Ian PUN, MD, Family Physician, Scarborough, Ontario.
OSCAR McMaster EMR user since 2010.

Abstract
As of 2014, over 75% of primary care physicians in Ontario have adopted,¹ or are in the process of adopting an EMR. Those physicians who are new to using EMR will find many pitfalls, many of which are common and are preventable. I will specifically deal with the OSCAR McMASTER EMR and what issues I saw my fellow colleagues and myself experience in the Ontario context.
Key Words: Hardware, Network, OSCAR McMaster EMR, issues, scanning, lab, HL7.

^1,2Darren M. Roffey PhD; ¹Simon Dagenais DC, PhD, MSc; ³Ted Findlay DO, CCFP; ^4,5Travis E. Marion MD, MSc; ⁶Greg McIntosh MSc; ^1,2,4,5Eugene K. Wai MD, MSc, FRCSC

¹University of Ottawa Spine Program, The Ottawa Hospital, Ottawa, ON, ²Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON,

³Department of Family Medicine, University of Calgary, Calgary, AB, ⁴Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, ⁵Department of Surgery, Faculty of Medicine, University of Ottawa, ON, ⁶CBI Health Group, Toronto, ON,

Abstract

Recognizing that the increasing incidence of obesity coincides with the rising prevalence of LBP, there is growing interest in establishing the relationship between over-weight and back pain. It is likely that any association is multi-factorial and that the connection is not as mechanistically simple as previously believed. Systemic inflammation associated with obesity may be an important contributor. Proposed treatment options vary from cognitive behavioural therapy to bariatric surgery with none yet fully proven. Despite the ambiguity, it appears prudent for primary care providers treating obese patients with LBP to recommend weight loss and exercise.

Key Words: Obesity, low back pain, inflammation, intervertebral disc, multi-factorial, causality, association.

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

Abstract
The process of prescribing medications, explaining the risks and benefits has classically been the role and responsibility of physicians with support from other health care providers such as pharmacists. In the modern age with the phenomenal expansion of the digital world, the world of the internet has become a major player. It is common for physicians to have to contend with and integrate into their practice the common phenomenon of family members looking at the internet and other sources for information about medications proposed for their loved ones.
Key Words: internet, medications, information, responsibility.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Mammary Paget disease (PD) is a less common form of breast cancer which involves the nipple-areola complex and occurs almost exclusively in females. Erythema, skin thickening, pruritus, burning sensation, inversion of the nipple, ulceration, serosanguineous nipple discharge are common clinical symptoms. Approximately 1-4% of female breast carcinoma are associated with PD of the nipple-areola complex. A biopsy including the dermal and subcutaneous tissue should be performed on all suspicious lesions of the nipple-areola complex for accurate diagnosis. The first line treatment of mammary PD is mastectomy (radical or modified) and lymph node clearance for patients with a palpable mass and underlying invasive breast carcinoma. The prognosis of mammary PD is determined by the disease stage and is similar to that of other types of breast cancer.
Key Words: Mammary Paget disease, breast cancer, nipple-areola complex, metastasis.

Dr. Ted Findlay, DO, CCFP, Clinical Assistant Professor, Department of Family Medicine, University of Calgary, Calgary, Alberta.

Abstract
Low back pain is one of the most common conditions for which patients seek medical attention. It can be managed with lifestyle modification, or less commonly medical and surgical intervention. Appropriate selection among various pharmacological options mandates an understanding of the underlying symptomatology and the over-riding treatment plan and objectives. The range of potential medications is substantial: over-the-counter analgesics include acetaminophen and non-steroidal anti-inflammatory drugs, muscle relaxants, and weak opioid combinations including codeine or tramadol. More potent versions of many of the same components are available on prescription, commonly employing stronger opioids either singly or in a combination analgesic. When the pain involves either chronic or neuropathic features, other classes of medications, including anti-epileptic drugs and anti-depressants, may be appropriate.
Key Words: low back pain, acute, chronic, neuropathic pain, nociceptive pain, medications.

Ian PUN, MD, Family Physician, Scarborough, Ontario.

Abstract
Although many doctors have embraced and modernized their practices with a the advent of an EMR (Electronic Medical Record) system, there still a remaining majority who are hesitant to convert to a computerized recording keeping system fearing change and hassle. I have listed a few brief points urging doctors to change to a more efficient system that saves time and space which will ultimately improve patient care. In future articles, I will go into more detail of specific usages of EMR, specifically the open-source OSCAR McMaster EMR. I will also point of the issues of maintaining an EMR.
Key Words: OSCAR McMaster EMR, computerized medical records, electronic prescription, health information technology.

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

Abstract
Diabetes Mellitus is very prevalent in the older population. It is one of the important causes of vascular problems which may play a role in the development of dementia, especially of the mixed variety. There has been much progress in the potential medications that can help promote successful glucose control and address the other metabolic correlates of Type 2 diabetes mellitus. Sulfonylureas should be used rarely and very carefully in older especially frail individuals because of their inherent risks. Getting physicians to change their prescribing practices in this frail elderly diabetic population is an important challenge to educators and drug program administrators.
Key Words: diabetes mellitus, sulfonylureas, diabetic management, treatment.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Herpes simplex viruses (HSVs) are DNA viruses that present as vesicles in clusters on an erythematous base. Infection occurs when close contact between an individual without antibodies against the virus and a person shedding the virus takes place. Most HSV infections are self-limited. Lesions tend to reappear at or near the same location of the initial site of infection. Systemic symptoms such as fever, malaise and acute toxicity may appear, especially in primary infection. A viral culture from the skin vesicles can identify up to 80 to 90% of untreated infection early in the course. Antiviral treatments aim at shortening the disease course and preventing viral dissemination and transmission. Treatments are most effective when they are administered at the first sign of symptom onset.

Dr. Pradeep Shenoy, MD, DLO, FRCS, FACS, is the ENT service chief, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.
Dr. Michael Aldea, MD, Anesthesiologists, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.
Dr. Jami Sridhar, MD, Anesthesiologists, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.

Abstract

Tonsillectomy is a routine surgery performed in Campbellton Regional Hospital. Before January 2012 all the tonsillectomies were one day procedure. Due to reduction in the hospital beds, there was a significant pressure on the ENT service to perform more of tonsillectomies as day case procedures.

A Prospective and retrospective study was done for the day case tonsillectomies from January 2012 till June 2013 and results are reported.

Key words: DCT (day-case-tonsillectomy), post-tonsillectomy hemorrhage (PTH), post-tonsillectomy pain (PTP),Post-operative nausea and vomiting (PONV), ASA (American Society of Anaesthesiologist) grading of patients, PACU (Post-anesthesia care Unit).

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH, is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. In addition, she trained as a physiotherapist and maintained an active license for 30 years. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.

Greg McIntosh, MSc, completed his Masters in Epidemiology from the University of Toronto’s Faculty of Medicine. He is currently the Director of Clinical Research for CBI Health Group and research consultant to the Canadian Spine Society.

Abstract
This article helps clinicians decide on appropriate referral to rehabilitation professionals while answering some of the common questions that clinicians are often asked by low back patients. The evidence for appropriate rehabilitation techniques will be interwoven into this article to promote a critical appraisal approach to evaluating rehabilitation outcomes. At the conclusion of this paper, clinicians should be able to identify best practices for rehabilitation referral.
Key Words: Low back pain, indications, rehabilitation, inter-professional referral.