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Basal Cell Carcinoma

Basal Cell Carcinoma

Teaser: 

Erin Dahlke, MD, Dermatology Resident, University of Toronto, Toronto, ON.
Christian A. Murray, MD, FRCPC, Assistant Professor of Medicine and Dermatology, University of Toronto; Co-director of Dermatologic Surgery, Women’s College Hospital, Toronto, ON.

Basal cell carcinoma (BCC) is a common, slow-growing malignant skin tumour that only very rarely metastasizes. The main subtypes of BCC are nodular, superficial, and sclerosing. The most important risk factors for the development of BCC include fair skin, extensive sun exposure as a child, past personal history of skin cancer, and advanced age. Basal cell carcinoma is the most common human malignancy, and its incidence is increasing worldwide. There are a number of different treatm ent modalities for BCC including topical therapies, cryotherapy, electrodesiccation and curettage, surgical excision, radiotherapy, and Mohs’ micrographic surgery. Treatment should be tailored to the individual situation, and advanced age does not typically alter the management choice or reduce the expectation of an excellent outcome, including cure.
Key words: basal cell carcinoma, nonmelanoma skin cancer, risk factors, epidemiology, treatment.

Osteoporosis Screening and Assessment of Fracture Risk

Osteoporosis Screening and Assessment of Fracture Risk

Teaser: 


Mohammed O. Rahman, BHSc student, McMaster University, Hamilton, ON.
Aliya Khan, MD, FRCPC, FACP, FACE, Professor of Clinical Medicine, McMaster University, Hamilton, ON, Director, Calcium Disorders Clinic, St. Joseph’s Healthcare, Hamilton; Director, Oakville Bone Center, Oakville, ON.

Osteoporosis is a skeletal disease characterized by impaired bone strength and an increased risk of fragility fracture. Effective screening should be aimed at evaluating risk factors for osteoporosis with identification of individuals at risk, allowing for intervention prior to fragility fracture. This article presents an overview of the risk factors for fracture in men and women and the integration of these factors in various models, enabling an assessment of the 10-year fracture risk. Through effective screening, early identification, and early intervention with pharmacological therapy of osteoporosis, significant impact can be made on reducing fragility fracture incidence, thereby alleviating the economic and clinical costs to our health care system.
Key words: osteoporosis, screening, risk factors, diagnosis, FRAX.

Poststroke Dementia among Older Adults

Poststroke Dementia among Older Adults

Teaser: 


Aleksandra Klimkowicz-Mrowiec, PhD, Department of Neurology, University Hospital Cracow, Poland.

Stroke and dementia are major health problems affecting older people. Cerebrovascular disease is the second-leading cause of dementia after Alzheimer’s disease, the third- leading cause of death, and one of 10 leading causes of physical disability. In parallel with the increased prevalence of stroke in aging populations and the decline in mortality from stroke, the rate of diagnosed poststroke dementia has increased, causing a growing financial burden for health care systems. This article discusses the epidemiology, etiology, and determinants of poststroke dementia and outlines the search for a suitable treatment.
Key words: dementia, stroke, cognition, risk factors, cognitive impairment.

Dehydration in Geriatrics

Dehydration in Geriatrics

Teaser: 

MC Faes, MD, MSc, Department of Geriatric Medicine, University Medical Centre Nijmegen, The Netherlands.
MG Spigt, PhD, Department of General Practice/Research Institute CAPHRI, University of Maastricht, The Netherlands.
MGM Olde Rikkert MD, PhD, Department of Geriatric Medicine, University Medical Centre Nijmegen, The Netherlands.

Homeostasis of fluid balance is an important prerequisite for healthy aging. The high prevalence of disturbances of fluid balance among older adult patients has triggered clinical research on age- and disease-related changes in water homeostasis. Empirical findings on risk factors of dehydration and on diagnostic and therapeutic strategies are reviewed in this paper. No single measure has proved to be the gold standard in the diagnosis of dehydration. Diagnosing dehydration and monitoring fluid balance requires repeated measurements of weight, creatinine, and physical signs such as tongue hydration. Rehydration and prevention requires fluid on prescription (> 1.5 litre/day), and the route of fluid administration depends on the acuteness and severity of clinical signs.
Keywords: older adults, dehydration, fluid therapy, risk factors, diagnosis.

Post-Stroke Depression: Focus on Diagnosis and Management during Stroke Rehabilitation

Post-Stroke Depression: Focus on Diagnosis and Management during Stroke Rehabilitation

Teaser: 

Elizabeth A. Johnson, RN, PhD(c), Board Certified Geriatric Clinical Nurse Specialist, Doctoral Candidate, Indiana University School of Nursing; Department of Adult Health, Indiana University School of Nursing, Indianapolis, IN, USA.
Tamilyn Bakas, RN, DNS, FAHA, Associate Professor, Department of Adult Health, Indiana University School of Nursing, Indianapolis, IN, USA.
Linda S. Williams, MD, Chief of Neurology, Roudebush Veterans Administration Medical Center; Research Coordinator, VA Stroke QUERI; Associate Professor of Neurology, Indiana University School of Medicine; Research Scientist, Regenstrief Institute, Indianapolis, IN, USA.

Depression, the most frequent neuropsychological problem after stroke, is greatly influenced by the complex relationships between the neurobiological and psychological changes that occur after stroke. Post-stroke depression leads to negative rehabilitation outcomes including less participation in therapy, extended recovery time, significantly decreased quality of life, and increased utilization of health care resources. Because of the high prevalence of post-stroke depression, all stroke survivors should be screened early in the rehabilitation process. Use of a biopsychosocial framework acknowledges the multifactorial etiology of post-stroke depression and contributes to effective, evidence-based treatment. Attention to the needs of the family caregivers further promotes successful post-stroke rehabilitation.
Key words: stroke, depression, risk factors, recovery, treatment.

Post-Stroke Depression -- July/August 2007

Post-Stroke Depression -- July/August 2007

Teaser: 

Lana S. Rothenburg, BSc(Hons), Neuropsychopharmacology Research Program, Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON.
Nathan Herrmann, MD FRCP(C), Neuropsychopharmacology Research Program; Department of Psychiatry, Sunnybrook Health Sciences Centre; Department of Psychiatry, University of Toronto, Toronto, ON.
Krista L. Lanctôt, PhD, Neuropsychopharmacology Research Program; Department of Psychiatry, Sunnybrook Health Sciences Centre; Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON.

Depression is a common sequela of stroke, occurring in approximately 33% of all patients. Post-stroke depression (PSD) is associated with greater cognitive and functional impairments, excess mortality, and increased health care costs, although symptoms are often mild. Diagnosis of PSD can be made using standard clinical criteria, despite the potential overlap with the somatic and vegetative symptoms of stroke. Post-stroke depression responds to standard antidepressant pharmacotherapies, but use of tricyclic antidepressants may result in increased cardiac adverse events. Given the high prevalence and major negative impact of PSD, active screening of all stroke patients for depression and aggressive treatment is recommended.
Key words: stroke, depression, diagnosis, risk factors, treatment.

Atypical Presentations of Depression

Atypical Presentations of Depression

Teaser: 


James L. Silvius, MD, FRCPC, Calgary Health Region, Clinical Associate Professor, Department of Medicine; Head and Chief, Division of Geriatric Medicine, University of Calgary, Calgary, AB.

Depression is common in older adults. This condition is often under-recognized and undertreated in this patient segment as it may present differently than in younger individuals. A number of risk factors for depression have been identified and may help increase recognition. Altered presentations include generalized anxiety/worry, somatisation, presence of a disability gap, subjective but not objective memory complaints, pseudodementia, hopelessness, change in adherence to medical regimens or change in function not otherwise explained. For individuals with dementia syndromes, excess disability may indicate depression. A high index of suspicion, recognition of risk factors, and asking about specific aspects of depression may increase diagnosis.
Key words: depression presentation, risk factors, function, dementia.

Pressure Ulcers: Etiology, Treatment and Prevention

Pressure Ulcers: Etiology, Treatment and Prevention

Teaser: 


The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme.htm

Anu Singhal, MD, Resident, Metrohealth Medical Centre, Cleveland, OH, USA.
Ernane D. Reis, MD, Assistant Professor, Department of Surgery, The Mount Sinai Medical Center, New York, NY, USA.
Morris D. Kerstein, MD, Chief of Staff, V.A. Medical & Regional Office Center, Wilmington, Delaware; Professor of Surgery, Jefferson Medical College, Philadelphia, PA, USA.

Frequently found on the sacrum, pressure ulcers develop due to prolonged periods of unrelieved pressure on soft tissues, but can occur anywhere there is pressure, including trochanters and especially heels. In the bedridden patient, constant pressure causes ischemia and necrosis of subcutaneous tissues and skin. Most patients are elderly, immobile and have neurologic impairments, often associated with inability to sense pain and discomfort and/or incontinence. Sacral ulcers can be treated with debridement, dressings and skin grafts. However, preventive efforts—including a regular turning schedule, proper assessments, moisturizers and adequate diet—are the most cost effective and remain the foundation of management. Pressure ulcers can occur anywhere there is pressure, including trochanters and, especially, heels.

Key words: pressure ulcer, debridement, sacrum, risk factors, wound healing.

Introduction
Pressure ulcers develop under conditions of prolonged pressure and circulatory stasis, which damage the involved tissue by ischemia and necrosis.

Diagnosis and Management of Glaucoma

Diagnosis and Management of Glaucoma

Teaser: 

Catherine M. Birt, MD, FRCSC, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, ON.

Primary open angle glaucoma (POAG) is a disease of the optic nerve head, frequently but not always associated with elevated intraocular pressure. This article discusses the presentation and risk factors associated with POAG, how the diagnosis is made by the ophthalmologist, and the current medical management of the disease.
Key words: primary open angle glaucoma, risk factors, anti-glaucoma medications.

Inherited Hypercoagulable Disorders in the Elderly

Inherited Hypercoagulable Disorders in the Elderly

Teaser: 

Vikas Gupta MD, MRCP(UK), MRCPath, Department of Medical Oncology and Hematology, Princess Margaret Hospital/University Health Network; University of Toronto, Toronto, ON.

Old age is usually considered a significant risk factor for venous thromboembolism (VTE), and the incidence of VTE increases exponentially with age. Associated comorbid conditions such as heart failure, postoperative states, malignancy and long-term immobility contribute considerably towards the higher incidence of these hypercoagulable disorders in this subgroup of patients. The optimal, cost-effective laboratory work-up for underlying thrombophilic or hypercoagulable states is not clear in older patients. The main aim of this article is to review the inherited thrombophilic disorders and discuss their clinical relevance in older patients.
Key words: hypercoagulable disorders, thrombophilia, venous thromboembolism, risk factors.