always be diagnosed based on the history and examination.


Feature 5
Q&A on Asthma Control
Louis-Philippe Boulet, MD, FRCPC

According to current guidelines, the main goal of asthma management is to achieve adequate control of the disease’s manifestations in order to minimize its consequences. Many patients do not achieve this control or cannot define their own degree of control. Dr. Boulet gives us some tools to help patients.


Feature 6
Education Seeping Through Sepsis
Delbert Dorscheid, MD, PhD, FCCP, FRCPC

Each year, sepsis develops in more than 750,000 patients in the U.S., and approximately 60% of these patients survive. Dr. Dorscheid describes what to do with patients with sepsis.

Feature 7
Coughing Up the Facts on Chronic Cough
BJ Mark FitzGerald, MB, FRCPI, FRCPC

Cough is the most common reason for a physician visit in North America.
Dr. Fitzgerald explains how to assess and treat your patient with chronic cough.


Feature 8
“Doctor, the flow won’t stop!”
Pétra Selke, MD, FRCSC

Dr. Selke discusses what is considered “normal” and “abnormal”menstrual bleeding and describes the dangers of abnormal blood flows.


Feature 9
“Why am I Coughing Up Blood?”
Jennifer M. Wilson, MD, FRCPC

The amount and persistence of hemoptysis, in combination with patient
characteristics, can guide the sequence and urgency of further investigations.


Feature 10
What’s New in Interstitial Lung Disease
Nasreen Khalil, MD, FRCPC, FCCP

A new classification describes idiopathic interstitial pneumonias, clearly
distinguishing between the diagnostic terminology of the disease entity and the histologic pattern on a surgical lung biopsy.

Feature 11
On the Alert for Excessive Daytime Sleepiness
Najib T. Ayas, MD, MPH; and Charlie S.K. Wang, MD

Daytime sleepiness is a common complaint, with potentially serious
consequences.


Feature 12
What To do About Breast Lumps
Urve Kuusk, MD, FRCSC

Most breast problems in the premenopausal age group are a manifestation of benign disease. The role of the physician is to make an accurate diagnosis and to arrange for appropriate treatment.


Editorial
Kendall Ho, MD, FRCPC


DermCase — New!


DermQuiz — New!


Ask the Experts
The Calgary Health Region


PhotoClinic
Benjamin Barankin, MD


You Asked About:
• Any studies on Botox®?
• How bad is West Nile Virus?
• Sweating it out at night: Why?

Feature 1
Genetics for the GP
By Ross McLeod, MD, FRCPC, FCCMG

Clinicians must recognize the wealth of information available in a patient’s family history and its vital importance in providing anticipatory care. Dr. McLeod demonstrates the significance and structures of pedigrees.


Feature 2
Hyperkinetic Movement Disorders
By Sarah Furtado, MD, PhD, FRCPC

Hyperkinetic movement disorders are characterized by excess of movement and may be classified as certain tremors, chorea/dyskinesia, dystonia, and tics. Dr. Furtado explains how to distinguish and treat these disorders.


Feature 3
When Growing Up Hurts: Limb & Joint Pain in Kids
By Ray Lewkonia, MB, DCH, FRCPC

What do you need to know about the nature, setting, and treatment of symptoms related to inflammatory and non-inflammatory pain in children?


Feature 4
HRT: To Prescribe or Not to Prescribe?
By Magali Robert, MD, FRCSC

There is presently a lot of controversy over the role of HRT. Dr. Robert sums up the risks and benefits of HRT therapy in this article.


Feature 5
TB: Closer to Home
By Robert L. Cowie, MD, MSc, FCP(SA);
Stephen K. Field, MD, CM, FRCPC;
and Dina A. Fisher, MD, FRCPC

The recognition of tuberculosis (TB) is the single most important step in maintaining control of the condition in Canada. The authors provide some insight on how to identify and manage the disease.


Feature 6
Prostate Cancer: When to Worry, When to Test?
By Bryan J. Donnelly, MSc, MCh, FRCSI, FRCSC

Dr. Donnelly walks us through the risk factors, symptoms, and treatment of prostate cancer.

Feature 7
“Could this man have andropause?”
By Bernard Corenblum, MD, FRCPC

What do you need to know about the possible fall of testosterone in the aging male?


Feature 8
What’s New in Breast Cancer?
By Theresa Trotter, MD, FRCPC

Breast cancer accounts for almost 33% of all cancer diagnoses, and has the second-highest mortality rate after lung cancer. Dr. Trotter discusses recent advancements in the treatment of this disease.


Feature 9
The Painful Truth: Anorectal Disorders
By Wayne Rosen, MD, FRCS(C), FASCRS

Symptoms related to the anus and rectum are among the most common complaints to family physicians. Dr. Rosen zeros in on the appropriate assessment and examination procedures related to anorectal disorders.


Feature 10
Targeting NSCLC: Update on a New Therapy
By Cynthia M. Card, MD, FRCPC

Non-small cell lung cancer (NSCLC) is the most common form of lung cancer. Dr. Card provides an update on therapy.


Feature 11
How Do You Know It’s Croup?
By David Johnson, MD

Dr. Johnson discusses the differential diagnoses of croup, as well as treatment options.


Feature 12
Getting Aggressive with Dementia
By Adrienne Cohen, MD, BSc, FRCPC

Up to 90% of people with dementia experience behavioural symptoms and 25% to 30% are aggressive during the course of their illness. Dr. Cohen focuses on aggression in the elderly.


Editorial
By John Toews, MD, FRCPC, FAPA


DermCase — New!


PhotoClinic


You Asked About:
• Can statins lower the risk of age-related macular degeneration?

Feature 1
Non-Vertiginous Dizziness
Janine L. Johnston, BSc Pharma, MD, FRCPC

Almost half of all patients will have more than one condition contributing to their dizziness. Dr. Johnston outlines seven main causes and the
corresponding treatments.


Feature 2
ENTs: Not-So-Easy Emergencies
F. Gigi Osler, MD, FRCSP(C)

Successful treatment of ENTs depends on rapid recognition and immediate, appropriate management. Dr. Osler walks through the presentation and treatment of both epistaxis and epiglottitis.


Feature 3
Charcot Arthropathy:
A Limb-Threatening Condition
Elly Trepman, MD; Chris Everhardus, RN; and John Embil, MD, FRCPC

Charcot arthropathy of the foot and ankle is a syndrome consisting of
fractures and dislocations in patients with peripheral neuropathy. Despite the presence of severe bone and joint destruction, pain may be absent or less than expected.


Annual Focus on Superbugs

C. difficile Infection: More Than Just Diarrhea
Gregory Hammond, MD, FRCP(C)

Clostridium difficile infection rates appear to be rising. While most infections have been seen historically in an institutional setting, the diagnosis of
C. difficile must now be considered in any elderly patient with diarrhea.


Fever in the Post-operative Patient
Christopher Sikora, BSc, MSc; John M. Embil, MD, FRCPC

In the first 24 hours after an operation, whether caused by infectious or
non-infectious reasons, 27% to 58% of patients may develop fever. It is important not to overlook the non-infectious causes when a fever is present.

Body Fluid Exposure: What To Do?
John Sokal, MD, CFPC

Calculating transmission risk and determining how to tackle cases of body fluid exposure can be a major headache for GPs. Dr. Sokal makes life a
little easier in outlining appropriate courses of action.


Travellers Beware! Staying Healthy in the Tropics
Pierre Plourde, MD, FRCPC

Travelling to tropical destinations involves inherent risks. Whether intentionally or not, international travellers can expose themselves to a plethora of hazards. Dr. Plourde provides tips on what, and what not, to do.


Mad Cow: What’s the Danger?
James L. Neufeld, DVM, Dipl path, Dipl ACVP

While relatively new, bovine spongiform encephalopathy is one of the most talked about animal prion diseases. There have been two cases in Canada, but is the health of beef-eating Canadians in danger?


Surface Water: What’s in Your Tap?
John M. Embil, MD, FRCPC; Bill Limerick, CPHI(C); and
Lyle Wiebe, BTech, DEH, DOHS, CRSP, CPHI(C), CIC

Many of us take water for granted. Water is often deemed adequate for consumption based strictly on its esthetic attributes. However, it is critical to assess an individual history and exposure to possible contaminents to assist in gastrointestinal-related diagnoses.


Taking Control of Septics Joints: A Guide
Thomas Jacob, MD; John M. Embil, MD, FRCPC; David Hedden, MB, FRCSC, and; Gerhard W. Bock, MD, FRCPC

Septic arthritis is a common clinical presentation. It is important that an aggressive diagnostic strategy be used, as septic arthritis can destroy a joint in 24 to 72 hours.


Editorial
Brent Kvern, MD, CCFP, FCFP


DermCase — New!


DermQuiz — New!


PhotoClinic


You Asked About:
1. What’s the family physician’s role with their oncology patients?
2. Can cholesterol absorption inhibitors lower lipids?
3. How are homocysteine levels lowered?
4. What’s the first-line treatment for BPH?
5. What are the options for osteoporosis?

4 Arguments Against
Colon Cancer Screening
Roger Ladouceur, MSc, MD, CCMF, FCMF

While it has been long acknowledged that screening for colorectal cancer reduces associated deaths, Dr. Ladouceur argues that the health-care
system has neither the means nor the resources to carry out systematic screening.


Editorial
Robert L. Thivierge, MD, FRCPC, FAAP


DermCase — New!


Ask the Expert
What errors do GPs make in detecting/managing hypertension?


DermQuiz — New!


PhotoClinic


You Asked About:
1. What winter-month allergen returns negative on testing?
2. Can an ARB and an ACE be used together?
3. Are seeds and nuts the enemy?
4. Osteoporosis in men
5. What’s the secret about eyelash lice?
6. Does a correlation exist between estrogen level from lab tests and dose in HRT?

Feature 1
Syphilis: Stemming the Outbreak
Christopher Sikora, MSc, MD; Dennis Loeppky, BN, RN;
and John Embil, MD, FRCPC

Although syphilis was thought to have been eradicated from Canada, recent outbreaks should heighten awareness of the threat posed by this often difficult-to-diagnosis disease. Dr. Sikora discusses options for identifying and dealing with the disease.


Feature 2
Health Literacy: Bridging the Gap
Monique Camerlain, MD, FRCPC; and Genevieve Myhal, BBA

Studies show patients with limited literacy have poorer health habits and are more likely to be hospitalized. Dr. Camerlain looks at what physicians can do to better communicate with their patients on a daily basis.


Feature 3
It’s No Yolking Matter:
Reaction During Insemination
Pierre-Michel Bédard, MD, FRCPC; Nina Verreault, BSc, MD;
Rémi Gagnon, MSc, MD; Jacques Mailloux, MD, FRCSC;
and Rita Demers, RN

Few adverse allergic reactions have been well documented in the 30 years since artificial insemination became commonplace. A case study, presented by Dr. Bédard, illustrates the importance of consulting patients about allergies.


Feature 4
Hypertension In Pregnancy: Measuring the Risk
Evelyne Rey, MSc, MD; and Stéphane Côté, MD

Hypertension affects 5% to 10% of pregnancies and is linked to many serious complications. Dr. Rey explores the advantages and disadvantages of home and ambulatory blood pressure monitoring.


Feature 5
The Three Sides of Anemia In the Elderly
By Thien Tuong Minh Vu, MD; Michel Dugas, MD, FRCPC

It has now been generally accepted that aging doesn’t cause anemia, but rather, predisposes a person to it. Dr. Vu discusses three types of anemia, and how they effect the geriatric population.


Feature 6
The Rounds on Rotator Cuff:
A Q&A on Consistent Shoulder Pain
By Richard Lirette, MD, FRCSC; and Pierre du Tremblay, MD, FRCSC

According to one study, 54% of patients over 60 have some degree of rotator cuff tear. Dr. Lirette provides essential answers to important questions on how to ease the pain.


Feature 7
AIDS: Where Are We Now?
Dan Turner, MD; and Mark A. Wainberg, PhD

AIDS was the leading cause of death for people aged 20 to 40 from the early 1980s until the mid-1990s. Dr. Turner delves into the changing world of antiretroviral therapy today.


Editorial
Lucien Latulippe, MD, FRCPC


Review: CME Congress 2004


DermCase


Ask the Expert
Alzheimer’s Disease and Education:
What’s the Correlation?


DermQuiz


You Asked About:
1. Is earlier really better?
2. Do antithyroid drugs help?
3. Waging war on tennis elbow
4. Is it adult ADHD?
5. Psoriasis–or is it?
6. The truth about halitosis

August 2004


Feature 1
Starting, Switching, and Stopping:
Cholinesterase Inhibitors for Alzheimer’s
Christopher Frank, MD, CCFP

Despite efforts to educate the public and physicans alike about the use of cholinesterase inhibitors, uncertainty remains. Dr. Frank sheds light on one of the more confusing aspects: management strategies once treatment has begun.


Feature 2
Anemia of Chronic Disease:
Making the Right Call
Benjamin H. Chen, MD, CM, CCFP, FRCPC; and Sonal Gandhi, Hon. BSc

Anemia is becoming an increasingly prevalent problem as the population ages. The authors walk through the diagnosis and treatment of the most common cause of anemia in the elderly: anemia of chronic disease.


The Gold Standard:
Feature on Geriatrics

Feature 3
Use It or Lose It:
The Importance of Excercise in the Elderly
Katherine Kilpatrick, MD, CCFP

Known as the “perfect pill”, exercise helps prevent and improve common, often difficult-to-treat geriatric problems. In this article, Dr. Kilpatrick outlines the amount and form of exercise physicians should be prescribing.

Feature 4
The Agitated Older Patient: What To Do?
Michelle Gibson, MD, CCFP

Dr. Gibson provides essential pointers on how to diagnose and treat both delirium and behavioural/psychologic symptoms of dementia in older,
agitated patients.


Feature 5
Looking Ahead, Acting Now:
Advance Care Planning
Jeffrey R. Sloan, MD, CCFP

While physicians are generally reluctant to initiate advance care planning (ACP) discussions, many patients expect them to. Dr. Sloan provides a guide for incorporating ACP into your daily practice.


Feature 6
Breathing New Life Into COPD
Denis E. O’Donnell, MD, FRCP(I), FRCP(C)

By 2020, it has been projected that chronic obstructive pulmonary disease will become the third leading cause of death worldwide. Dr. O’Donnell answers several questions, ranging from intervention strategies to assessing patient response.


Feature 7
Say, What? The Info on Leg Ulcers
Imaan M. Bayoumi, MD; and Maureen Buchanan, RN, BScN

According to a recent survey, Canadian family physicians are not confident in their abilities to manage leg ulcers. The authors look to help reverse that trend with this comprehensive review.


Feature 8
Proving the Point: Evidence-Based Medicine
Walter W. Rosser, MRCGP, CCFP, FCFP

With an ever-increasing number of medical studies bombarding physicians on a daily basis, assessing the quality of critically appraised information is essential. Dr. Rosser provides tips for effectively dealing with the volume of medical information.


Editorial
Lewis L. Tomalty, PhD, FCCM (CCM)


Bug of the Month
The Lowdown on Clostridium difficile


DermCase


Ask the Expert
Anemia in Long-Term Care Patients:
What’s the Best Approach?


DermQuiz


Consultant’s Corner
1. Can botulinum toxin A beat migraines?
2. At risk of cancer?
3. What about that itchy fungus?
4. Discovering gynecomastia

Acetylsalicylic acid (ASA) for patients with
atherosclerotic disease is now uncontested. But the
benefits of ASA use for those without the disease are still up for debate. Dr. Lanthier provides four solid answers to your most important questions on when to use ASA and related risks.


Feature 2
Solutions for the Empty Scrotum
Sandeep K. Mayer, MD, FRCSC; and Samer Hanna, MD

Dr. Mayer and Dr. Hanna explore how to diagnose
undescended testes and strategies for managing this pediatric disorder.


Editorial
Paul Bessette, MD


DermCase


Consultant’s Corner
1. Reactive airway disease or asthma?
2. Can we stop the flu?
3. What to know about testosterone
4. What’s the goal in BP control?
5. Where to start with personality disorder
6. Chiropractic medicine—a good alternative?
7. Combine with care
8. Tools to ease chronic pain
9. Antidepressants—is there a “right” age?
10. Hidden causes of hyperkalemia
11. Don’t forget to flush!
12. Making the right choice for geriatric care
13. How should we manage persistent AF?


Photo Clinic


Bug of the Month
John Embil, MD, FRCPC; and Richard Long, MD, FRCPC

The Trouble with Tuberculosis


Quick Queries
Marcel Arcand, MD, MSc, FCMF

Road Rules: Dementia & the Elderly Driver


Update
Laura Calhoun, MD, FRCPC

Women & Depression: A Real Problem


Case In... Chemotherapy
Jean Dufresne, MD

Essentials for the GP


Time Out
Howard A. Winston, MD, CCFP, FCFP, Dip. Sport Med. (CASM)

Shouldering Shoulder Pain


Clinical Approach
François Cabana, MD, CSPQ

A pain in the... Looking at Lower Back Pain


Workshop
Monique Camerlain, MD, FRCPC

No Bones About It: The Osteoporosis Care Gap