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September 22, 2014

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

July 30, 2014

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

June 4, 2014

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

April 14, 2014

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

February 24, 2014

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

November 26, 2013

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

October 15, 2013

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

August 22, 2013

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

July 15, 2013

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

June 11, 2013

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

April 23, 2013

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

November 21, 2012

Marc Bradette, MD, FRCPC, CSPQ, Clinical Professor, Department of Gastroenterology, Pavillon Hôtel-Dieu de Québec, Québec, QC.


November 21, 2012

Marc Bradette, M.D., FRCPC, CSPQ, professeur clinicien, département de gastroentérologie, Pavillon Hôtel-Dieu de Québec, Québec (Québec).

November 20, 2012

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

October 31, 2012

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

September 4, 2012

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

As children rush to be on time for school and we fall back into our regular routines it can only mean that sadly this is the end of a beautiful, hot summer. Did I make you feel nostalgic? Don’t worry because we’re pleased to bring you the next edition of the Journal of Current Clinical Care. In this issue, we offer some articles expanding on themes from recent issues, as well as important new topics.

Doctors Kelly Murphy and Angela Troyer, from the Baycrest Centre in Toronto, describe an approach to the recognition of early dementia in clinical practice. They remind us that cognitive impairment is common, with approximately one in 11 older adults suffering some form of dementia. In the early state of the disease, where intervention has the most potential to reduce the disease burden on patients, families and society, the clues may be quite subtle.  The authors review not only the current diagnostic criteria, but also practical early warnings signs of dementia and various screening tools available.

Dr. Michael Gordon’s blog Plants are Good for the Soul Including for those Living with Dementia reminds us that to witness the growth of a plant, affirms for many that there is a meaning to life, and anything that gives life meaning is a worthwhile endeavor.

Also from the Baycrest Centre in Toronto, Doctors Svoboda, Rowe, and Murphy review the fact that different types of memory can be affected to a different extent in cognitive impairment. Episodic memory, the memory that allows us to remember events and details specific to a time and place are often affected early in the course of cognitive impairment, and procedural memory, the memory that underlies automatic or repeated skills is often preserved. They review their research into the use of devices, such as smart phones, which can be used as an external memory aid to overcome episodic memory impairment by using intact procedural memory, and thus and maintaining independence.

As a radiologist, I am frequently reminded that the incidence of small renal masses (SRMs) has risen steadily over time. The lesions are often incidentally detected on CT and ultrasound. Drs. Yap, Alibhai, and Finelli from the University Health Network in Toronto review a practical approach to the diagnosis and management of SMRs.  Although SMRs are a heterogenous group, consisting of both benign and malignant diseases, approximately 80% of incidentally-detected lesions are still malignant—most often a subtype of renal cell carcinoma. Imaging has some limitations in the accurate characterization of lesions as benign or malignant, and the increasing role of image-guided percutanous renal biopsy has increased.  Treatment of such lesions is now tailored to the individual patient, depending on disease characteristics, comorbidity, and patient preference.  Various types of therapies available are reviewed, including surgery, ablative therapy, and active surveillance.

In the case study for the Dermatology Educational Resource, Dr. Francesca Cheung focuses on cutaneous larva migrans, a parasitic infection caused by percutaneous penetration and subsequent migration of the larvae of hookworm.

The potentially severe and even fatal complications of acute tonsillitis, if left untreated, are reviewed by Dr. Shenoy of  the Campbellton Regional Hospital in New Brunswick.  Tonsillitis is an inflammation of the tonsils most commonly caused by a viral or bacterial infection, although more unusual organisms are also reviewed.  Most often, bacterial tonsillitis is treated with antibiotics on the basis of a positive throat culture, however, the reasons for a false negative result are reviewed.  The treatment of the infection and reasons for treatment failure are also reviewed.

I hope you enjoy adding this edition of the Journal to your end of summer reading list.  As always, your comments are welcomed.

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

July 18, 2012

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

The latest issue of The Journal of Current Clinical Care is once again packed with highly informative articles and interactive content.

Drs. Moorhouse and Mallery from the Division of Geriatric Medicine at Dalhousie University in Nova Scotia recognize that as our population ages, patients often develop an accumulation of multiple chronic health conditions—known as frailty. Their article not only describes the features health systems that make caring for such patients difficult, but also reviews a model, known as PATH—Palliative and Therapeutic Harmonization, to respond to these system problems. In my role as a hospital-based radiologist, I see on a regular basis one of their tenets: when older adults present with acute decline in cognition, mobility or function, it is often a sign of underlying medical disease in a frail substrate. As clinicians we can definitely use an approach to this ever-increasing patient population.

Dr. Bardai reviews the role of neural plasticity in the development and the amelioration of cognitive decline. Neural plasticity has been described as a “complex interaction between the neurons’ electrical, biochemical and physical structure and the individual’s behavioural, psychological and sociological activities.” This article reviews the neurobiology of cognition, and the sequence of events that lead to its deterioration, as well as reviewing strategies for maintaining cognitive faculties in the aging process.

Dr. Francesca Cheung, a Family Physician and Senior Editor of the Dermatology Educational Resource reviews a challenging dermatological diagnosis, Granuloma annulare (GA). GA is a benign and usually self-limited skin condition that classically presents as arc-like or annular plaques in a symmetrical and acral distribution with an unknown etiology. The condition is commonly seen in children and young adults and has been described as a paraneoplastic condition.

Drs. Shenoy and Bali describe an approach to the complex problem of the removal of impacted sharp esophageal foreign bodies using a case study.

As part of our Lecture Series, Dr. Robert Madan, the Chief Psychiatrist at Baycrest Geriatric Health Care System at the University of Toronto, gives an engaging talk on Treatment for Behavioral and Psychological Symptoms of Dementia.

Dr. Barry Goldlist sat down for an interview with Dr. Charles Lynde, the Editor-in-Chief of Dermatology Educational Resource.

Our choice of topic to present as an infographic is Lumbar Spinal Stenosis, a condition we review as part of the larger scope of Back Pain for which we are developing a blended CME program that is scheduled for release later this year.

I hope you enjoy the issue as much as I enjoyed reviewing for you. As always, comments and questions are welcomed. I hope you are enjoying the Summer season!

D’Arcy Little, MD, CCFP, FRCPC
Medical Director, JCCC and HealthPlexus.NET

June 12, 2012

I
have the pleasure of introducing the latest edition of the Journal Of Current Clinical Care. As always there are a multitude of noteworthy developments to report and
a variety of interesting and clinically relevant topics that are covered in this issue.

As hinted in my last editorial, I am pleased to welcome Dr. Charles Lynde as Editor-in-Chief for the Dermatology Educational Resource @HealthPlexus and the Journal of Current Clinical Care. Dr. Lynde with the help of his fellow editors Drs. Anne
Goodfellow
, John Kraft and Francesca Cheung, will spearhead a Dermatology
section on www.healthplexus.net and the Journal of Current Clinical Care. For this edition, Shahana Nathwani and Dr. Joseph Lam from the University of British Columbia provide an approach to ‘lumps and bumps’ in the pediatric population. There are
a number of conditions that present clinically as ‘lumps and bumps’ in this age group.
Some of these follow a benign course and can be safely observed, and others are more
concerning and require definitive therapy and may even result in serious complications.
A helpful feature of the article is a practice helper tool: A menu of cutaneous lesions in
the pediatric population categorized according to colour.

I am also happy to introduce our new department called Infographics. Going
forward we will select a topic and present the information and facts in an exciting and
visually informative format. In this issue our choice of condition to present as an infographic is Ulcerative Colitis, an important topic for which we are also developing a
CME program that is scheduled for release later this year.

Another first that we are introducing in this issue is a Lecture Series department.
Dr. Michael Gordon, the Medical Program Director at Baycrest Geriatric Health
Care System at the University of Toronto, is one our regular contributors, and is the
Editor-in-Chief of our Dementia Educational Resource, gives an engaging talk on Later
Stage Dementia and focusing on Promotion of Comfort, Compassion and Care
, complete with video and slides.

Also in this issue, Dr. Michael Gordon in his article When to Have the Critical
Conversation? Issues in Planning for Persons with Dementia and their Caregivers
,
uses a poignant family vignette to remind us that as health care providers we should
encourage families and our patients to initiate conversations early regarding treatment
at the end of life.

Drs. Lovingly Quitania Park and Sarah Tomaszewski Farias from the
Department of Neurology at the University of California at Davis review the concept of
Functional Limitations Predict Future Decline in Mild Cognitive Impairment (MCI).
MCI is a term used to describe a transitional stage between normal aging and dementia.
In MCI there are subtle changes in everyday activities that may indicate the presence
of an under lying neurodegenerative condition, however patient independence is maintained. The authors review how to assess for cognitive impairment in this population
and the prognostic implications of on subsequent conversion to dementia and the rate
of progression of dementia.

The effects of caregiver burden are often expressed as a decline in psychological and
physical health, as well as an increase in physician visits. In the article, Identifying and
Managing Caregiver Burden Among Spouses of Individuals with Parkinson’s Disease
Dr. Andrew Johnson et al., examines some of the predictors of caregiver burden,
with a specific emphasis on the burden experienced by caregivers of individuals with
Parkinson’s disease. Helpful strategies for relieving caregiver burden are also reviewed.

I hope you enjoy this edition of the journal. As always, your comments and questions are welcomed.

I have the pleasure of introducing the latest edition of the Journal Of Current Clinical Care. As always there are a multitude of noteworthy developments to report and a variety of interesting and clinically relevant topics that are covered in this issue.

June 8, 2012

Skin is the body’s largest organ. It acts as a protective layer between the insides and the rest of the world, helps regulate body temperature, acts as a natural filter and is constantly growing. It’s affected by every aspect of our life, by what we eat and the environment. Skin that is healthy is able to resist signs of aging, heals faster and can even stave off potential disease. It often manifests some underlying diseases and when it’s visually altered or damaged can make a profound effect on one’ quality of life.

As the newly appointed Editor-in-Chief for the Dermatology Educational Resource @HealthPlexus and the Journal of Current Clinical Care and with the help of my fellow editors Drs. Anne Goodfellow, John Kraft, and Francesca Cheung, we will solicit, organize and present to you educational materials of relevance to primary care practitioners and specialists alike by asking for contributions from recognized Key Opinion Leaders in the field of Dermatology on evidence-based best practices and treatment options.

In this issue, we are featuring the first article in our dermatology section titled Common Lumps and Bumps in Children: A Colour-coded Differential. Dr. Joseph Lam and Shahana Nathwani examine the many conditions that present as ‘lumps and bumps’ in the pediatric population. While some follow a benign course, others require definitive therapy or carry the potential for serious complications. Their review presents and categorizes common pediatric cutaneous lesions according to colours as a tool to help the general practitioner recognize and remember these lesions.

If you have questions, interested in serving as a contributor or peer-reviewer please reach out to us at contactus@healthplexus.net

I hope you enjoy this issue of the Journal. Feedback and discussion, as always, is welcomed.

March 22, 2012


D’Arcy Little, MD, CCFP, FRCPC, Medical Director, JCCC and www.healthplexus.net

There have been some significant developments at Health Plexus, the publisher of this Journal. At the beginning of the year we launched our first “specialty” channel—the Dementia Educational Resource. Considering that the founding members of Health Plexus have deep historical roots in Geriatrics, it was only natural to build a dedicated team to address the tremendous interest of our readership in the area of Dementia. Dr. Michael Gordon has assumed responsibility of Editor-in-Chief for the Dementia Educational Resource. Please see Dr. Barry Goldlist’s interview with Dr. Michael Gordon in this issue and stay tuned for further announcements on similar launches of other specialty channels. I have a hint for you, the next has something to do with the skin...

The Journal of Current Clinical Care and www.healthplexus.net are innovative educational platforms and social forums for knowledge transfer and are a medium for sharing ideas. We encourage dialogue and are asking our readers to step in and participate in the development of content. We also welcome individuals or professional groups to lead the development of specialty channels where they would be able to share their expertise.

I have the pleasure of introducing the first issue of 2012 of the Journal of Current Clinical Care. This issue addresses a variety of interesting and clinically relevant topics.

Dr. Andrew Johnson et al., present the topic The Hidden Cost of Cognition: Examining the Link Between Dual-Task Interference and Falls. The article acknowledges that falls are a leading contributor to mortality and morbidity in older adults. Cognition is important factor in falls, as individuals who are unable to orient an appropriate amount of attention to the task of maintaining safe and stable balance are more likely to fall. They describe several strategies to address falls prevention in this context.

Dr. Yoav Keynan et al., present a case study of a Diffuse Rash in an HIV Infected Patient, reminding us that syphilis incidence is currently increasing in North America, and that HIV infection is present in 1/5 of individuals diagnosed with syphilis.

In his article, Helping Families Worried about Developing Dementia: Strategies to ease the Burden Stress, Fear and Guilt, Dr. Michael Gordon presents some of the challenges of and some practical strategies for caregivers of patients with dementia.

Type 2 diabetes mellitus is increasingly common, and previously unrecognized complications are emerging, including cognitive impairment and dementia. The article, Vascular and Metabolic Contributions to Cognitive Decline and Dementia Risk in Older Adults with Type 2 Diabetes, by Liesel-Ann Meusel et al., emphasizes that proper management of metabolic and vascular complications of diabetes may minimize the adverse effects on cognitive function and quality of life.

I hope you enjoy this issue of the Journal. Feedback and discussion, as always, is welcomed.


D’Arcy Little, MD, CCFP, FRCPC, Medical Director, JCCC and www.healthplexus.net

September 7, 2011

It is my pleasure to introduce the latest issue of The Journal Of Current Clinical Care. This current issue has a number of key articles, for the primary care physician and specialist, alike that summarize a practical approach to important issues in daily practice.

From Dr. Shabbir Alibhai, we have an update on cancer screening in the older adult. Cancer remains a major cause of morbidity and mortality in older adults—as more than half of all new cancers and over 70% of cancer deaths occur in the over -65 age group. Cancer screening is an important tool to decrease the incidence and mortality from cancer in older adults. Dr. Alibhai reviews the evidence and the screening recommendations for this population.

Dr. James Wright reviews the choice of first line anti-hypertensive agents in the older adult. This article examines the evidence for the different classes of first-line antihypertensive drugs in the context of four important treatment goals: reduction in mortality and morbidity; efficacy in lowering blood pressure; ensuring tolerability; and minimizing cost.

Many may consider Parkinson’s disease as primarily a motor disorder. However, it has important effects on cognition and personality. Important neuropsychiatric sequelae of Parkinson’s, known as impulse-control disorders, can have significant negative effects on patients and their families. Examples are pathological gambling and hypersexuality. Dr. Andrew Johnson reviews the treatment options for this condition, including dopamine agonist dose reduction or cessation, the use of psychosocial strategies, and deep-brain stimulation of the subthalamic nucleus.

Proteinuria is frequently a marker of unsuspected kidney disease, progressive atherosclerosis, or a systemic disease. A strong correlation exists between urinary protein excretion and the progression of renal failure. Proteinuria is also a strong and independent predictor of increased risk for cardiovascular disease and death, especially in people with diabetes, hypertension, and chronic kidney disease. Dr. Fatemeh Akbarian et al. review the diagnosis and treatment of proteinuria in the adult.

Dr. Michael Gordon’s article discusses the sensitive issue of conflict among family members in the context of substitute decision making for patients with dementia. The article emphasizes that physicians must use the art of medicine, including their communication skills and sensitivities, to help families resolve their differences so that the best possible care can be provided to their family members.

I hope you enjoy the issue. As always your comments are welcome.

It is my pleasure to introduce the latest issue of The Journal Of Current Clinical Care. This current issue has a number of key articles, for the primary care physician and specialist, alike that summarize a practical approach to important issues in daily practice.

April 18, 2011

New approaches and thinking are required in order to meet the demands for quality care

It's hard to minimize the importance of CME in geriatrics these days hence the theme of this issue is geriatrics and I will do the 'de rigueur' exercise of stating my conflicts of interest. The first is that I am a geriatrician, and I think that care of the elderly is an issue that is the most impor­tant one facing our health care system. It's also clear that there are simply not enough trained geriatricians in Canada and the burden of providing care for elderly and aging patients has shifted to family doctors. Second, I have long been involved in continuing medical education, and I believe the experienced staff at the Jour­nal of Current Clinical Care and HealthPlexus have the knowledge, and creativity to make a substantial contribution to the continuing education of physicians in Canada. I certainly hope they continue covering geriatric issues and topics on a regular basis.

Our Dementia article this month "Nutrition and Dementia: An Update" by Drs. Guylaine Ferland, Carol E. Greenwood, and Bryna Shatenstein, comes appropriately enough after the recent publication of important research in this area. Our Caregiving column this month is also on the theme of dementia: "End-stage Dementia and Death: Breaking the Conspiracy of Silence" by Dr. Michael Gordon and Natalie Baker.

As usual, we have several articles of interest in other areas. Our Wom­en's Health column addresses an often overlooked topic in geriatric medicine, namely "Domestic Violence and Older Women: A Review of the Evidence" by Dr. Julie McGarry and Christine Simpson. We have an informative article on "Restorative Home Care Services" by Dr. Gill Lewin. Finally, very practical article, "Hyper­hidrosis: A Common Problem" has been contributed by Drs. Christian A. Murray and Nowell Solish.

Enjoy this issue,
Barry Goldlist

New approaches and thinking are required in order to meet the demands for quality care

December 1, 2009

Sir William Osler referred to pneumonia as “the old man’s friend,” correctly realizing that infection is a common cause of death in old age. Some hundred years later, even in this age of potent antimicrobial agents, Osler’s assessment still holds true. Disease frequently presents in an atypical manner in old age, and often fever in bacterial infections is a late manifestation, following delirium, falls, or “taking to bed.” Delay in treatment may result in poor outcomes but, on the other hand, overtreatment may be likely to harm an older person. One of the most difficult environments in which to accurately diagnose infection is the long-term care (LTC) facility. The residents tend to be more frail and more likely to be cognitively impaired than community-dwelling patients coming to their family doctor’s office; therefore, the utility of the history is much decreased. As well, the vast array of diagnostic tools available in the acute hospital is relatively inaccessible in LTC, and the transfer to acute care from LTC often results in deleterious consequences to the patient.

Our focus in this issue is infectious disease in the older adult, and our CME article addresses a major public health concern: “Long-term Care for Older Adults: Reservoirs of Methicillin-Resistant Staphylococcus Aureus and Vancomyin-Resistant Enterococci” by Drs. D.F. Gilpin, M.M. Tunney, N. Baldwin, and C.M. Hughes. We all know that we should not treat asymptomatic bacteriuria, but most of us are unsure whether our patients are truly asymptomatic or not. The article “Asymptomatic Bacteriuria: To Treat or Not to Treat” by Dr. Dimitri M. Drekonja will address this clinical conundrum. I still remember treating my first case of severe antibiotic-induced colitis as an intern. It was in the wife of my physician-in-chief and occurred two months before clindamycin-associated pseudomembranous colitis was first described in a classic article in the Annals of Internal Medicine. Since then, C. difficile infection has become a major problem in older patients, particularly for those in acute hospital or LTC. This important topic is addressed in the article “Treatment and Prevention of Clostridium difficile Infection in the Long-Term Care Setting” by Dr. Natasha Bagdasarian and Dr. Preeti N. Malani.

Further, we offer our usual collection of important and informative articles on medical care of older people. In geriatric medicine, it has been frequently noted that the risk factors for each of the “geriatric giants” overlap to a great degree. In our Cardiovascular column, our frequent and much valued contributor, Dr. Wilbert S. Aronow, asks the question “Bone Mineral Density: What Is Its Relationship to Heart Disease?” Our Dementia column reviews the difficult area of screening in the article “Screening for Dementia: First Signs and Symptoms Reported by Family Caregivers” by Dr. Mary Corcoran. There is more evidence arriving on a regular basis to show how important our teeth are for both quality of life and for good health, so it is very appropriate that our Biology of Aging column by Dr. Gregory An discusses “Normal Aging of Teeth.” Our Falls and Fitness column, “Psychoactive Medications and Falls” is written by Dr. James Cooper and Dr. Allison Burfield. Our featured geriatrician this month is Dr. Angela Juby, the president of the Canadian Geriatrics Society.

Enjoy this issue,
Barry Goldlist