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Whose Decision is it Anyway?

Whose Decision is it Anyway?

Teaser: 

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

Abstract
One of the most challenging and at the same time hopefully rewarding activities is to be the substitute decision maker (SDM) for someone important to you such as a parent. The assumption is by designating a child or children to be one's substitute they will make the right decisions and keep your wishes or best interests at the centre of the decision-making. This unfortunately is not always the case and for a variety of reasons some of which are just a misunderstanding of the legislation and the meaning of the Health Care Consent Act some SDMs start making decisions based on their personal preferences and biases and not of the person they are meant to represent. This can lead to varying degrees of conflict sometime so serious that health care professionals may explore the steps that might be needed to remove the SDM from the role and find a more appropriate substitute. This is not something one likes to do and with proper explanation it usually can be avoided. The most important point is that the patient must always be the centre of the decision-making process.
Keywords: substitute decision-maker, capable patient, consent, Public Guardian.

Top Ten Tips for Atopic Tots

Top Ten Tips for Atopic Tots

Teaser: 

Katia Faustini, Faculty of Medicine, McGill University, Montreal, Quebec.
Joseph M Lam, MD, FRCP(C), Clinical Assistant Professor, Department of Pediatrics, Associate Member, Department of Dermatology and Skin Sciences, University of British Columbia.


Abstract
Atopic dermatitis is the most common inflammatory skin condition affecting children. Given the complex waxing and waning nature of this common dermatologic condition, patient education and frequent family physician involvement, is the key to proper long term management. While topical steroids have long been accepted as the standard therapy in management of eczema, concern over its side effects by both family doctors and patients greatly impact compliance. Topical steroids are safe and efficacious if used properly. This article examines the top ten things to know about atopic dermatitis in order to properly and safely manage this chronic disease.
Keywords: atopic dermatitis, inflammatory skin condition, topical corticosteroids.

Ear Lesions That Recur Every Spring

Ear Lesions That Recur Every Spring

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

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Teaser: 

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
Juvenile spring eruption is a photodermatosis that is considered a localized variant of polymorphic light eruption. This condition appears on the light exposed areas of the ears and is primarily found in boys and young males in early spring or summer. The exact pathogenesis of juvenile spring eruption is not clear. The symptoms usually clear within 2 weeks, but recurrences are common under similar climatic conditions. The diagnosis of juvenile spring eruption is made clinically and investigations are not required. Treatments include avoidance of sun exposure, emollients, potent topical corticosteroids, and antihistamines.
Keywords: juvenile spring eruption, photodermatosis, polymorphic light eruption, spring, ears.

An Unusual Case of Large B-cell Lymphoma of the Sinonasal Tract in a Ninety Year Old Woman

An Unusual Case of Large B-cell Lymphoma of the Sinonasal Tract in a Ninety Year Old Woman

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

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Teaser: 

P.K. Shenoy, MD, DLO, FRCS, FACS1, W. Wang, MD2
1ENT Service Chief, Campbellton Regional Hospital, New Brunswick, Campbellton, Canada. 2Pathology Service Chief, Campbellton Regional Hospital, New Brunswick, Campbellton, Canada.

Abstract
Lymphoma accounts for 3 to 5% of malignant tumours, non-Hodgkin's lymphoma (NHL) accounts for 60% of all lymphoma. NHL of the sinonasal tract is an uncommon neoplasm that can be morphologically difficult to distinguish from non-neoplastic destructive lesions or malignant neoplasm. Only Immuno histochemistry could give a definite diagnosis. These represent 1.5 to 15% of NHL in the United States,1 2.6 to 6.7% of all lymphoma in Asia.2 B cell phenotype are most frequently found in the Western Hemisphere while T cell lymphomas are found in Asian countries. B-cell lymphoma of sinonasal tract occur in 6th to 8th decade of life and have a better prognosis.3 Review of the literature shows that early diagnosis and prompt treatment with local radiation (XRT) or combined modality treatment (CMT) have shown good prognosis.4
Keywords: non-Hodgkin lymphoma, diffuse large B-cell lymphoma (DLBCL), disease free survival (DFS), overall survival (OS), epistaxis, rapid rhino® (Arthrocare ENT products).

Advances in Alzheimer's Disease Management

Advances in Alzheimer's Disease Management

Teaser: 

CHAPTER 7: Ethical and clinically humane end-of-life care for those living with dementia
by Michael Gordon

 

Editors:
Serge Gauthier, McGill University, Montreal, Quebec, Canada
Pedro Rosa-Neto, McGill University, Montreal, Quebec, Canada
Publisher: Future Medicine
Reviewed by: Michael Gordon, MD, MSc, FRCPC, FACP, FRCPEdin

It is always a pleasure to be able to discuss a new book to a receptive audience when I believe the book has something special to offer. When it comes to reviewing books outside the realm of medicine or the medical sciences, reviews often are reflective of the personal and aesthetic views of the reviewer. There are many books written for professional readers on the fringe of medical science that deal with non-clinical aspects of medicine and many that have translated important medical concepts to the lay audience and others in the form of memoirs and novels of the personal and historical type that add a great deal to the general wealth and richness of medicine and the associated medical sciences.

To undertake an academic text book is always a daunting task. Generally if experts and specialists in the field cannot write such a book without the help of others and currently the idea of editors securing experts to write the relevant chapters is a well-accepted methodology for achieving that goal. That being said it becomes the responsibility of the editors to make sure that those that they recruit to write the relevant chapters have the academically sound and clinically and research-based capability of doing so and on top of that have the writing skills to achieve their goal. Moreover, for the chapters to hang together in one strives to have some degree of congruence in the writing approaches and styles, while at the same time promoting the particular capabilities of the writers of each chapter. At the end it is hoped that the chapters hang together into a whole that attracts the reader and provides a perspective on the subject and each of its varied components that would be hard to achieve if the reader decided to explore each of the subject chapters separately without the benefit of them being collated, edited and reference into one easily accessible book.

I am therefore pleased and honoured to not only present the book to subscribers of HealthPlexus.net, Advances in Alzheimer’s Disease Management edited by Serge Gauthier and Pedro Rosa-Neto but to have been one of the contributors. At a time when the knowledge surrounding Alzheimer’s disease and other dementias is on the one hand expanding rapidly from the scientific perspective, for the practicing physician and patient living with dementia and their families, the challenges seems to be overwhelming. There seems to be a huge disconnect between the understanding and scientific progress of the causes in many domains of enquiry and the actual clinical impact that all this new knowledge currently has that physicians in the front lines of care can utilize clinically.

In medicine however, one never knows what key will be the one that opens the door we are all looking to enter. At any given time all we can do is to try and figure out using the best clues and evidence available to know what secrets lay behind that door. The readily accessible E-book format in which Advances in Alzheimer’s disease management is produced allows for a relatively low cost alternative to the usual costs of hard copy texts. The content of the book covers all the main challenging concepts and recommended or best-practices as they exists currently. Obviously in time, perhaps a very short time, some of these will change but for those in the field we all know that many of the concepts and practices have not changed in many years.

The table of contents includes the following subjects by the authors listed next to the chapter titles, with mine at the end. I have been given permission to reproduce my chapter, Ethical and clinically humane end-of-life care for those living with dementia on the HealthPlexus.net website so that subscribers can get a taste of the e-book itself.

1) Genetics of Alzheimer’s disease by Jayashree Viswanathan, Hilkka Soininen & Mikko Hiltunen;
2) Diagnosis of Alzheimer’s disease by Pedro Rosa-Neto, Jared Rowley, Antoine Leuzy, Sara Mohades, Monica Shin, Marina T Dauar and Serge Gauthier
3) Available symptomatic antidementia drugs by Marie-Pierre Thibodeau and Fadi Massoud
4) New drugs under development for Alzheimer’s disease by Lezanne Ooi, Kirubakaran Shanmugam, Mili Patel, Rachel Debono and Gerald Münch
5) Management of agitation and aggression: controversies and possible solutions by Clive Ballard and Anne Corbett
6) Guidelines for the diagnosis and treatment of Alzheimer’s disease by Serge Gauthier and Christopher JS Patterson
7) Ethical and clinically humane end-of-life care for those living with dementia by Michael Gordon

For those interested in ordering the book, this can be done through the following links:
The direct URL for the book is:
http://www.futuremedicine.com/doi/book/10.2217/9781780840840

For those who are interested in finding more information about the book/our e-book series, the email address is:
info@futuremedicine.com
For those who wish to place an order, the email is:
sales@futuremedicine.com

A Practical Review of the Diagnosis and Management of Small Renal Masses

A Practical Review of the Diagnosis and Management of Small Renal Masses

Teaser: 

Stanley A. Yap,1 Shabbir M.H. Alibhai,2,3Antonio Finelli,1
1Division of Urologic Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada. 2Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. 3Department of Medicine, University of Toronto, Toronto, ON, Canada.


Abstract
The incidence of small renal masses (SRMs) has risen steadily over time, and SRMs now represent the majority of newly diagnosed renal lesions. Approximately 80% of newly diagnosed SRMs will be malignant. However, identifying a benign versus malignant lesion non-invasively can be difficult since no distinct imaging characteristics or growth patterns exist between the two. We have witnessed concurrent improvements in treatment strategies for small, localized tumors and have gained a better understanding of their natural history. Along with these changes there has been a shift in the manner in which we diagnose and treat SRMs. Although surgery remains the standard of care, we can now offer a variety of therapies individualized to the patient.
Keywords: kidney cancer, small renal mass, diagnosis, treatment.

From Science to Smartphones: Boosting Memory Function One Press at a Time

From Science to Smartphones: Boosting Memory Function One Press at a Time

Teaser: 

Eva Svoboda, PhD,1,2 Gillian Rowe, PhD,1,2 Kelly Murphy, PhD,1,2
1Neuropsychology and Cognitive Health Program, Baycrest Centre, Toronto, ON.
2Department of Psychology, University of Toronto, Toronto, ON.

Abstract
Memory problems can be devastating as they limit independent functioning and disrupt social, family, and occupational roles. One form of remembering, prospective memory - remembering to attend to a task or event in the future—is particularly vulnerable to disruption. Fortunately memory is not a singular ability and patients can learn to compensate for memory difficulties by using preserved memory systems. Combining smartphone technology with appropriate training techniques has been shown to be effective in supporting prospective memory function even in individuals with amnesia. We have evidence that such technology may be used in a similar fashion to promote memory in mild cognitive impairment with the aim of delaying or preventing dementia onset. Even in dementia, memory training or support in forming new habits and routines which tap into preserved memory systems can be effectively used to help patients learn new names, reduce repetitive questions and remain oriented to the present. The best prevention is early intervention. Older adults presenting with memory complaints, no matter how mild, should be directed to maintain, reestablish, or institute habits of organization and written reminders, both to support current memory functioning and to preserve functional independence into the future should their concerns turn out to be the early manifestations of a neurodegenerative condition.
Keywords: amnesia, technology, dementia, mild cognitive impairment, memory intervention.

“Acute Tonsillitis”—if Left Untreated Can Result in Severe Fatal Complications

“Acute Tonsillitis”—if Left Untreated Can Result in Severe Fatal Complications

Teaser: 

A Clinical Presentation and Review of the Literature

Pradeep K. Shenoy, MD, DLO, FRCS, FACS, ENT Service Chief, Campbellton Regional Hospital, NB, Campbellton, Canada.

Abstract
A case of acute tonsillitis is reported where proper antibiotic treatment was not given because of a negative throat culture, and the patient presented with complications. Review of the literature regarding acute tonsillitis, its presentation, treatment and various complications are discussed.
Keywords: acute tonsillitis, throat swab, peritonsillar abscess, retropharyngeal abscess, parapharyngeal abscess, GABHS, MRSA, PANDAS, Lemierre’s syndrome.

Palliative and Therapeutic Harmonization (PATH): A New Model for Decision-Making in Frail Older Adults

Palliative and Therapeutic Harmonization (PATH): A New Model for Decision-Making in Frail Older Adults

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

Mainpro+® Overview
Teaser: 

Paige Moorhouse, MD MPH FRCPC, and Laurie Mallery MD FRCPC, Division of Geriatric Medicine, Dalhousie University, Halifax Nova Scotia

www.pathclinic.ca

Abstract
As the population ages, advances in medical technology paradoxically result in the accumulation of multiple chronic health conditions—known as frailty. Despite increasing numbers of frail older adults, healthcare systems have not been designed to meet the challenges associated with caring for this patient population. This article describes the characteristics of health systems that exacerbate the complex issues associated with caring for those who are frail and reviews one possible model, known as PATH—Palliative and Therapeutic Harmonization, as a way to respond to these system challenges.
Keywords: frailty, care planning, dementia, knowledge translation, health program.

Neural Plasticity and Cognitive Reserve

Neural Plasticity and Cognitive Reserve

Teaser: 

Zahra Bardai, BSc, MD, CCFP, MHSc, FCFP, Community Family Physician, Lecturer, University of Toronto, Assistant Clinical Professor (Adjunct), Department of Family Medicine, McMaster University, Hamilton, ON.

Abstract
Neural plasticity in the context of normal aging and dementia can be evaluated on a number of levels. Traditionally there has been much focus on cellular dysfunction, which is evidenced by the plaques and tangles that are the hallmarks of Alzheimer type dementia. Now, more than ever, there is an emerging spotlight on the preservation of functional levels despite failing cognition be it from normal aging, mild cognitive impairment (MCI) or diagnosed dementia. Neural plasticity can be viewed as the complex interaction between the neurons' electrical, biochemical and physical structure and the individual's behavioural, psychological and sociological activities.1 This article will briefly review the neurobiology of cognition and the sequence of events that lead to its demise. The remainder of this review concentrates on tangible, evidence based strategies to uphold clinical cognition through the aging process.
Keywords: neural plasticity, aging, dementia, cognition, neurons.

…there were neurons in her head, not far from her ears, that were being strangled to death, too quietly for her to hear them. Some would argue that things were going so insidiously wrong that the neurons themselves initiated events that would lead to their own destruction. Whether it was molecular murder or cellular suicide, they were unable to warn her of what was happening before they died.

-Still Alice
Lisa Genova