Faculty of Medicine 62 nd Annual Refresher Course for Family Physicians
December 5-7, 2011 Hilton Montréal Bonaventure Hotel
Program Committee
Rohan, Ivan MD, CCFP - Course Director ______Abrahams, Heather MDCM, CCFP Dannenbaum, David MD, CCFP Glaser, Stuart R. MD, Emeritus Member Lalla, Daniel E. MDCM, CCFP, FCFP Macek, Adrian MDCM, CCFP Narasiah, Lavanya MD, MSc, CCFP Nazerali, Najmi MD, CCFP, FCFP Schulz, Jan MD, FRCPC, FACP Zigman, Michael MDCM, FCFP
Course Organizer IS Event Solutions
Isabel Stengler | President Sponsorship Carole Laflamme Registration / Exhibition Tess Brown Program / Website Janique Deslauriers Project Manager www.course-mcgill.ca Course Secretariat: IS Event Solutions | 607 Notre-Dame, St-Lambert, QC J4P 2K8 Telephone: 450-550-3488 ext. 114 | Fax: 514-227-5083 | E-mail: [email protected] ACKNOWLEDGEMENTS
Our thanks to the following companies for providing the 62 nd Annual Refresher Course for Family Physicians with an unrestricted educational grant:
PATRON
Boehringer Ingelheim (Canada) Ltd.
BENEFACTORS
AstraZeneca
Pfizer Canada
FRIENDS
Amgen Bristol-Myers Squibb Canada Calian GlaxoSmithKline Lundbeck Canada Inc. Merck Canada Pendopharm Takeda Canada, Inc.
December 5-7, 2011 -2- McGill University - Faculty of Medicine TABLE OF CONTENTS
General Information General Course Information ...... page 4 Hilton Montréal Bonaventure Hotel Floor Plan ...... page 5 CME Information ...... page 6 Future Refresher Course ...... page 7 Social Program ...... page 8
Exhibitor Directory Exhibitor Listing and Floor Plan ...... page 9 Exhibitor Directory ...... page 10
Program Overview
Monday, December 5 ...... page 13 Tuesday, December 6 ...... page 15 Wednesday, December 7 ...... page 17
Spine Symposium ...... page 19
Course Faculty ...... page 21
PowerPoint Slides ...... page 23 Slides are in chronological order of the program.
Delegate Directory & Certificates Participant List RAMQ Reimbursement Form Daily Certificates of Attendance
December 5-7, 2011 -3- 62 nd Annual Refresher Course for Family Physicians GENERAL INFORMATION
GENERAL COURSE INFORMATION BUSINESS CENTRE LOST AND FOUND
A business centre is located on the lobby level of the Any lost and found items will be held at the registration hotel. It will be able to handle requests for photocopies, desk for the duration of the event. faxes, Internet access, etc. Hours of operation are For any unclaimed items after the Course, please contact 8 am to 5 pm. IS Event Solutions.
COURSE EVALUATION LUGGAGE / COAT CHECK
A Conference evaluation form is included in your delegate During the Course, whether you are staying at the Hilton bag. Please complete it and drop it off at the registration Montréal Bonaventure or at a different hotel, you can desk before leaving the Course. You will then receive leave your suitcases with the concierge. The Course your CME certificate. The Committee appreciates your organizers do not accept liability for any luggage left constructive feedback. unattended and will not store any suitcases at the registration desk. DELEGATE HOSPITALITY A complimentary coat check is available. A pen is included in your delegate bag for your convenience. Montréal maps and guidebooks are MEALS AND REFRESHMENTS available at the hotel’s information desk. Coffee breaks and lunches will be served daily in ENVIRONMENTAL CONSIDERATIONS Fontaine ABC. For times of service, please refer to the program section. We incorporated the following considerations into the planning of this Course: A continental breakfast will be available in the foyer area • Online registration system reducing printing every morning. Please feel free to serve yourself before • Recyclable lanyard entering the morning session. Breakfast will also be • Cornstarch-based recyclable pens served in the Educational Fora sessions. • PowerPoints available online instead of on CD • Careful meal planning to minimize waste PUBLIC NOTICE • Condiments, milk, juices in bulk containers The Hilton Montréal Bonaventure Hotel specifically and all EMERGENCY/FIRST AID Québec public spaces in general are smoke-free environ - ments. Smoking is permitted only outside of buildings. For any emergency or first aid services inside the hotel, please dial “0” for the operator from any available house REGISTRATION phone. For identification and security purposes, delegates INFORMATION must wear their name badges when onsite at the Hilton Montréal Bonaventure Hotel. Should you require any assistance during the Conference, please call the registration desk via the hotel operator at REGISTRATION & INFORMATION DESK HOURS 514-878-2989. Monday 06:30 – 17:30 Tuesday 06:30 – 18:00 Wednesday 06:30 – 16:30
December 5-7, 2011 -4- McGill University - Faculty of Medicine GENERAL INFORMATION
EXERCISES
Carolyne Dubé Carolyne's true passion is all about dreams and their meaning. It is her mission to provide a simple approach that promotes the understanding of dreams and the importance of good sleep habits. Her main objective is to bring awareness to the power of dreams and the importance of good sleep.
She is a member of IASD (International Association for the Study of Dreams), an international association of scientists studying dreams and sleep.
She offers workshops, consultations and conferences on the understanding of dreams and sleep quality. Carolyne is appreciated for her listening skills, availability and practical approaches.
After an intense 20-year career in the hospitality and service industry, Carolyne now enjoys her new work, including working as a certified aerobics instructor.
She can be reached at 514-776-9007.
HILTON MONTRÉAL BONAVENTURE HOTEL FLOOR PLAN | CONVENTION LEVEL
December 5-7, 2011 -5- 62 nd Annual Refresher Course for Family Physicians GENERAL INFORMATION
CME INFORMATION
STUDY CREDIT HOURS CME REIMBURSEMENT | Allowance Fund
The Centre for Continuing Health Professional Education This course qualifies for CME reimbursement for those (CCHPE) has approved this event for up to 23 CME study Quebec physicians who meet the requirements for the credits : RCPSC: MOC Section 1, CFPC Mainpro-M1, AMA fund from the Régie d’Assurance du Québec. To obtain an Category 1. application form (see back of the binder) and for further information please visit the website: http://www.ramq.gouv.qc.ca/fr/professionnels/form_pro/p The Centre for CCHPE, Faculty of Medicine, McGill df/3814.pdf University is fully accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS), and through the CACMS is accredited to award AMA PRA DECLARATION OF POTENTIAL CONFLICT OF category 1 credits. INTEREST
This program meets the accreditation criteria of the Speakers will be requested to disclose to the College of Family Physicians of Canada for MAINPRO-M1 audience any real or apparent conflict(s) of interest credits. Members of the American Academy of Family that may have a direct bearing on the subject matter Physicians are eligible to receive credit hours for of this program. attendance at this meeting due to a reciprocal agreement with the College of Family Physicians of Canada. Objectives: The aim of this course is to provide an overall review of topics that would be of interest and relevance to This event is an accredited group learning activity family physicians in both rural and urban practice. A (Section 1) as defined by the Maintenance of Certification mixture of material will be presented and news breaking program of the Royal College of Physicians and Surgeons developments in Family Medicine reviewed. Exposure to of Canada. Through a reciprocal agreement, The Centre basic topics across the entire spectrum of Family for CCHPE, Faculty of Medicine, McGill University Medicine will be ensured. A chance to brush up on designates this activity for AMA Physicians Recognition “hands-on” skills will be offered. There will be ample Award, Category 1 credit up to the maximum number of opportunity for interaction with colleagues and faculty. credit hours noted above. Methods: Short and focused didactic lectures will cover Each physician should claim only those hours of credit recent developments in Family Medicine. Seventy (70) that he/she actually spent at the educational activity. workshops will offer a choice from among a variety of To claim your CME certificate, please sign in daily basic medical topics. Streams in Emergency Medicine, and return the completed evaluation form at the Geriatrics and Pediatrics, as well as a Hands-On stream end of the Course. will be offered for those with particular needs. The workshops will allow for informal discussion and consultation with faculty. The David J.G. Tector Memorial CCHPE : Lecture will present an in-depth examination of an academic topic in medicine. The faculty includes both Lady Meredith House family physicians and specialists affiliated with McGill 1110 Pine Avenue West, Room 301 University, as well as invited speakers from other Montréal, Quebec H3A 1A3 institutions. Tel.: 514-398-3500, Fax: 514-398-2231 Email: [email protected] Web Site: http://cme.mcgill.ca
December 5-7, 2011 -6- McGill University - Faculty of Medicine GENERAL INFORMATION
FUTURE REFRESHER COURSE LOOKING AHEAD TO 2012 & 2013
Circle your calendar for these dates!
63 RD ANNUAL REFRESHER COURSE FOR FAMILY PHYSICIANS November 26-28, 2012 Hilton Montréal Bonaventure Hotel
www.course-mcgill.ca
December 5-7, 2011 -7- 62 nd Annual Refresher Course for Family Physicians
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M A R G O R P L A I C O S
N O I T A M R O F N I L A R E N E G Faculty of Medicine
62 ND ANNUAL REFRESHER COURSE FOR FAMILY PHYSICIANS DECEMBER 5-7, 2011
Exhibitor Directory EXHIBITOR DIRECTORY
EXHIBITOR LISTING
Amgen 16 AstraZeneca 17 & 18 Boehringer Ingelheim (Canada) Ltd. 9 Boehringer Ingelheim / Eli Lilly Canada Inc. 8 Bristol-Myers Squibb Canada 10 Calian 21 GlaxoSmithKline 19 & 20 Johnson & Johnson 3 Lundbeck Canada Inc. 1 McGill Bookstore 5 & 6 McGill University CHPE Office (CME) 13 Merck Canada 11 & 12 Pendopharm 4 Pfizer Canada 14 & 15 Takeda Canada, Inc. 7 The Running Room 13 ZoomMed 2
EXHIBITOR FLOOR PLAN
December 5-7, 2011 -9- 62 nd Annual Refresher Course for Family Physicians EXHIBITOR DIRECTORY
EXHIBITOR DIRECTORY Amgen Booth # 16 Boehringer Ingelheim (Canada) Ltd. Booth # 9 Contact: Gregory Proestou Contact: Ms. Agnes David 2367, 100 Avenue 5180 South Service Road Laval, QC H7T 0C3 Burlington, ON L7H 5H4 Tel.: 514-449-2434 Tel.: 905-631-4559 E-Mail: [email protected] Fax: 905-634-4421 AMGEN is a global biotechnology pioneer combining science and E-Mail: [email protected] innovation for over a quarter century. AMGEN’s research in bone biology Boehringer Ingelheim has earned a reputation as a leader in the treatment revealed RANK ligand as an essential mediator of osteoclast-related bone of respiratory diseases, in particular Chronic Obstructive Pulmonary loss in the skeleton. AMGEN is the first company to commercialize the first Disease (COPD), and has broadened the scope of its work to include RANK ligand inhibitor named Prolia. diseases such as hypertension, stroke, atrial fibrillation, arthritis, Parkinson’s disease, HIV/AIDS, Hepatitis C and Type II Diabetes.
AstraZeneca Booths # 17 &18 For more information please visit our website: www.boehringer-ingelheim.ca 1004 Middlegate Road Mississauga, ON L4Y 1M4 Tel.: 1-888-669-2987 Bristol-Myers Squibb Canada Booth # 10 AstraZeneca is a major international healthcare business engaged in the Contact: Ms. Laura Del Grande research, development, manufacturing and marketing of meaningful 2344 Alfred-Nobel, Suite 300 prescription medicines; and a supplier for healthcare services. AstraZeneca Saint-Laurent, QC H4S 0A4 is one of the world's leading pharmaceutical companies and is a leader in Tel.: 514-333-4222 gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and E-Mail: [email protected] infectious disease medicines. For more information, please visit: Bristol-Myers Squibb Canada: One of the world’s leading research-based www.astrazeneca.ca. pharmaceutical companies whose mission is to extend and enhance human life by providing the highest-quality biopharmaceutical products. Boehringer Ingelheim / Eli Lilly Canada Inc. Booth # 8
Contact: Ms. Agnes David Calian Booth # 21 5180 South Service Road Contact: Mrs. Erin Rogers Burlington, ON L7H 5H4 340 Legget Drive, Suite 101 Tel.: 905-631-4559 Ottawa, ON K2K 1Y6 Fax: 905-634-4421 Tel.: 1-877-225-4264 ext 229 E-Mail: [email protected] Fax: 1-866-662-7848 Trajenta™ (linagliptin) is the first product of the Boehringer Ingelheim E-Mail: [email protected] (Canada) and Eli Lilly and Company alliance in the field of diabetes, Calian employs approximately 500 healthcare professionals at 30 locations centring on four pipeline compounds. By joining forces, the companies across the country. More than half of these professionals are civilian demonstrate commitment in the care of patients with diabetes and stand physicians who work in partnership with military professionals ensuring together to focus on patient needs. today's Forces' Members receive comprehensive primary care. Visit us and discover the unique benefits available to you in these rewarding roles.
December 5-7, 2011 -10 - McGill University - Faculty of Medicine EXHIBITOR DIRECTORY
EXHIBITOR DIRECTORY
GlaxoSmithKline Booths # 19 & 20 McGill Bookstore Booths # 5 & 6 Contact: Mr. François Bélair Contact: Anna Stein 8455 Route Transcanadienne 3420 McTavish Street Saint-Laurent, QC H4S 1Z1 Montréal, QC H3A 3L1 Tel.: 514-738-8886 Tel.: 514-398-3222 E-Mail: [email protected] Fax: 514-398-1589 GlaxoSmithKline Inc. – one of the world’s leading research-based Toll free: 1-800-362-0320 pharmaceutical, vaccine and healthcare companies – is committed to The Bookstore is open year round and carries new and used textbooks and improving the quality of human life by enabling people to do more, feel custom courseware as well as reference and general books, stationery, better and live longer. In Canada, GlaxoSmithKline is a top 15 investor in office supplies, McGill insignia and confectionery. research and development, contributing more than $156 million in 2008 alone. GSK is designated a Caring Company by Imagine Canada, and is McGill University CHPE Office (CME) Booth # 13 consistently recognized as one of the 50 best companies to work for in 1110 Pine Avenue, Room 301 Canada. For company information please visit, www.gsk.ca. Montréal, QC H3A 1A3 Tel.: 514-398-3500 Johnson & Johnson Medical Companies Booth # 3 Fax: 514-398-2231 Contact: Elizabeth Coll The mission of the CHPE Office is to promote: excellence in healthcare by contributing to the continuum of medical education including 200 Whitehall Drive undergraduate, postgraduate and lifelong learning; lifelong learning Markham, ON L3R 0T5 pertinent to health professionals' activities; interprofessionalism and Tel: 905-946-7362 collaboration with other CHPE stakeholders; accountability to our patients, Fax: 905-946-2006 learners and communities; innovation and critical inquiry in continuing E-Mail: [email protected] health professional education. DePuy Spine develops innovative orthopaedic and neurosurgical products that address key areas of spinal care, including cervical, aging spine, Merck Canada Booths # 11 & 12 vertebral body replacement, minimally invasive surgery and the emerging area of biologics. We collaborate with spine surgeons and other experts to Contact: Mr. Brian Epstein improve techniques and pioneer new technologies that have the potential 16711 Trans-Canada Highway to transform spinal care and make a real difference in the lives of patients. Kirkland, QC H9H 3L1 Tel.: 514-428-6127 Lundbeck Canada Inc. Booth # 1 E-Mail: [email protected] Contact: Mr. Alec Wilson Today’s Merck is working to help the world be well. Merck is a global health care leader with a diversified portfolio of prescription medicines, 1000 de la Gauchetière Ouest, Suite 500 vaccines, consumer and animal health products. In Canada, Merck Montréal, QC H3B 4W5 markets over 530 pharmaceutical, consumer and animal health products. Tel.: 514-703-3068 Merck is a leader in a broad range of areas such as cardiology, infectious E-Mail: [email protected] diseases, respiratory, vaccines, women's health and sun care, and is focused on expanding offerings in other areas, including virology, oncology Lundbeck Canada is a subsidiary of H. Lundbeck A/S, an international and diabetes. research-based pharmaceutical company which focuses on diseases of the Central Nervous System. Based in Montréal, Lundbeck Canada has Merck is one of the top R&D investors in Canada, with an investment of been part of the Canadian pharmaceutical industry for more than a decade $78.6 million in 2010. Merck has a large manufacturing facility in Québec and markets products for the treatment of depression, anxiety, Alzheimer’s dedicated to the annual production of some 35 million units of its various Disease, and schizophrenia. Through original research and development as brands, including Claritin® and Aerius®. Based in Montréal, Québec, Merck employs over 1400 people across Canada. For more information well as in-licensing agreements with other companies, we are fulfilling our about our operations in Canada, visit www.merck.ca. mission to improve the quality of life for those suffering from psychiatric and neurological disorders.
December 5-7, 2011 -11 - 62 nd Annual Refresher Course for Family Physicians EXHIBITOR DIRECTORY
EXHIBITOR DIRECTORY
Pendopharm Booth # 4 The Running Room Booth # 13 6111 Royalmount Avenue Galerie Des Boutiques Montréal, QC H4P 2T4 1 Place Ville-Marie, Unit 11318 Tel.: 514-340-5045 Montréal, QC H3B 3Y1 Fax: 514-733-9684 Tel.: 514-871-8199 Pendopharm is a rapidly growing and independent pharmaceutical Fax: 514-871-4891 business that focuses on commercializing a portfolio of specialty E-mail: [email protected] prescription products as well as a large and established line of OTC and The Running Room is North America’s largest specialty Running & Walking BTC products. Retailer of sporting goods, apparel and footwear, operating 92 corporately Pendopharm is a division of Pharmascience Inc., a Canadian privately- owned stores from coast to coast. owned company. Established in 1983, Pharmascience Inc. is the largest pharmaceutical company in Quebec. ZoomMed Booth # 2 Pfizer Canada Booths # 14 & 15 6300 Auteuil, Suite 121 Contact: Geneviève Massé Champoux Brossard, QC, J4Z 3P2 17300 Route Transcanadienne, Room R2126b Tel.: 450-678-5457 Kirkland, QC H9J 2M5 Fax: 450-678-9650 E-mail: [email protected] Tel.: 514-639-4676 E-Mail: genevieve.massechampoux@pfizer.com ZoomMed manufacturers and markets the ZRx Prescriber, a Web-based application that improves prescription management and facilitates Pfizer Canada Inc. is the Canadian operation of Pfizer Inc, the world's communication between health care professionals. It runs on a pocket leading biopharmaceutical company. Pfizer discovers, develops, computer, smart phone or PC. Not only is this solution advantageous for manufactures and markets prescription medicines for humans and health care professionals, it also provides patients with faster, safer care. animals. Pfizer's ongoing research and development activities focus on a Launched in November 2006, ZoomMed’s solution is now used by wide range of therapeutic areas following our guiding aspiration... Working thousands of physicians across Canada. together for a healthier world. For more information on ZoomMed visit our website at www.zoommed.com. Takeda Canada, Inc. Booth # 7 400-6750 Century Avenue Mississauga, ON L5N 2V8 Tel.: 905-814-2300 Fax: 905-814-2489 Takeda is committed to striving towards better health for patients worldwide through leading innovation in medicine. As the largest pharmaceutical company in Japan and a top 15 pharmaceutical company worldwide, Takeda will bring a number of therapeutic options to Canadians in metabolic disease, cardiovascular disease, oncology and the central nervous system.
December 5-7, 2011 -12 - McGill University - Faculty of Medicine Faculty of Medicine
62 ND ANNUAL REFRESHER COURSE FOR FAMILY PHYSICIANS DECEMBER 5-7, 2011
Program Overview PROGRAM OVERVIEW
PROGRAM – MONDAY, DECEMBER 5, 2011 A question period will follow all lectures on all days.
06:30 – 17:30 Registration Lower Lobby 07:00 – 07:45 Continental Breakfast Foyer
08:20 – 10:35 PLENARY 1 Morning Chair • David Dannenbaum 08:20 – 08:30 P1.1 Welcome and Introduction Ivan Rohan Westmount 08:30 – 09:00 P1.2 Post MI Management Richard Haichin Westmount 09:00 – 09:30 P1.3 Lipids Beyond Statins Mark Sherman Westmount 09:30 – 09:35 Exercise Stretch Carolyne Dubé Westmount 09:35 – 10:05 P1.4 Health Promotion: A Skeptic’s Approach Steven Grover Westmount 10:05 – 10:35 P1.5 Atrial Fibrillation Guidelines Update Marcel Fournier Westmount
10:35 – 11:00 Refreshment Break Fontaine ABC
11:00 – 12:00 WORKSHOPS A A-01 ER: Pulmonary Embolism Raymond Sorge Fontaine E A-02 GER: Decision-Making Capacity Assessment Catherine Ferrier Fontaine F A-03 PEDS: Office Orthopedics - What Not to Miss Thierry E. Benaroch Fontaine G A-04 Hands On: Case Studies of Lumbar Spine Pain for Family Practice Mohan Radhakrishna Fontaine H A-05 An Unusual Morning in the Preop Center: A Case-based Discussion of Principles, Priorities and Challenges David Hornstein & Jeffrey Segal St-Pierre A-06 Common Pitfalls in ECG Interpretation David Kostiuk Fundy A-07 Lipid Guidelines and Management: Clinical Pearls Mark Sherman Mont-Royal A-08 Atrial Fibrillation and Common Arrhythmias Marcel Fournier Hampstead A-09 An Introduction to Wound Care Mark Karanofsky Côte-St-Luc A-10 Occupational Medicine - Family Practice Peter Rohan St-Michel
12:00 – 12:45 LUNCH-TIME EDUCATIONAL FORUM 1 Moderator • Najmi Nazerali New Perspectives on Alzheimer’s Disease: From the Asymptomatic to Prodromal and Dementia Stages Serge Gauthier Le Portage (overflow in Fontaine D)
12:00 – 13:30 Lunch Fontaine ABC
13:30 – 14:35 PLENARY 2 Afternoon Chair • Michael Zigman 13:30 – 14:00 P2.1 Smoking Mark Palayew Westmount 14:00 – 14:05 Exercise Stretch Carolyne Dubé Westmount 14:05 – 14:35 P2.2 Sleep Apnea Richard Payne Westmount
December 5-7, 2011 -13 - 62 nd Annual Refresher Course for Family Physicians PROGRAM OVERVIEW
PROGRAM – MONDAY, DECEMBER 5, 2011 A question period will follow all lectures on all days.
14:35 – 15:35 WORKSHOPS B B-01 ER: Procedures Phyllis Vetere St-Pierre B-02 GER: Driving Competence Paul Lysy Mont-Royal B-03 PEDS: Interpretation of the Growth Curve Johanne Morel Fundy B-04 Hands On: Shoulder Exam J. Scott Delaney Hampstead B-05 Tailoring Anti-smoking Cessation Mark Palayew St-Michel B-06 Interpretation of PFT's for the Family Physician Andrew Hirsch Côte-St-Luc B-07 Updates in Heart Failure: Case Studies Nadia Giannetti Fontaine E B-08 Chronic Kidney Disease Sameena Iqbal Fontaine F B-09 Female Incontinence Marie-Claude Lemieux Fontaine G B-10 Hypertension: CHEP 2011 Update Luc Trudeau Fontaine H
15:35 – 16:00 Refreshment Break Fontaine ABC
16:00 – 17:00 WORKSHOPS C C-01 ER: Procedures (repeat of B-01) Phyllis Vetere St-Pierre C-02 GER: Leg Edema Management in the Older Patient: A Geriatrician's POV Wendy Chiu Mont-Royal C-03 PEDS: Interpretation of the Growth Curve (repeat of B-03) Johanne Morel Fundy C-04 Hands On: Knee Exam J. Scott Delaney Hampstead C-05 Tailoring Anti-smoking Cessation (repeat of B-05) Mark Palayew St-Michel C-06 Interpretation of PFTs for Family Physician (repeat of B-06) Andrew Hirsch Côte-St-Luc C-07 Updates in Heart Failure: Case Studies (repeat of B-07) Nadia Giannetti Fontaine E C-08 Chronic Kidney Disease (repeat of B-08) Sameena Iqbal Fontaine F C-09 Female Incontinence (repeat of B-09) Marie-Claude Lemieux Fontaine G C-10 Hypertension: CHEP 2011 Update (repeat of B-10) Luc Trudeau Fontaine H
18:00 – 22:00 COCKTAILS FOLLOWED BY THE ANNUAL COURSE DINNER AND ENTERTAINMENT L'Ensemble du Square St-Louis, under the leadership of Robert O’Callaghan, will once Westmount again perform during the cocktail and dinner. Carole Montmarquette will interpret various repertoires including English and Irish ballads of the 17th & 18th centuries, as well as a French repertoire from the 15th century until present. A sumptuous four-course meal will be served.
December 5-7, 2011 -14 - McGill University - Faculty of Medicine PROGRAM OVERVIEW
PROGRAM – TUESDAY, DECEMBER 6, 2011 A question period will follow all lectures on all days.
06:30 – 18:00 Registration Lower Lobby 07:00 – 08:00 Continental Breakfast Foyer
07:00 – 07:45 BREAKFAST - EDUCATIONAL FORUM 2 Moderator • Ivan Rohan Prostate Health Education Live Program Simon Tanguay Le Portage (overflow in Fontaine D)
08:00 – 09:35 PLENARY 3 Morning Chair • Heather Abrahams 08:00 – 08:30 P3.1 Vaccinations: Latest Developments John Yaremko Westmount 08:30 – 09:00 P3.2 New Canadian Guidelines for Immigrant and Refugee Health Kevin Pottie Westmount 09:00 – 09:05 Exercise Stretch Carolyne Dubé 09:05 – 09:35 P3.3 Restless Legs - Nocturnal Movement Diagnosis and Treatment Liam Durcan Westmount
09:35 – 10:35 WORKSHOPS D D-01 ER: Killer Headaches Willis Grad Fontaine E D-02 GER: Delirium in the Elderly Robert Bailey St-Pierre D-03 PEDS: Common Problems in Pediatrics John Yaremko Mont-Royal D-04 Hands On: Practical Corticosteroid Injections of Joints and Soft Tissues for Family Physicians Michael Stein Hampstead D-05 Approach to Adolescents Allan Pavilanis Fontaine F D-06 Family Medicine Informatics and eMR John Hughes & Ray Simkus Fontaine G D-07 Approach to Dyspnea Bruce Campbell Fundy D-08 The Spiritual-immaterial Value of the Values of the Self in the Rehabilitation Process John Sader St-Michel D-09 Diabetes in the Elderly - What’s the Evidence? Laurence Green Fontaine H D-10 Neurology Exam Liam Durcan Côte-St-Luc
10:35 – 11:00 Refreshment Break Fontaine ABC
11:00 – 12:00 WORKSHOPS E E-01 ER: TIA and CVA Management – Brain Attack Theodore Wein Fontaine E E-02 GER: Pain in the Elderly David Lussier Fontaine F E-03 PEDS: Common Problems in Pediatrics (repeat of D-03) John Yaremko Mont-Royal E-04 Hands On: Practical Corticosteroid Injections of Joints and Soft Tissues for Family Physicians Michael Stein Hampstead (repeat of D-04) E-05 New Canadian Guidelines for Immigrant and Refugee Health Kevin Pottie & Lavanya Narasiah Fontaine G E-06 Andropause Peter Chan Fontaine H E-07 Delirium in the Elderly Robert Bailey St-Pierre E-08 Gambling - An Overview John Sader St-Michel E-09 Exercise - Benefits beyond Cardiovascular Ivan Rohan Fundy E-10 Neurology Exam (repeat of D-10) Liam Durcan Côte-St-Luc
December 5-7, 2011 -15 - 62 nd Annual Refresher Course for Family Physicians PROGRAM OVERVIEW
PROGRAM – TUESDAY, DECEMBER 6, 2011 A question period will follow all lectures on all days.
12:00 – 12:45 LUNCH-TIME EDUCATIONAL FORUM 3 Moderator • Daniel E. Lalla An Update in ACS and Anti-platelet Therapy Thao Huyhn Le Portage (overflow in Fontaine D) 12:00 – 13:30 Lunch Fontaine ABC
13:30 – 15:30 PLENARY 4 Afternoon Chair • Adrian Macek 13:30 – 14:00 P4.1 Top 5 Pediatric Articles of 2011! Will They Change Your Practice in 2012? David McGillivray Westmount 14:00 – 14:30 P4.2 The Management of Celiac Disease Gad Friedman Westmount 14:30 – 15:00 P4.3 Infectious Souvenirs in Travel Medicine Dominique Tessier Westmount 15:00 – 15:30 P4.4 Follow-up of Diagnostic Testing Ross Berringer Westmount
15:30 – 16:00 Exercise Stretch & Refreshment Break Carolyne Dubé Fontaine ABC
16:00 – 17:00 WORKSHOPS F F-01 ER: Psychiatric Emergencies Hani Iskandar Mont-Royal F-02 GER: Geriatric Common Problems with Medications and More? Allen Huang Hampstead F-03 PEDS - Lessons Learnt from Patients. Pediatric Red Flag Cases! David McGillivray Côte-St-Luc F-04 Exercise Promotion in a Five Minute Office Visit Ilka Lowensteyn St-Pierre F-05 Family Travel Vaccinations Dominique Tessier Fontaine E F-06 Vestibular Rehabilation - Epley Manoeuver and Other Techniques Elizabeth Dannenbaum Fontaine F F-07 Managing Treatment - Resistant Depression: Psychopharmacological and Neuromodulation Approaches Marcelo Berlim Fontaine G F-08 Gastroenterology - Case Studies of Common Office GI Disorders Gad Friedman Fontaine H F-09 Eating Disorders: Risk Evaluation, Medical Complications and Evidence-based Treatments Mimi Israel St-Michel F-10 Responding to Complaints: General Principles Ross Berringer Fundy
December 5-7, 2011 -16 - McGill University - Faculty of Medicine PROGRAM OVERVIEW
PROGRAM – WEDNESDAY, DECEMBER 7, 2011 A question period will follow all lectures on all days.
06:30 – 16:30 Registration Lower Lobby 07:00 – 08:00 Continental Breakfast Foyer
07:00 – 07:45 BREAKFAST - EDUCATIONAL FORUM 4 Moderator • David Dannenbaum Understanding and Managing Type 2 Diabetes in the Presence of Declining Renal Function Jean-François Yale & Mark Lipman Le Portage (overflow in Fontaine D) 08:00 – 10:05 PLENARY 5 Morning Chair • Najmi Nazerali 08:00 – 08:30 P5.1 Those Miserable Soft Tissue Pains: A Practical Update Mary-Ann Fitzcharles Westmount 08:30 – 09:00 P5.2 When Oral Agents Fail, What Are the Options? Tina Kader Westmount 09:00 – 09:05 Exercise Stretch Carolyne Dubé 09:05 – 09:35 P5.3 New Therapies for Diabetes: DPP-4 Inhibitors and More Jean-François Yale Westmount 09:35 – 10:05 P5.4 PMR, TA, Vasculitis Jan Schulz Westmount
10:05 – 10:30 Refreshment Break Fontaine ABC
10:30 – 11:30 WORKSHOPS G G-01 ER: Anaphylaxis: The Latest Recommendations to Better Understand and Prevent Fatal Reactions TBD Fontaine E G-02 GER: One Minute to Prescribe, One Million Minutes to Discontinue: Ten Questions to Ask Louise Mallet Fontaine F G-03 PEDS: Oral Allergy Syndromes Christine McCusker St-Pierre G-04 Hands On: Prescribing Home Exercises – Principles and Pitfalls Ian Shrier Fundy G-05 Reading Logbooks: Case Presentations on Adjusting Hypoglycemics Using Home Monitoring Jean-François Yale Fontaine G G-06 Prediabetes and Early Type 2 Diabetes: Where Are We in 2011? Tina Kader Fontaine H G-07 EMR Update – Implementation Plans and More Daniel E. Lalla St-Michel G-08 Update in Cervical Cancer Screening Cleve Ziegler Mont-Royal G-09 Tricks of the Trade in Musculoskeletal Medicine Mary-Ann Fitzcharles Hampstead G-10 Hands On: Laboratory Investigation in Rheumatology Jan Schulz Côte-St-Luc
11:30 – 12:15 LUNCH-TIME EDUCATIONAL FORUM 5 Moderator • Peter Rohan Canadian Approaches to Stroke Pr Evention in Atrial Arrhythmia S (CASES) Mario Talajic Le Portage (overflow in Fontaine D)
11:30 – 13:00 Lunch Fontaine ABC
December 5-7, 2011 -17 - 62 nd Annual Refresher Course for Family Physicians PROGRAM OVERVIEW
PROGRAM – WEDNESDAY, DECEMBER 7, 2011 A question period will follow all lectures on all days.
13:00 – 16:30 PLENARY 6 Afternoon Chair • Daniel E. Lalla 13:00 – 13:30 P6.1 Green Medicine: The Poly-Dividend Principle David J.G. Tector Memorial Lecture Jean Zigby Westmount 13:30 – 14:00 P6.2 New Paradigm for Cervical Cancer Screening Say Goodbye to Screening Cytology Alex Ferenczy Westmount 14:00 – 14:30 P6.3 Panel Discussion: Utility of PSA Screening Daniel E. Lalla & Maurice Anidjar Westmount
14:30 – 14:45 Exercise Stretch & Refreshment Break Carolyne Dubé Fontaine ABC
14:45 – 16:30 PLENARY 6 ( cont’d ) Afternoon Chair • Daniel E. Lalla 14:45 – 15:15 P6.4 The Debate on Euthanasia: Can Bioethics Help Clarify the Issues? Isabelle Leblanc Westmount 15:15 – 15:45 P6.5 Celebrity Medicine Joseph A. Schwarcz Westmount 15:45 – 16:15 P6.6 Medical Marijuana Mark Ware Westmount 16:15 – 16:30 P6.7 Closing Comments Ivan Rohan Westmount
December 5-7, 2011 -18 - McGill University - Faculty of Medicine PROGRAM OVERVIEW
SPINE SYMPOSIUM 2nd Spine Symposium of the McGill Scoliosis and Spine Group
Purpose and Objectives of the Symposium
This Symposium is designed to improve the family physician’s comfort in recognizing, diagnosing, and performing appropriate referrals for cervical myelopathy. Differentiating non-myelopathic features in both sport and automotive collisions will also be covered.
Intended Audience This multidisciplinary symposium is of interest to: * Family physicians * Emergency physicians * Specialists who deal with spinal pain: orthopaedic surgeons, neurologists, neurosurgeons * Physiatrists, physical and occupational therapists
At the end of the Symposium, participants will be able to: * Be aware of the McGill Cervical Myelopathy algorithm; * Develop confidence in the physical diagnosis of cervical myelopathy; * Appreciate the natural history of degenerative disk changes; * Understand the role of imaging of the cervical spine; * Name the types of pathology for whom referral to a Spine Surgeon is necessary as well as be aware of new surgical techniques; * More comfortably treat patients with neck injury in acute sport environments as well as in pain after automotive collisions.
Accreditation
This event is approved for up to 2.5 credits by the Centre for Continuing Health Professional Education (CCHPE). The Centre for CCHPE, Faculty of Medicine, McGill University is fully accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS), and through the CACMS is accredited to award AMA PRA category 1 credits. This program meets the accreditation criteria of the College of Family Physicians of Canada for MAINPRO-M1 credits. Members of the American Academy of Family Physicians are eligible to receive credit hours for attendance at this meeting due to a reciprocal agreement with the College of Family Physicians of Canada. This event is an accredited group learning activity (Section 1) as defined by the Maintenance of Certification program of the Royal College of Physicians and Surgeons of Canada. Through a reciprocal agreement between the American Medical Association and the Royal College of Physicians and Surgeons of Canada, the Centre for CCHPE, Faculty of Medicine, McGill University designates this activity for AMA PRA Category 1 credit(s) up to the maximum number of credit hours noted above. Each physician should claim only those hours of credit that he/she actually spent at the educational activity. Note: The accreditation of the Spine Symposium is separate from the Refresher Course. Please collect your CME certificate.
December 5-7, 2011 -19 - 62 nd Annual Refresher Course for Family Physicians PROGRAM OVERVIEW
SPINE SYMPOSIUM 2nd Spine Symposium of the McGill Scoliosis and Spine Group
Outremont
17:00 – 17:30 Introduction and Welcome Mohan Radhakrishna , Head, Physical Medicine & Rehabilitation, McGill University
17:30 – 18:00 Algorithm on Cervical Myelopathy and Introduction to Physical Exam Mohan Radhakrishna, Head, Physical Medicine & Rehabilitation, McGill University Jeff Golan , Department of Neurosurgery, Jewish General Hospital
18:00 – 18:45 Natural History of Cervical Myelopathy and Review of Imaging Modalities Jean Ouellet , Chief of Scoliosis and Spine Service, Montréal General Hospital
18:45 – 19:15 Surgical Approaches and Long-term Complications of Surgery that the GP Should Be Aware Of Peter Jarzem , Spine Surgeon, McGill University Health Centre, Jewish General Hospital, McGill University
19:15 – 20:00 Approach to Whiplash/Neck Injuries in Sport - Why This Is Not Myelopathy Simon Tinawi , Physical Medicine and Rehabilitation, McGill University, Quebec Medicolegal Expert Society Vincent Lacroix, McGill Spine Clinic, McGill University and Montréal Alouettes
20:00 Close of Meeting
December 5-7, 2011 -20 - McGill University - Faculty of Medicine PROGRAM OVERVIEW
COURSE FACULTY
Anidjar, Maurice MD, PHD Gauthier, Serge MD, FRCPC (Neurology) Assistant Professor, Urology, McGill University; Department of Surgery Director, Alzheimer Disease Research Unit, McGill Center for Studies in Aging, (Division of Urology), Jewish General Hospital Douglas Mental Health Research Institute; Professor, Departments of Bailey, Robert MD, FRCP Neurology & Neurosurgery, Psychiatry, Medicine Director, Division of Geriatrics, St. Mary’s Hospital Center Giannetti, Nadia MD Benaroch, Thierry E. MD, FRCS(C), FAAOS Department of Medicine, McGill University, Royal Victoria Hospital Site Director, Pediatric Orthopedic Surgery and Trauma Program, Grad, Willis MD, CM, CCFP(EM), FRCPC, CSPQ The Montréal Children’s Hopsital, MUHC Attending Staff, Emergency Department, Jewish General Hospital ; Assistant Berlim, Marcelo T. MD, MSc Professor, Faculty of Medicine, McGill University Assistant Professor, Department of Psychiatry, McGill University; Green, Laurence MD, FRCPC Director, Neuromodulation Program, Douglas Mental Health Institute; Staff Associate Professor, Medicine, McGill University; Associate Director, Division Psychiatrist, Depressive Disorders Program, Douglas Mental Health Institute of General Internal Medicine, McGill University Berringer, Ross G. MD, D(ABEM), MCFP(EM) Grover, Steven MD Physician, Risk Manager, Risk Management Services, Canadian Medical Professor, Department of Medicine, McGill University; Director, McGill Protective Association Cardiovascular Health Improvement Program (CHIP), MUHC Campbell, Bruce MD, FRCPC Hirsch, Andrew MD Assistant Professor of Medicine, Internal Medicine, Department of Medicine, Associate Professor, Medicine, McGill University; Division of Respiratory St. Mary's Hospital Center Medicine, Jewish General Hospital Chan, Peter MD, CM, MSc, FRCS(C), FACS Haichin, Richard MD, CM Director of Male Reproductive Medicine, Division of Urology, MUHC; Assistant Professor, McGill University; Cardiologist, Senior Physician, MUHC Associate Professor, Department of Surgery, MUHC Hornstein, David MD Chiu, Wendy MD, CM, FRCPC Associate Professor, Medicine, McGill University Assistant Professor (Clinical) & Physician, Division of Geriatric Medicine, Huang, Allen MDCM, FRCPC, FACP Department of Medicine, McGill University; Medical Director, Geriatric Day Senior Geriatrician, Division of Geriatric Medicine, MUHC; Associate Hospital, Royal Victoria Hospital, MUHC Professor, Department of Medicine, McGill University; Senior Physician, Dannenbaum, Elizabeth PT, MSc Department of Medicine, MUHC Physiotherapist, Vestibular Rehabilitation Program, Jewish Rehabilitation Hughes, John B . MD, CM Hospital Assistant Professor, McGill University, Faculty of Medicine Delaney, J. Scott MDCM, FRCPC, FACEP Huynh, Thao MD, MSC, FRCP(C) Research Director, Department of Emergency Medicine, MUHC; Cardiologist, Associate Professor of Medicine, McGill University Health Team Physician, Montréal Alouettes, Impact and Cirque du Soleil Center, McGill University Durcan, Liam MD, FCRPC Iqbal, Sameena MD Assistant Professor, Department of Neurology and Neurosurgery, McGill Program Director, Nephrology Fellowship, Royal Victoria Hospital, MUHC University; Consultant Neurologist, Montréal Neurological Hospital and Institute Iskandar, Hani MD Medical Chief, Intensive Care Unit, Emergency, Brief Intervention Unit, Ferenczy, Alex MD Electroconvulsive Therapy Unit, Douglas Institute; Coordinator, Continuing Professor, Departments of Pathology & Obstetrics and Gynecology, Medical Education, Douglas Institute; Associate Professor, Department of McGill University; Director, Gynecologic Pathology and Cytopathology, Psychiatry, McGill University Department of Pathology, Jewish General Hospital Israel, Mimi MD, FRCPC Ferrier, Catherine MD, FCFP Psychiatrist in Chief, Douglas Hospital; Department of Psychiatry; Chair, Assistant Professor, Department of Family Medicine, McGill University; Psychiatry, Associate Professor, McGill University Physician, Division of Genetic Medicine, MUHC Kader, Tina MD, FRCPC, CDE Fitzcharles, Mary-Ann MD Assistant Professor, Department of Medicine, McGill University; Certified Associate Professor, Division of Rheumatology, McGill University; Diabetes Educator Rheumatologist, The Montréal General Hospital, MUHC Karanofsky, Mark MD, CM, CCFP Fournier, Marcel MD Faculty Lecturer, Department of Family Medicine, McGill University Cardiologist, St. Mary’s Hospital Kostiuk, David MD Friedman, Gad MDCM, FRCP Faculty of Medicine, McGill University Division of Gastroenterology, Sir Mortimer B. Davis Jewish General Hospital; Assistant Professor, School of Medicine, McGill University Lalla, Daniel E. MDCM, FCFP Faculty Lecturer, McGill Family Medicine
December 5-7, 2011 -21 - 62 nd Annual Refresher Course for Family Physicians PROGRAM OVERVIEW
COURSE FACULTY
Leblanc, Isabelle MSc, MD, CFPC Sader, John P. MD, BSc, ASAM-certified, ABAM Family Physician, St. Mary’s Family Medicine Centre, Faculty Lecturer, McGill Associate Professor, Department of Family Medicine, McGill University University Segal, Jeffrey Steven MDCM, FRCP Lemieux, Marie-Claude MD PGY-F, General Internal Medicine, McGill University Department of Urology, Jewish General Hospital Schulz, Jan MD Lipman, Mark L. MD Associate Professor, Department of Medicine, McGill University Chief, Division of Nephrology & Associate Physician-in-Chief, Schwarcz, Joseph A. PhD Jewish General Hospital; Associate Professor of Medicine, McGill University Director, Office for Science and Society, McGill University Lowensteyn, Ilka PhD Sherman, Mark H. MDCM, FRCPC Clinical Research Director, McGill Comprehensive Health Improvement Diplomate, American Board of Clinical Lipidology; Director, Lipid Clinic, Programme; Medical Scientist, Montréal General Hospital Research Institute; MUHC; Director, Metabolic Day Centre, Royal Victoria Hospital Adjunct Assistant Professor, McGill University Shrier, Ian MD, PhD, Dip Sport Med, FACSM Lussier, David MD, FRCPC Assistant Professor, Department of Family Medicine, McGill University, Director, Geriatric Pain Clinic, MUHC; Assistant Professor, McGill University Assistant Professor, Centre for Clinical Epidemiology and Community Studies, Lysy, Paul G . MD, FCFP Jewish General Hospital Assistant Professor, Family Medicine, McGill University Simkus, Ray MD, CM Mallet, Louise BScPharm, PharmD, CGP Physician, Brookswood Family Practice; Adjunct Professor, School of Health Professor in Clinical Pharmacy, Faculty of Pharmacy, University of Montréal; Information Science, University of Victoria Clinical Pharmacist in Geriatrics, Royal Victoria Hospital, MUHC Sorge, Raymond S . MDCM, CCFP(EM), FCFP McCusker, Christine MD, MSC Assistant Professor, Department of Family Medicine, McGill University Associate Professor, Pediatrics, Montréal Children’s Hospital, MUHC; Stein, Michael MDCM, FRCPC Research Director, Meakins-Christie Laboratories, McGill University; Director, Assistant Professor of Medicine, Division of Rheumatology, McGill University Clinical Immunology Laboratory Talajic, Mario MD, FRCPC McGillivray, David MD Cardiac Electrophysiologist, Montréal Heart Institute; JC Edwards Professor, Associate Professor, Department of Pediatrics, McGill University Medicine, University of Montréal Morel, Johanne MD Tanguay, Simon MD, FRCSC Assistant Professor, Department of Pediatrics, Montréal Children’s Hospital, Head, Division of Urologic Oncology, MUHC; Associate Professor, Department McGill University of Surgery (Urology), McGill University Narasiah, Lavanya MD, MSc, CCFP Tessier, Dominique MD, CCFP, FCFP Family Practitioner, Programme régional d'accueil et d'intégration des Family Physician, Clinique Médicale du Quartier Latin; Clinical Professor, demandeurs d'asile Université de Montréal; Family Physician, Post-exposure Prophylaxis Clinic, Palayew, Mark David MD Hôpital Saint-Luc, CHUM Division of Pulmonary Diseases, McGill University Trudeau, Luc MD Pavilanis, Allan MD, CM, CCFP, FCFP, DipEpi Assistant Professor, Division of Internal Medicine, Cardiovascular Prevention Director, Family Medicine Centre, St. Mary's Hospital Centre; Associate Centre, Jewish General Hospital Professor, Family Medicine, McGill University Vetere, Phyllis MD Payne, Richard MD, MSc Supervisor, Emergency Medicine, Montreal General Hospital Attending Staff, Head & Neck Surgery, Sir Mortimer B. Davis-Jewish General Ware, Mark MBBS, MRCP(UK), MSc Hospital, Royal Victoria Hospital and Montréal General Hospital; Assistant Associate Professor, Director of Clinical Research, Family Medicine Professor, Department of Otolaryngology, Head and Neck Surgery, McGill and Anesthesia, McGill University and Alan Edwards Pain University Management Unit, MUHC Pottie, Kevin MD Wein, Theodore MD, FRCPC Associate Professor, Departments of Family Medicine and Epidemiology & Assistant Professor, Department of Neurology & Neurosurgery, Montréal Community Medicine, University of Ottawa General Hospital Radhakrishna, Mohan MD, FRCPC, Dip. Sport Med Yale, Jean-François MD, CSPQ Assistant Professor, Physical Medicine and Rehabilitation, McGill University Professor of Endocrinology, McGill Nutrition and Food Science Centre, McGill Rohan, Ivan MD, CCFP University Associate Dean CHPE par interim, Assistant Professor, Family Medicine Yaremko, John MD, FRCPC Department, Faculty of Medicine, McGill University Assistant Professor, Pediatrics, Staff Physician,The Montréal Children's Rohan, Peter MD, DOH Hospital, McGill University Program Director, Inter University Occupational & Environmental Health Ziegler, Cleve MD, FRCSC, CSPQ Clinic, Montréal Chest Institute, MUHC; Adjunct Professor, Department of Assistant Professor, Department of Ob/Gyn, McGill University; Attending Epidemiology, Biostatistics and Occupational Health, McGill University Physician, Department of Ob/Gyn, SMBD–Jewish General Hospital Zigby, Jean MD President, Canadian Association of Physicians for the Environment
December 5-7, 2011 -22 - McGill University - Faculty of Medicine Monday, December 5 Richard Haichin 08:30 – 09:00 PLENARY 1.2 Post MI Management Westmount
December 5-7, 2011 -23 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Richard Haichin 08:30 – 09:00 PLENARY 1.2 Post MI Management Westmount
December 5-7, 2011 -24 - McGill University - Faculty of Medicine Monday, December 5 Mark Sherman 09:00 – 09:30 PLENARY 1.3 Lipids: Beyond Statins Westmount
December 5-7, 2011 -25 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Mark Sherman 09:00 – 09:30 PLENARY 1.3 Lipids: Beyond Statins Westmount
December 5-7, 2011 -26 - McGill University - Faculty of Medicine Monday, December 5 Steven Grover 09:35 – 10:05 PLENARY 1.4 Health Promotion: A Skeptic’s Approach Westmount
December 5-7, 2011 -27 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Steven Grover 09:35 – 10:05 PLENARY 1.4 Health Promotion: A Skeptic’s Approach Westmount
December 5-7, 2011 -28 - McGill University - Faculty of Medicine Monday, December 5 Marcel Fournier 10:05 – 10:35 PLENARY 1.5 Atrial Fibrillation Guidelines Update Westmount
December 5-7, 2011 -29 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Marcel Fournier 10:05 – 10:35 PLENARY 1.5 Atrial Fibrillation Guidelines Update Westmount
December 5-7, 2011 -30 - McGill University - Faculty of Medicine Monday, December 5 Marcel Fournier 10:05 – 10:35 PLENARY 1.5 Atrial Fibrillation Guidelines Update Westmount
December 5-7, 2011 -31 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Raymond Sorge 11:00 – 12:00 A-01 ER: Pulmonary Embolism Fontaine E
December 5-7, 2011 -33 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Raymond Sorge 11:00 – 12:00 A-01 ER: Pulmonary Embolism Fontaine E
December 5-7, 2011 -34 - McGill University - Faculty of Medicine Monday, December 5 Raymond Sorge 11:00 – 12:00 A-01 ER: Pulmonary Embolism Fontaine E
December 5-7, 2011 -35 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Raymond Sorge 11:00 – 12:00 A-01 ER: Pulmonary Embolism Fontaine E
December 5-7, 2011 -36 - McGill University - Faculty of Medicine Monday, December 5 Catherine Ferrier 11:00 – 12:00 A-02 GER: Decision-Making Capacity Assessment Fontaine F
December 5-7, 2011 -37 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Catherine Ferrier 11:00 – 12:00 A-02 GER: Decision-Making Capacity Assessment Fontaine F
December 5-7, 2011 -38 - McGill University - Faculty of Medicine Monday, December 5 Catherine Ferrier 11:00 – 12:00 A-02 GER: Decision-Making Capacity Assessment Fontaine F
December 5-7, 2011 -39 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Thierry E. Benaroch 11:00 – 12:00 A-03 PEDS: Office Orthopedics - What Not to Miss Fontaine G
December 5-7, 2011 -41 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Thierry E. Benaroch 11:00 – 12:00 A-03 PEDS: Office Orthopedics - What Not to Miss Fontaine G
December 5-7, 2011 -42 - McGill University - Faculty of Medicine Monday, December 5 Thierry E. Benaroch 11:00 – 12:00 A-03 PEDS: Office Orthopedics - What Not to Miss Fontaine G
December 5-7, 2011 -43 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 David Hornstein & Jeffrey Segal 11:00 – 12:00 A-05 An Unusual Morning in the Preop Center: A Case-based Discussion of Principles, Priorities and Challenges St-Pierre
December 5-7, 2011 -45 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Mark Sherman 11:00 – 12:00 A-07 Lipid Guidelines and Management: Clinical Pearls Mont-Royal
December 5-7, 2011 -47 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Mark Sherman 11:00 – 12:00 A-07 Lipid Guidelines and Management: Clinical Pearls Mont-Royal
December 5-7, 2011 -48 - McGill University - Faculty of Medicine Monday, December 5 Mark Karanofsky 11:00 – 12:00 A-09 An Introduction to Wound Care Côte-St-Luc
December 5-7, 2011 -49 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Mark Karanofsky 11:00 – 12:00 A-09 An Introduction to Wound Care Côte-St-Luc
December 5-7, 2011 -50 - McGill University - Faculty of Medicine Monday, December 5 Peter Rohan 11:00 – 12:00 A-10 Occupational Medicine - Family Practice St-Michel
December 5-7, 2011 -51 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Serge Gauthier 12:00 – 12:45 EDUCATIONAL FORUM 1 New Perspectives on Alzheimer’s Disease: From the Le Portage Asymptomatic to Prodromal and Dementia Stages
December 5-7, 2011 -53 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Serge Gauthier 12:00 – 12:45 EDUCATIONAL FORUM 1 New Perspectives on Alzheimer’s Disease: From the Le Portage Asymptomatic to Prodromal and Dementia Stages
December 5-7, 2011 -54 - McGill University - Faculty of Medicine Monday, December 5 Paul Lysy 14:35 – 15:35 B-02 GER: Driving Competence Mont-Royal
December 5-7, 2011 -55 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Paul Lysy 14:35 – 15:35 B-02 GER: Driving Competence Mont-Royal
December 5-7, 2011 -56 - McGill University - Faculty of Medicine Monday, December 5 J. Scott Delaney 14:35 – 15:35
B-04 Hands On: Shoulder E xam Hampstead
Today’s workshop will deal mainly with the painful shoulder and will concentrate on the physical examination. The physical examination leading to the diagnosis of shoulder tendinitis, rotator cuff tears, labral cuff tears, and impingement syndromes will be emphasized. Due to time constraints, the diagnosis of the various fractures and dislocations around the shoulder will not be covered today.
Overview
1) Anatomy of Shoulder Joint 3 joints : sternoclavicular 1 articulation : scapulothoracic acromioclavicular glenohumeral
Muscles around shoulder : see ROM Bursa : subacromial
2) History age occupation / recreational activities location of pain ( +/- radiation) onset of pain : acute or chronic duration aggravating / alleviating factors associated symptoms other medical history
3) Physical Examination Note : - always include an exam of the cervical spine!! - disrobe ( women place bra in halter or tube top style)
A- Inspection : from the front and back of the patient - asymmetry ( compare to other side ) - gross deformities - wasting / atrophy of musculature - abnormal movement
B- Palpation : may do from the front and / or back of the patient - bones - joints / articulations - muscles / tendons / bursa - axilla
1
- usually check both sides at once
- need to externally rotate humerus after 120o
scapulothoracic motion - adduction = 45o
- external rotation = 80o
December 5-7, 2011 -57 - 62 nd Annual Refresher Course for Family Physicians i bra”) = internal rotation and adduction i S
supraspinatus : especially first 15o - adduction : pec major lat dorsi - flexion : anterior deltoid coracobrachialis pec major - extension : lat dorsi teres major posterior deltoid - internal rotation : subscapularis pec major lat dorsi teres major - external rotation : infraspinatus teres minor - scapular elevation : trapezius levator scapulae - scapular retraction : rhomboid major and minor - scapular protraction : serratus anterior
Monday, December 5 J. Scott Delaney 14:35 – 15:35 B-04 Hands On: Shoulder Exam Hampstead
- axilla
C- Range of Motion Note : - do active range of motion first - only need to do passive range of motion if there is limitation with active - usually check both sides at once - not so important to remember numbers : compare to unaffected side
- abduction = 180o - need to externally rotate humerus after 120o - after first 20o : 2o of glenohumeral motion for every 1o of scapulothoracic motion - adduction = 45o - flexion = 180o - extension = 60o - internal rotation = 70o - external rotation = 80o - combinations : i- Reach behind back and touch opposite scapula ( “ undoing your bra”) = internal rotation and adduction ii- Reach behind head and touch upper part of opposite scapula ( Apley Scratch test) = external rotation and abduction
D- Strength Testing - abduction : medial deltoid supraspinatus : especially first 15o of motion - adduction : pec major lat dorsi - flexion : anterior deltoid coracobrachialis pec major - extension : lat dorsi teres major posterior deltoid - internal rotation : subscapularis pec major lat dorsi teres major - external rotation : infraspinatus teres minor - scapular elevation : trapezius levator scapulae - scapular retraction : rhomboid major and minor - scapular protraction : serratus anterior (remember scapular winging when serratus anterior is weak)
2
December 5-7, 2011 -58 - McGill University - Faculty of Medicine Monday, December 5 J. Scott Delaney 14:35 – 15:35 B-04 Hands On: Shoulder Exam Hampstead
-***Rotator Cuff Testing*** i) Supraspinatus (Abduction) - abduct shoulder to 90o at side, internally rotate with thumbs pointing down to the ground and move arm 30o forward from coronal plane (emptying a can position) : now abduct against resistance
ii) Infraspinatus and Teres Minor (External Rotation) - elbows flexed to 90o at side with thumbs pointing up : now externally rotate against resistance
iii) Subscapularis (Internal Rotation) - arm behind back with hand around belt level (as if starting to undo bra) and palm facing backwards towards examiner: now push palm back against resistance - Abdominal compression test
Note: Dynamic testing of the rotator cuff or lag signs of the rotator cuff muscles are also useful examination tools for assessing rotator cuff tears. A) The lower fibers of the infraspinatous and teres minor are tested by abducting the patient's arm and maximally externally rotating. The patient is asked to keep the arm in this position. A positive test is if the patient is unable to keep the arm in this position and the arm springs back. This is also known as the positive horn-blower's sign. B) Supraspinatous and infraspinatous insufficiency is tested by maximally externally rotating the arm at the side and asking the patient to keep the arm in this position. If the patient is unable to keep the arm in this position, the test is considered positive.
iv) Long head Bicep tendinitis: I- The Yergenson's test is performed with the patient's elbow flexed to 90 degrees and stabilized against the thorax with the forearm pronated. The examiner resists supination while the patient also laterally rotates the arm against resistance. A positive result elicits tenderness in the bicipital groove and is indicative of bicipital tendinitis. II- The Speed's test is a more effective way of eliciting bicipital tendinitis. The examiner resists shoulder forward flexion by placing his hand on the patient's supinated forearm while the patient is elevating the arm and keeping the elbow extended. For a more effective method of pain reproduction, the examiner places fingers on the bicipital groove while performing this maneuver.
E- Neurologic Testing - motor testing done as above - sensory : pinprick to area i- lateral arm = C5 (axillary nerve - important in anterior shoulder dislocation / subluxations)
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December 5-7, 2011 -59 - 62 nd Annual Refresher Course for Family Physicians
Forward flex the arm to 90o
Pain in the AC area indicates a positive test.
c This is accomplished by placing the greater t t The greater tuberosity will then pinch the tendon against the c
f I
-
- This is less common than anterior instability. -
-
-
E The presence of a sulcus lateral a If the
Monday, December 5 J. Scott Delaney 14:35 – 15:35 B-04 Hands On: Shoulder Exam Hampstead
dislocation / subluxations) ii- thumb and index finger = C6 iii- long finger = C7 iv- ring and index finger = C8 v- medial forearm = T1 vi- axilla = T2 vii- nipple = T4
F- Special Tests i- Acromioclavicular Joint Separation I- Scarf Test : Forward flex the arm to 90o, internally rotate the arm so the palm is facing the ground, and adduct the arm across the chest at shoulder height. Pain in the AC area indicates a positive test.
ii- Impingement Tests - These tests try to pinch a tendon (usually the supraspinatus) under the coracoacromial complex . This is accomplished by placing the greater tuberosity underneath the coracoacromial ligament by internally rotating the arm. The greater tuberosity will then pinch the tendon against the coracoacromial ligament causing pain.
I- Hawkins Test : Forward flex the arm to 90o, flex elbow to 90o, and forcibly internally rotate the arm. II- Neer Test : Internal rotation of the arm so palm is facing the ground and forward flex the arm passively or actively
iii- Instability - There are several types of instability. - Anterior instability is classic with the humeral head subluxing out of the glenoid usually when the arm is abducted, externally rotated, and extended. - Posterior instability refers to the glenoid subluxing posteriorly out of the glenoid. This is less common than anterior instability. - Multidirectional instability refers to a lax shoulder joint (usually bilateral) that may sublux or dislocate in any direction. - Grades of Instability: - Grade 1 instability denotes translation up to the labrum without an ability to dislocate. - Grade II instability is the ability of the examiner to dislocate the shoulder while a spontaneous reduction occurs at the time of the maneuver. - Grade III instability is the dislocation of the shoulder the requires a subsequent reduction by the examiner.
I- Sulcus Sign : Patient stands with arms at side and muscles relaxed. Examiner pulls down on forearms. The presence of a sulcus lateral and inferior to the acromion indicates inferior instability. If the patient demonstrates inferior instability, he/she has multidirectional instability.
4 The other hand loads the h to gauge the p December 5-7, 2011 -6 0 - McG ill Universit y - Faculty of Medicine T
It can be p
The examiner abducts and externally r This will tend to push the humeral head out o A p The patient may state that t
This is termed a positive R
iv- L
of the knee. The examiner stands behind the patient. One hand r posteriorly on the humeral head. The other holds the arm at t The arm is abducted to different degrees while the h The other hand loads the h glenoid and externally rotates the arm. A
T
c
A positive maneuver produces either apprehension, p
Monday, December 5 J. Scott Delaney 14:35 – 15:35 B-04 Hands On: Shoulder Exam Hampstead
patient demonstrates inferior instability, he/she has multidirectional instability.
II- Load and Shift Maneuver : Examiner stands behind patient. One hand stabilizes the scapula at the acromion. The other hand loads the humeral head into the glenoid and then pushes the humeral head posterior to gauge the posterior laxity or excursion. The humeral head may start to ride over the rim of the glenoid if laxity is present. The humeral head is then pushed anteriorly to gauge the anterior laxity or excursion Compare with the other side.
III- The Jerk test is used to assess posterior instability. It can be performed with the patient sitting or standing. The arm is forward flexed to 90 degrees and internally rotated approximately 90 degrees. The examiner grasps the elbow and axially loads the humerus. While maintaining this load, the examiner adducts the arm across the body. A positive test occurs when the examiner feels a sudden jerk occurs as the head slides posteriorly. A second jerk can be felt as the arm is returned to a 90 degree abduction posttion. This is an indication of the shoulder reducing back into joint.
III- Apprehension (Crank) Test and Relocation Test : The patient lies supine on the edge of the bed. The examiner abducts and externally rotates the arm slowly. This will tend to push the humeral head out of the glenoid anteriorly in patients with anterior instability. A positive Apprehension or Crank Test is indicated by a look of apprehension or fear on the patient’s face. The patient may state that the sensation is similar to a previous dislocation. If a posterior force is now applied to the proximal humerus so as to push the humerus back into its proper position in the glenoid, the patient may lose the apprehension and feel less anxious. This is termed a positive Relocation Test.
iv- Labral Tear tests I- Modified Labral “Clunk” Test : This test is akin to the McMurray’s test of the knee. The examiner stands behind the patient. One hand rests posteriorly on the humeral head. The other holds the arm at the elbow. The arm is abducted to different degrees while the humeral head is pushed anteriorly. The other hand loads the humeral head into the glenoid and externally rotates the arm. A painful clunk is a positive test and is indicative of a labral cuff tear. This test may also cause apprehension in a patient with anterior instability.
II- The Obrien's test is performed by placing the arm patient's arm in cross chest adduction (horizontal flexion) of the affected shoulder with the elbow extended and forearm pronated (thumb down toward the ground). A resisted downward movement is applied to the arm by the examiner. A positive maneuver produces either apprehension, pain referable to the bicipital groove, and an audible or palpable click. The test is repeated with the forearm supinated, which must cause
5
December 5-7, 2011 -61 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 J. Scott Delaney 14:35 – 15:35 B-04 Hands On: Shoulder Exam Hampstead
diminution of the pain. Mechanically, elbow extension and forearm pronation places traction on the long head biceps tendon. When anterior scapular protraction is limited by the clavicle, further adduction entraps the unstable biceps tendon and superior glenoid labrum between the glenoid fossa and head thus causing the pain produced by this test
6
December 5-7, 2011 -62 - McGill University - Faculty of Medicine Monday, December 5 Sameena Iqbal 14:35 – 15:35 B-08 Chronic Kidney Disease Fontaine F
December 5-7, 2011 -63 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Sameena Iqbal 14:35 – 15:35 B-08 Chronic Kidney Disease Fontaine F
December 5-7, 2011 -64 - McGill University - Faculty of Medicine Monday, December 5 Marie-Claude Lemieux 14:35 – 15:35 B-09 Female Incontinence Fontaine G
December 5-7, 2011 -65 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Marie-Claude Lemieux 14:35 – 15:35 B-09 Female Incontinence Fontaine G
December 5-7, 2011 -66 - McGill University - Faculty of Medicine Monday, December 5 Marie-Claude Lemieux 14:35 – 15:35 B-09 Female Incontinence Fontaine G
December 5-7, 2011 -67 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Luc Trudeau 14:35 – 15:35 B-10 Hypertension: CHEP 2011 Update Fontaine H
December 5-7, 2011 -69 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Luc Trudeau 14:35 – 15:35 B-10 Hypertension: CHEP 2011 Update Fontaine H
December 5-7, 2011 -70 - McGill University - Faculty of Medicine Monday, December 5 Luc Trudeau 14:35 – 15:35 B-10 Hypertension: CHEP 2011 Update Fontaine H
December 5-7, 2011 -71 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 ( ( ( ( ( Wend(y Chiu ( ( ( ( ( ( ( ( 16:00 – 17:00 C-02 ( ( GE(R: Leg( Edema Mana(gement in the Older Patient: A Geriatrician's POV Mont-Royal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ecember 5-7, 2011 -73 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 J. Scott Delaney 16:00 – 17:00 C-04 Hands On : Knee Exam Hampstead y I)Introduction Today’s workshop is designed to focus on the physical examination of the injured knee, focusing on specific case presentations. We will discuss three cases that might present to your office. The emphasis will be placed on helpful examination tools and tests which can help the clinician address common knee injuries and complaints. The workshop is not intended to address major traumatic injuries, such as acute fractures and dislocations, but will focus more on common knee injuries and complaints which may present to your office. The notes below are to be used as reference for the physical examination skills we will discuss during the cases. II) Biomechanics Range of Motion - as the knee is basically a modified hinge joint, most of its motion occurs in flexion - capable of : Flexion to 135° Extension to 5° Internal rotation of 20° External rotation of 30° Loose packed position of the knee = the position where the joint is under the least amount of stress - capsule: largest potential space - supporting ligaments: lax - articular spaces: greatest distance apart from each other - swollen joint: position of comfort - knee = 25-30° of flexion Closed packed position of the knee = the position where the joint is under the most stress - 2 joint surfaces are the closest together - capsule: smallest potential space - supporting ligaments: taut - articular spaces: closest together - swollen joint: uncomfortable - knee = full extension with lateral rotation III) Physical Exam Hi-lights A) Tests for Intra-articular Swelling December 5-7, 2011 -75 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 J. Scott Delaney 16:00 – 17:00 C-04 Hands On: Knee Exam Hampstead 1) Temperature difference - a normal un-inflamed knee should feel cooler than the rest of the thigh - this can be demonstrated in a patient without an effusion: - feel the anterior thigh or quadriceps with your hand - now feel the temperature of an un-swollen knee - the un-swollen knee is normally noticeably cooler than the anterior thigh - a swollen knee should feel warmer than usual and it is usually warmer than the anterior thigh - if the temperature of the knee is as warm or warmer than the anterior thigh, the knee is likely inflamed or swollen - if the patient has only one swollen knee at the time, you may also feel how much warmer the swollen knee is as compared to the unaffected knee - this test is especially helpful for a knee that is mildly swollen and in which it is difficult to appreciate any swelling visually or by palpation 2) Bulge sign - because the large suprapatellar pouch that exists behind the quadriceps muscle communicates with the intrarticular synovium, intra-articular fluid can be shifted or milked into this space and later pushed out to create a fluid wave or bulge - to perform this test, the patient should be in a supine position. The examiner should milk the medial aspect of the knee superiorly so that any fluid is pushed into the suprapatellar pouch. The examiner then milks the fluid downward from the lateral aspect of the knee - a fluid wave or bulge should appear medial to the patella in a swollen knee - the examiner may also place his or her hand along the medial aspect of the knee and feel the fluid wave 3) Ballottement of the patella - this test is best used for moderate effusions and utilizes the fact that fluid in the knee joint can displace the patella away from its normal snug position against the femoral condyles - the examiner firmly grabs the distal femur and pushes the fluid out of the suprapatellar pouch into the space between the patella and the femoral condyles. The other hand cups the infrapatellar aspect of the knee and pushes the patella down against the femur - in a moderately swollen joint, the patella will be felt to ballotte or tap against the femur - it should be noted that this does not work in a minimally swollen joint because the patella stays nestled against the femur. It also does not work in a tensely swollen knee because there is too much fluid to allow the patella to ballotte down against the femur B) Stability Testing of the Knee I- Tests for Medial Stability December 5-7, 2011 -76 - McGill University - Faculty of Medicine Monday, December 5 J. Scott Delaney 16:00 – 17:00 C-04 Hands On: Knee Exam Hampstead 1) Valgus stress test - the valgus stress test is done to test the integrity of the MCL and the rest of the medial stabilizing structures of the knee - the test should be performed with the patient in a supine position. The examiner places the distal leg in his or her axilla. One hand is placed with the fingers (thumb) along the medial joint line. The fingers will be used to feel for any opening or gapping of the joint during stress testing. The other hand is placed along the lateral joint line and is used as a fulcrum to provide the valgus stress and to feel for any bony apposition on the lateral side A) 30° flexion - the examination should be done in 30° of flexion first. The flexion eliminates the posterior capsule from the stabilizing mechanism and makes the test much more selective for the MCL - during the test, the valgus force comes from the examiner’s body using the lateral hand as a fulcrum - the examiner should look and feel for any gapping or opening of the medial joint compartment - the examiner should also feel for an endpoint during the test - the examiner should remember that little force is required to open an unstable joint, and that any excessive force may cause extreme pain and may further damage an already injured ligament - injuries to the MCL will usually cause pain on stress testing, and there should be a difference between both sides - the exam should be repeated on the other side so as to determine the normal amount of laxity in the medial stabilizing structures of the knee B) 0° flexion - the valgus stress test should be repeated in 0° flexion - in 0° flexion, the posterior capsule is taut and acts as a medial stabilizing structure of the knee - i) if the knee opens in 30° flexion but not in 0° flexion, it indicates that the MCL has been damaged but the posterior capsule remains intact - ii) if the knee opens in 30° flexion and in 0° flexion, it indicates MCL and the posterior capsule have been damaged. This is indicative of a more severe injury II-Tests for Lateral Stability 1) Varus stress test - the varus stress test is done to test the integrity of the LCL and the rest of the lateral stabilizing structures of the knee. Often this test is done in conjunction with the valgus stress test due to the similarities of the hand positions - see above valgus stress test for details III-Tests for Anterior Stability 1) Lachman test - the lachman test is felt to be the most sensitive and reliable test for ACL injuries December 5-7, 2011 -77 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 J. Scott Delaney 16:00 – 17:00 C-04 Hands On: Knee Exam Hampstead - the test is performed with the patient in a supine position - the examiner places one hand around the distal femur - this hand stabilizes the femur and also ensures there is no contraction of the hamstrings, which, if contracted, will prevent anterior displacement of the tibia - the other hand is placed around the proximal tibia - the knee is flexed to 20-30° of flexion - the examiner tries to pull the tibia forward on the femur - a positive test occurs when there is significant movement of the tibia on the femur and a soft end point is felt - the amount of displacement can be felt or visualized - visualization of the anterior displacement of the tibia may be more easily seen by someone standing to the side Acutely swollen joint - the Lachman test is usually not uncomfortable for a patient with an acutely swollen knee as the test is performed in the loose packed position of the joint which is 20-30° of flexion 2) Anterior drawer tests - the patient is supine - the hip is flexed to 45° and the knee is flexed to 90° - the examiner may sit on the patient’s foot to stabilize the distal leg. Be sure to tell the patient you are going to sit on their foot. If the patient is unaware that you are going to sit on their foot, they may become surprised and they may try to move the foot out from underneath you - the two hands are placed around the proximal tibia with both thumbs along the anterior joint line - the thumbs can be used to assess for anterior displacement of the tibia on the femur - the examiner pulls the tibia forward or towards him or herself - the examiner looks and feels with the thumbs for anterior displacement of the tibia on the femur - the examiner should ensure the forward displacement of the tibia is from a torn ACL in that the tibia is moving from a normal resting position to an abnormal anterior position - Note: in a patient with a PCL injury, a drawer test will produce anterior tibial movement, but the tibia is starting from an abnormally posterior position and is being reduced to a normal position Acutely swollen joint - the drawer test may be difficult to perform for a patient with an acutely swollen knee as the patient must be able to flex the knee to 90°, which is often uncomfortable in a swollen joint 3) Pivot shift test - this test assesses both anterior stability and anterolateral rotary stability - a positive test is indicative of an ACL and posterolateral capsule injury - the patient lies in the supine position. The examiner grabs the distal leg or ankle and internally rotates the leg. The other hand is placed along the December 5-7, 2011 -78 - McGill University - Faculty of Medicine Monday, December 5 J. Scott Delaney 16:00 – 17:00 C-04 Hands On: Knee Exam Hampstead lateral aspect of the tibial plateau and applies a valgus and internal rotary force to the knee - in this position, the anterolateral tibia is subluxed forward on the femur - the knee is flexed slowly in this position. As the knee is flexed beyond 30- 40°, the tibia is reduced posteriorly into its normal position with a clunking sensation - this occurs because as the knee is flexed beyond 30°, the ITB moves from its anterior position relative to the femoral epicondyle, to a posterior position behind the epicondyle. Because of this change in position, the ITB changes from an extensor to a flexor, and thus pulls the tibia posteriorly back into its normal position IV-Tests for Posterior Stability 1) Bumper sign - this test is performed with the patient in a supine position - the patient flexes the hip to 45° and the knee to 90° - the examiner slides his or her fingers down the anterolateral femur and tibia - normally, the tibial plateau juts out ANTERIORLY about half a centimeter or so from the femoral condyle - in a PCL injury, this anterior displacement is not present, and as the examiner slides his or her fingers along the anterolateral femur and tibia, the tibia is neutral or slightly posterior to the femoral condyle - this is the so called “bumper sign” - the test may also be performed medially along the medial femoral condyle and medial tibial plateau - 2) Posterior drawer test - this test is done in the same position as the anterior drawer ( see above) - the examiner pushes the tibia posteriorly or away from him or herself - the examiner looks and feels for posterior displacement of the tibia on the femur - in reality, the anterior and posterior drawer test are done simultaneously during the examination C) Meniscus tests - the menisci are 2 cup-shaped pieces of cartilage that rest between the articular surfaces of the tibia and femur - as such, they are prone to injury during twisting or rotation movements of the femur on the tibia Medial meniscus - the medial “C” shaped meniscus is more commonly injured because of its more rigid attachment to the tibia (it is less mobile between the tibia and the femur than the lateral meniscus) Lateral meniscus December 5-7, 2011 -79 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 J. Scott Delaney 16:00 – 17:00 C-04 Hands On: Knee Exam Hampstead - the lateral “circular” shaped meniscus is less commonly injured because of its less rigid attachment to the tibia and its greater mobility between the tibia and the I-Tests for Meniscus Injuries - although the menisci are separate, they are usually tested together - Note: palpation of the joint line should be performed before the special tests as joint line tenderness is very sensitive for a meniscal tear 1) Modified McMurray test - the test is designed to help with posterior tears of the meniscus that may be difficult to palpate along the joint line - the patient lies supine. The examiner grabs the distal ankle with one hand and flexes the knee fully - Note: the patient should be able to fully flex the knee, otherwise the test cannot accurately be performed. As such, the test may be impossible to perform in an acutely swollen knee - the other hand is placed along the joint to palpate for any clicks or pops - the thumb should be along the lateral joint line while the index finger is along the medial joint line - the examiner should internally and externally rotate the tibia so as to loosen the knee joint - medial meniscus - to test the medial meniscus, the examiner fully flexes the knee applies a valgus stress with the hand along the joint lines, and externally rotates the leg with the other hand as the knee is extended - a positive test occurs if there is a painful click or pop - some examiners believe the test is positive if there is a click or a pop even if they are not painful - lateral meniscus - to test the lateral meniscus, the examiner fully flexes the knee applies a valgus stress with the hand along the joint lines, and internally rotates the leg with the other hand as the knee is extended - a positive test occurs if there is a painful click or pop E) Patellar Problems Patellar Stability - the patella can sublux or dislocate in certain patients, usually laterally - patients with a history of a patellar dislocation will usually give a history of an acutely painful event where the patella was displaced laterally while the knee was stuck in a flexed position - patients with chronic subluxation will usually present complaining of pain, popping, swelling, and a feeling of instability or of the knee giving out, especially while pivoting or cutting I-Tests for Patellar Instability - these tests should not be performed soon after a dislocation as they may be extremely painful and may cause another dislocation December 5-7, 2011 -80 - McGill University - Faculty of Medicine Monday, December 5 J. Scott Delaney 16:00 – 17:00 C-04 Hands On: Knee Exam Hampstead 1) Patellar mobility tests - the amount of laxity in the patella can be assessed by medially and laterally displacing the patella - patients with above average lateral displacement of the patella are at risk for patellar subluxation and dislocations 2) Patellar apprehension test - this test is to assess for patients who have truly dislocated their patella’s and not for mild subluxation - the patient lies supine with the quadriceps relaxed - the examiner applies lateral pressure along the medial patella while looking at the patient for any expressions of apprehension - if the patient has dislocated in the past, he or she will look apprehensive and will usually contract the quadriceps muscle to bring the patella back into a more natural alignment - the test can be repeated at different degrees of flexion (0°, 30°, 60°) Patellofemoral Syndrome - patellofemoral syndrome refers to a variety of disorders which produce anterior knee pain - although often referred to as chondromalacia, chondromalacia is usually a surgical or MRI diagnosis that should be reserved for documented patellar articular cartilage damage - pain from PFS may emanate from the subchondral bone, patellar retinaculem, or the synovium of the knee - athletes will usually complain of anterior knee pain that is worse with the knees being flexed for a prolonged period of time- this is also called the “movie goers sign” because patients are unable to sit with their knees flexed throughout an entire movie because of the discomfort, and they must keep extending their knees - pain is often worse when descending the stairs - may also complain of grinding or popping in the knee because of the swelling II-Tests for Patellofemoral Syndrome - besides palpating the inferior poles of the patella, 2 tests are commonly described 1) Clarke’s test - although this test is described, it is not often used by clinicians because of it’s low specificity in that it is positive in patients with and without PFS - to perform the test, the patient lies supine with the leg extended. The examiner presses down on the superior pole of the patella - the patient is asked to contract the quadriceps muscle while the examiner pushes down on the patella - the test is positive if the patient experiences retropatellar pain and is unable to sustain a forceful contraction December 5-7, 2011 -81 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 J. Scott Delaney 16:00 – 17:00 C-04 Hands On: Knee Exam Hampstead - the test can be repeated in different degrees of flexion so as to test different parts of the patella (30°, 60°, 90°) 2) Patellar grind test - this test is not often performed because of similar reasons to the Clarke’s test - the patient lies supine with the leg extended. The examiner presses down on the patella and grinds the patella against the femur - pain and/or grinding is considered to be a positive test F) Iliotibial Band Dysfunction - as the knee is flexed beyond 30°, the ITB moves from an anterior position in relation to the lateral femoral epicondyle to a posterior position. This movement along femoral epicondyle can result in friction along the lateral femoral epicondyle - this condition is common in runners who have tight ITB and can result in tenderness along the femoral epicondyle and is called iliotibial band syndrome I-Tests for Iliotibial Band Syndrome 1) Noble’s compression test - the patient lies in supine position. The examiner takes the distal leg and flexes the knee to 90° - the other hand applies pressure at the lateral femoral epicondyle or 1 cm or so proximal. The examiner maintains pressure and passively extends the knee - in a patient with ITB band syndrome, at 30°,when the ITB is passing back over the lateral femoral epicondyle to move from a posterior to anterior position, the patient will complain of pain over the lateral femoral epicondyle area December 5-7, 2011 -82 - McGill University - Faculty of Medicine Monday, December 5 Sameena Iqbal 16:00 – 17:00 C-08 Chronic Kidney Disease (repeat of B-08) Fontaine F PLEASE REFER TO WORKSHOP B-08 December 5-7, 2011 -83 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Marie-Claude Lemieux 16:00 – 17:00 C-09 Female Incontinence (repeat of B-09) Fontaine G PLEASE REFER TO WORKSHOP B-09 December 5-7, 2011 -85 - 62 nd Annual Refresher Course for Family Physicians Monday, December 5 Luc Trudeau 16:00 – 17:00 C-10 Hypertension: CHEP 2011 Update (repeat of B-10) Fontaine H PLEASE REFER TO WORKSHOP B-10 December 5-7, 2011 -87 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Simon Tanguay 07:00 – 07:45 EDUCATIONAL FORUM 2 Prostate Health Education Live Program Le Portage December 5-7, 2011 -89 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Simon Tanguay 07:00 – 07:45 EDUCATIONAL FORUM 2 Prostate Health Education Live Program Le Portage December 5-7, 2011 -90 - McGill University - Faculty of Medicine Tuesday, December 6 Simon Tanguay 07:00 – 07:45 EDUCATIONAL FORUM 2 Prostate Health Education Live Program Le Portage December 5-7, 2011 -91 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Simon Tanguay 07:00 – 07:45 EDUCATIONAL FORUM 2 Prostate Health Education Live Program Le Portage December 5-7, 2011 -92 - McGill University - Faculty of Medicine Tuesday, December 6 John Yaremko 08:00 – 08:30 PLENARY 3.1 Vaccinations: Latest Developments Westmount December 5-7, 2011 -93 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 John Yaremko 08:00 – 08:30 PLENARY 3.1 Vaccinations: Latest Developments Westmount December 5-7, 2011 -94 - McGill University - Faculty of Medicine Tuesday, December 6 John Yaremko 08:00 – 08:30 PLENARY 3.1 Vaccinations: Latest Developments Westmount December 5-7, 2011 -95 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 John Yaremko 08:00 – 08:30 PLENARY 3.1 Vaccinations: Latest Developments Westmount December 5-7, 2011 -96 - McGill University - Faculty of Medicine Tuesday, December 6 Kevin Pottie 08:30 – 09:00 PLENARY 3.2 New Canadian Guidelines for Immigrant and Refugee Health Westmount December 5-7, 2011 -97 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Kevin Pottie 08:30 – 09:00 PLENARY 3.2 New Canadian Guidelines for Immigrant and Refugee Health Westmount December 5-7, 2011 -98 - McGill University - Faculty of Medicine Tuesday, December 6 Kevin Pottie 08:30 – 09:00 PLENARY 3.2 New Canadian Guidelines for Immigrant and Refugee Health Westmount December 5-7, 2011 -99 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Liam Durcan 09:05 – 09:35 PLENARY 3.3 Restless Legs - Nocturnal Movement Diagnosis and Treatment Westmount December 5-7, 2011 -101 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Liam Durcan 09:05 – 09:35 PLENARY 3.3 Restless Legs - Nocturnal Movement Diagnosis and Treatment Westmount December 5-7, 2011 -102 - McGill University - Faculty of Medicine Tuesday, December 6 Liam Durcan 09:05 – 09:35 PLENARY 3.3 Restless Legs - Nocturnal Movement Diagnosis and Treatment Westmount December 5-7, 2011 -103 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 & & & Wi&llis Grad& & 09:35 – 10:35 D-01 ER: Killer Headaches Fontaine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ecember 5-7, 2011 -105 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Robert Bailey 09:35 – 10:35 D-02 GER: Delirium in the Elderly St-Pierre December 5-7, 2011 -107 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Robert Bailey 09:35 – 10:35 D-02 GER: Delirium in the Elderly St-Pierre December 5-7, 2011 -108 - McGill University - Faculty of Medicine Tuesday, December 6 Michael Stein 09:35 – 10:35 D-04 Hands On: Practical Corticosteroid Injections of Joints and Soft Tissues for Family Physicians Hampstead December 5-7, 2011 -109 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Michael Stein 09:35 – 10:35 D-04 Hands On: Practical Corticosteroid Injections of Joints and Soft Tissues for Family Physicians Hampstead December 5-7, 2011 -110 - McGill University - Faculty of Medicine Tuesday, December 6 John Hughes & Ray Simkus 09:35 – 10:35 D-06 Family Medicine Informatics and eMR Fontaine G December 5-7, 2011 -111 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 John Hughes & Ray Simkus 09:35 – 10:35 D-06 Family Medicine Informatics and eMR Fontaine G December 5-7, 2011 -112 - McGill University - Faculty of Medicine Tuesday, December 6 John Hughes & Ray Simkus 09:35 – 10:35 D-06 Family Medicine Informatics and eMR Fontaine G December 5-7, 2011 -113 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 John Hughes & Ray Simkus 09:35 – 10:35 D-06 Family Medicine Informatics and eMR Fontaine G December 5-7, 2011 -114 - McGill University - Faculty of Medicine Tuesday, December 6 Bruce Campbell 09:35 – 10:35 D-07 Approach to Dyspnea Fundy December 5-7, 2011 -115 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Bruce Campbell 09:35 – 10:35 D-07 Approach to Dyspnea Fundy December 5-7, 2011 -116 - McGill University - Faculty of Medicine Tuesday, December 6 Bruce Campbell 09:35 – 10:35 D-07 Approach to Dyspnea Fundy December 5-7, 2011 -117 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 John Sader 09:35 - 10:35 D-08 The Spiritual-immaterial Value of the Values St-Michel of the Self in the Rehabilitation Process December 5-7, 2011 -119 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 John Sader 09:35 - 10:35 D-08 The Spiritual-immaterial Value of the Values St-Michel of the Self in the Rehabilitation Process December 5-7, 2011 -120 - McGill University - Faculty of Medicine Tuesday, December 6 John Sader 09:35 - 10:35 D-08 The Spiritual-immaterial Value of the Values St-Michel of the Self in the Rehabilitation Process December 5-7, 2011 -121 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Laurence Green 09:35 – 10:35 D-09 Diabetes in the Elderly - What’s the Evidence? Fontaine H December 5-7, 2011 -123 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Laurence Green 09:35 – 10:35 D-09 Diabetes in the Elderly - What’s the Evidence? Fontaine H December 5-7, 2011 -124 - McGill University - Faculty of Medicine Tuesday, December 6 Liam Durcan 09:35 – 10:35 D-10 Neurology Exam Côte-St-Luc December 5-7, 2011 -125 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Liam Durcan 09:35 – 10:35 D-10 Neurology Exam Côte-St-Luc December 5-7, 2011 -126 - McGill University - Faculty of Medicine Tuesday, December 6 Liam Durcan 09:35 – 10:35 D-10 Neurology Exam Côte-St-Luc December 5-7, 2011 -127 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Liam Durcan 09:35 – 10:35 D-10 Neurology Exam Côte-St-Luc December 5-7, 2011 -128 - McGill University - Faculty of Medicine Tuesday, December 6 Theodore Wein 11:00 – 12:00 E-01 ER: TIA and CVA Management – Brain Attack Fontaine E December 5-7, 2011 -129 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Theodore Wein 11:00 – 12:00 E-01 ER: TIA and CVA Management – Brain Attack Fontaine E December 5-7, 2011 -130 - McGill University - Faculty of Medicine Tuesday, December 6 Theodore Wein 11:00 – 12:00 E-01 ER: TIA and CVA Management – Brain Attack Fontaine E December 5-7, 2011 -131 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Theodore Wein 11:00 – 12:00 E-01 ER: TIA and CVA Management – Brain Attack Fontaine E December 5-7, 2011 -132 - McGill University - Faculty of Medicine Tuesday, December 6 David Lussier 11:00 – 12:00 E-02 GER: Pain in the Elderly Fontaine F December 5-7, 2011 -133 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 David Lussier 11:00 – 12:00 E-02 GER: Pain in the Elderly Fontaine F December 5-7, 2011 -134 - McGill University - Faculty of Medicine Tuesday, December 6 David Lussier 11:00 – 12:00 E-02 GER: Pain in the Elderly Fontaine F December 5-7, 2011 -135 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Michael Stein 11:00 – 12:00 E-04 Hands On: Practical Corticosteroid Injections of Joints Hampstead and Soft Tissues for Family Physicians (repeat D-04) PLEASE REFER TO WORKSHOP D-04 December 5-7, 2011 -137 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Kevin Pottie & Lavanya Narasiah 11:00 – 12:00 E-05 New Canadian Guidelines for Immigrant and Refugee Health Fontaine G December 5-7, 2011 -139 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Kevin Pottie & Lavanya Narasiah 11:00 – 12:00 E-05 New Canadian Guidelines for Immigrant and Refugee Health Fontaine G December 5-7, 2011 -140 - McGill University - Faculty of Medicine Tuesday, December 6 Peter Chan 11:00 – 12:00 E-06 Andropause Fontaine H December 5-7, 2011 -141 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Peter Chan 11:00 – 12:00 E-06 Andropause Fontaine H December 5-7, 2011 -142 - McGill University - Faculty of Medicine Tuesday, December 6 Robert Bailey 11:00 – 12:00 E-07 Delirium in the Elderly St-Pierre December 5-7, 2011 -143 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Robert Bailey 11:00 – 12:00 E-07 Delirium in the Elderly St-Pierre December 5-7, 2011 -144 - McGill University - Faculty of Medicine Tuesday, December 6 John Sader 11:00 – 12:00 E-08 Gambling - An Overview St-Michel December 5-7, 2011 -145 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 John Sader 11:00 – 12:00 E-08 Gambling - An Overview St-Michel December 5-7, 2011 -146 - McGill University - Faculty of Medicine Tuesday, December 6 John Sader 11:00 – 12:00 E-08 Gambling - An Overview St-Michel December 5-7, 2011 -147 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 John Sader 11:00 – 12:00 E-08 Gambling - An Overview St-Michel December 5-7, 2011 -148 - McGill University - Faculty of Medicine Tuesday, December 6 Ivan Rohan 11:00 – 12:00 E-09 Exercise - Benefits beyond Cardiovascular Fundy December 5-7, 2011 -149 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Ivan Rohan 11:00 – 12:00 E-09 Exercise - Benefits beyond Cardiovascular Fundy December 5-7, 2011 -150 - McGill University - Faculty of Medicine Tuesday, December 6 Ivan Rohan 11:00 – 12:00 E-09 Exercise - Benefits beyond Cardiovascular Fundy December 5-7, 2011 -151 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Liam Durcan 11:00 – 12:00 E-10 Neurology Exam (repeat D-10) Côte-St-Luc PLEASE REFER TO WORKSHOP D-10 December 5-7, 2011 -153 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Thao Huyhn 12:00 – 12:45 EDUCATIONAL FORUM 3 An Update in ACS and Anti-platelet Therapy Le Portage December 5-7, 2011 -155 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Thao Huyhn 12:00 – 12:45 EDUCATIONAL FORUM 3 An Update in ACS and Anti-platelet Therapy Le Portage December 5-7, 2011 -156 - McGill University - Faculty of Medicine Tuesday, December 6 David McGillivray 13:30 – 14:00 PLENARY 4.1 Top 5 Pediatric Articles of 2011! Will They Change Your Practice in 2012? Westmount December 5-7, 2011 -157 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 David McGillivray 13:30 – 14:00 PLENARY 4.1 Top 5 Pediatric Articles of 2011! Will They Change Your Practice in 2012? Westmount December 5-7, 2011 -158 - McGill University - Faculty of Medicine Tuesday, December 6 David McGillivray 13:30 – 14:00 PLENARY 4.1 Top 5 Pediatric Articles of 2011! Will They Change Your Practice in 2012? Westmount December 5-7, 2011 -159 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 David McGillivray 13:30 – 14:00 PLENARY 4.1 Top 5 Pediatric Articles of 2011! Will They Change Your Practice in 2012? Westmount December 5-7, 2011 -160 - McGill University - Faculty of Medicine Tuesday, December 6 David McGillivray 13:30 – 14:00 PLENARY 4.1 Top 5 Pediatric Articles of 2011! Will They Change Your Practice in 2012? Westmount December 5-7, 2011 -161 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 David McGillivray 13:30 – 14:00 PLENARY 4.1 Top 5 Pediatric Articles of 2011! Will They Change Your Practice in 2012? Westmount December 5-7, 2011 -162 - McGill University - Faculty of Medicine Tuesday, December 6 David McGillivray 13:30 – 14:00 PLENARY 4.1 Top 5 Pediatric Articles of 2011! Will They Change Your Practice in 2012? Westmount December 5-7, 2011 -163 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Gad Friedman 14:00 – 14:30 PLENARY 4.2 The Management of Celiac Disease Westmount December 5-7, 2011 -165 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Gad Friedman 14:00 – 14:30 PLENARY 4.2 The Management of Celiac Disease Westmount December 5-7, 2011 -166 - McGill University - Faculty of Medicine Tuesday, December 6 Gad Friedman 14:00 – 14:30 PLENARY 4.2 The Management of Celiac Disease Westmount December 5-7, 2011 -167 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Dominique Tessier 14:30 – 15:00 PLENARY 4.3 Infectious Souvenirs in Travel Medicine Westmount Many tourists want to bring back home a miniature Eiffel Tower, a key chain, multiple photographs evenutally left untouched on a hard drive or other commemorative merchandise associated with a location. They represent an important part of the tourism industry and usually help improve the local economy. Unfortunately, other forms of memento of their visit may be brought home by travellers, including infectious diseaases, some transmissible. In Canada, West nile encephalitis, SRAS and H1N1 are certainly the most recent examples. Variola, introduced in the Americas by european explorers, typhus and influenza have also been well described. The impact on the economy can be very negative. This session will provide a very rapid overview of some key elements in travel medicine history that have touched my mind. December 5-7, 2011 -169 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Ross Berringer 15:00 – 15:30 PLENARY 4.4 Follow-up of Diagnostic Testing Westmount December 5-7, 2011 -171 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Ross Berringer 15:00 – 15:30 PLENARY 4.4 Follow-up of Diagnostic Testing Westmount December 5-7, 2011 -172 - McGill University - Faculty of Medicine Tuesday, December 6 Ross Berringer 15:00 – 15:30 PLENARY 4.4 Follow-up of Diagnostic Testing Westmount December 5-7, 2011 -173 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Hani Iskandar 16:00 – 17:00 F-01 ER: Psychiatric Emergencies Mont-Royal December 5-7, 2011 -175 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Hani Iskandar 16:00 – 17:00 F-01 ER: Psychiatric Emergencies Mont-Royal December 5-7, 2011 -176 - McGill University - Faculty of Medicine Tuesday, December 6 Hani Iskandar 16:00 – 17:00 F-01 ER: Psychiatric Emergencies Mont-Royal December 5-7, 2011 -177 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Hani Iskandar 16:00 – 17:00 F-01 ER: Psychiatric Emergencies Mont-Royal December 5-7, 2011 -178 - McGill University - Faculty of Medicine Tuesday, December 6 Hani Iskandar 16:00 – 17:00 F-01 ER: Psychiatric Emergencies Mont-Royal December 5-7, 2011 -179 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Allen Huang 16:00 – 17:00 F-02 GER: Geriatric Common Problems with Medications and More? Hampstead December 5-7, 2011 -181 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Allen Huang 16:00 – 17:00 F-02 GER: Geriatric Common Problems with Medications and More? Hampstead December 5-7, 2011 -182 - McGill University - Faculty of Medicine Tuesday, December 6 Allen Huang 16:00 – 17:00 F-02 GER: Geriatric Common Problems with Medications and More? Hampstead December 5-7, 2011 -183 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 David McGillivray 16:00 – 17:00 F-03 PEDS - Lessons Learnt from Patients. Pediatric Red Flag Cases! Côte-St-Luc December 5-7, 2011 -185 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 David McGillivray 16:00 – 17:00 F-03 PEDS - Lessons Learnt from Patients. Pediatric Red Flag Cases! Côte-St-Luc December 5-7, 2011 -186 - McGill University - Faculty of Medicine Tuesday, December 6 David McGillivray 16:00 – 17:00 F-03 PEDS - Lessons Learnt from Patients. Pediatric Red Flag Cases! Côte-St-Luc December 5-7, 2011 -187 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 David McGillivray 16:00 – 17:00 F-03 PEDS - Lessons Learnt from Patients. Pediatric Red Flag Cases! Côte-St-Luc December 5-7, 2011 -188 - McGill University - Faculty of Medicine Tuesday, December 6 David McGillivray 16:00 – 17:00 F-03 PEDS - Lessons Learnt from Patients. Pediatric Red Flag Cases! Côte-St-Luc December 5-7, 2011 -189 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Ilka Lowensteyn 16:00 – 17:00 F-04 Exercise Promotion in a Five Minute Office Visit St-Pierre December 5-7, 2011 -191 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Ilka Lowensteyn 16:00 – 17:00 F-04 Exercise Promotion in a Five Minute Office Visit St-Pierre December 5-7, 2011 -192 - McGill University - Faculty of Medicine Tuesday, December 6 Elizabeth Dannenbaum 16:00 – 17:00 F-06 Vestibular Rehabilitation - Epley Manoeuver and Other Techniques Fontaine F December 5-7, 2011 -193 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Elizabeth Dannenbaum 16:00 – 17:00 F-06 Vestibular Rehabilitation - Epley Manoeuver and Other Techniques Fontaine F December 5-7, 2011 -194 - McGill University - Faculty of Medicine Tuesday, December 6 Elizabeth Dannenbaum 16:00 – 17:00 F-06 Vestibular Rehabilitation - Epley Manoeuver and Other Techniques Fontaine F December 5-7, 2011 -195 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Marcelo Berlim 16:00 – 17:00 F-07 Managing Treatment - Resistant Depression: Fontaine G Psychopharmacological and Neuromodulation Approaches December 5-7, 2011 -197 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Marcelo Berlim 16:00 – 17:00 F-07 Managing Treatment - Resistant Depression: Fontaine G Psychopharmacological and Neuromodulation Approaches December 5-7, 2011 -198 - McGill University - Faculty of Medicine Tuesday, December 6 Gad Friedman 16:00 – 17:00 F-08 Gastroenterology - Case Studies of Common Office GI Disorders Fontaine H December 5-7, 2011 -199 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Gad Friedman 16:00 – 17:00 F-08 Gastroenterology - Case Studies of Common Office GI Disorders Fontaine H December 5-7, 2011 -200 - McGill University - Faculty of Medicine Tuesday, December 6 Gad Friedman 16:00 – 17:00 F-08 Gastroenterology - Case Studies of Common Office GI Disorders Fontaine H December 5-7, 2011 -201 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Mimi Israel 16:00-17:00 F-09 Eating Disorders: Risk Evaluation, Medical Complications St-Michel and Evidence-based Treatments December 5-7, 2011 -203 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Mimi Israel 16:00-17:00 F-09 Eating Disorders: Risk Evaluation, Medical Complications St-Michel and Evidence-based Treatments December 5-7, 2011 -204 - McGill University - Faculty of Medicine Tuesday, December 6 Ross Berringer 16:00 – 17:00 F-10 Responding to Complaints: General Principles Fundy December 5-7, 2011 -205 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Ross Berringer 16:00 – 17:00 F-10 Responding to Complaints: General Principles Fundy December 5-7, 2011 -206 - McGill University - Faculty of Medicine Tuesday, December 6 Ross Berringer 16:00 – 17:00 F-10 Responding to Complaints: General Principles Fundy December 5-7, 2011 -207 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Ross Berringer 16:00 – 17:00 F-10 Responding to Complaints: General Principles Fundy December 5-7, 2011 -208 - McGill University - Faculty of Medicine Tuesday, December 6 Ross Berringer 16:00 – 17:00 F-10 Responding to Complaints: General Principles Fundy December 5-7, 2011 -209 - 62 nd Annual Refresher Course for Family Physicians Tuesday, December 6 Ross Berringer 16:00 – 17:00 F-10 Responding to Complaints: General Principles Fundy December 5-7, 2011 -210 - McGill University - Faculty of Medicine Tuesday, December 6 Ross Berringer 16:00 – 17:00 F-10 Responding to Complaints: General Principles Fundy December 5-7, 2011 -211 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Jean-François Yale & Mark Lipman 07:00 – 07:45 EDUCATIONAL FORUM 4 Understanding and Managing Type 2 Diabetes Le Portage in the Presence of Declining Renal Function (overflow in Fontaine D) December 5-7, 2011 -213 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Jean-François Yale & Mark Lipman 07:00 – 07:45 EDUCATIONAL FORUM 4 Understanding and Managing Type 2 Diabetes Le Portage in the Presence of Declining Renal Function (overflow in Fontaine D) December 5-7, 2011 -214 - McGill University - Faculty of Medicine Wednesday, December 7 Jean-François Yale & Mark Lipman 07:00 – 07:45 EDUCATIONAL FORUM 4 Understanding and Managing Type 2 Diabetes Le Portage in the Presence of Declining Renal Function (overflow in Fontaine D) December 5-7, 2011 -215 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Mary-Ann Fitzcharles 08:00 – 08:30 PLENARY 5.1 Those Miserable Soft Tissue Pains: A Practical Update Westmount December 5-7, 2011 -217 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Mary-Ann Fitzcharles 08:00 – 08:30 PLENARY 5.1 Those Miserable Soft Tissue Pains: A Practical Update Westmount December 5-7, 2011 -218 - McGill University - Faculty of Medicine Wednesday, December 7 Mary-Ann Fitzcharles 08:00 – 08:30 PLENARY 5.1 Those Miserable Soft Tissue Pains: A Practical Update Westmount December 5-7, 2011 -219 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Tina Kader 08:30 – 09:00 PLENARY 5.2 When Oral Agents Fail, What Are the Options? Westmount Currently there are many options to treat type two diabetes. We are revising our guidelines for diabetes and they will be out in 2013; In the meantime we have new oral agents and new injectables to treat type two diabetes. This is confusing for many family Md. as there are many choices available. The best approach is to have a designer approach to treat diabetes. It is no longer a one size fit all disease and each option should be discussed and reviewed with the patients. Currently if two oral agents fail then the options would be to add a third oral agent or to add insulin. If the sugars are minimally elevated a third oral agent would work however if the sugars are very elevated then insulin or glp-1 analog should be considered. We usually start by basal insulin as there is less weight gain and less hypoglycemia using this approach then going to four injections a day. Whether to start with GLP-1 analog or insulin therapy is still an ongoing debate. Both options ; pros and cons can be discussed with the patient. We are in exciting times in diabetes management. Every patient is different and should be offered the therapy that best suites their needs. cpg guidelines 2008 December 5-7, 2011 -221 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Tina Kader 08:30 – 09:00 PLENARY 5.2 When Oral Agents Fail, What Are the Options? Westmount December 5-7, 2011 -222 - McGill University - Faculty of Medicine Wednesday, December 7 Tina Kader 08:30 – 09:00 PLENARY 5.2 When Oral Agents Fail, What Are the Options? Westmount December 5-7, 2011 -223 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Tina Kader 08:30 – 09:00 PLENARY 5.2 When Oral Agents Fail, What Are the Options? Westmount December 5-7, 2011 -224 - McGill University - Faculty of Medicine Wednesday, December 7 Tina Kader 08:30 – 09:00 PLENARY 5.2 When Oral Agents Fail, What Are the Options? Westmount December 5-7, 2011 -225 - 62 nd Annual Refresher Course for Family Physicians P W D L e e c E e d N m n A b e R e s r Y d 5 a 5 - 7 y . , , 3 2 D 0 1 e 1 c e m Agent A1c BW Hypos Comments $/d b e r Metformin (Glucophage) ! ! ! No Diarrhea, less mortality 0.48 7 Sitagliptine (Januvia) 2.55 Long-term safety not Saxagliptine (Onglyza) ! ! Stable No 2.30 established N Linagliptine (Trajenta) 2.25 J e e a w n T Liraglutide (Victoza) Injection, Long-term safety not - F h ! ! ! ! ! No 4.85 r e a Exenatide (Byetta) established r n a p ç i o e i s s Edema, heart failure, fractures, f - Y o 2 Rosiglitazone (Avandia) 2.85 2 a r 7 infarcts ? l D e - ! ! i " " No a durable b e t Pioglitazone (Actos) Edema, heart failure, fractures 2.29 e s : D P P Glyburide (Diabeta) ! ! +++ 0.28 - 4 I n Gliclazide (Diamicron) ! ! ++ 0.56 h i b i t o Glimepiride (Amaryl) ! ! " " ++ 0.78 r s 6 2 a n d n A d n Repaglinide (GlucoNorm) ! ! +++ 1.62 n M u a o l r R e e Nateglinide (Starlix) ! ++ 1.95 f r e s h e r Acarbose (GlucoBay) ! Stable No Gaz 0.96 C o u r s e Human insulin +++++ 1.77 f 0 o r 9 F ! ! ! " " Injections : a 0 W m 1.95R 5 i Analog insulin ++++ e l y s – 4.54L P t m h 0 y 9 s o i : c u 3 i a n 5 n t s Wednesday, December 7 Jan Schulz 09:35 – 10:05 PLENARY 5.4 PMR, TA, Vasculitis Westmount December 5-7, 2011 -229 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Jan Schulz 09:35 – 10:05 PLENARY 5.4 PMR, TA, Vasculitis Westmount December 5-7, 2011 -230 - McGill University - Faculty of Medicine Wednesday, December 7 Louise Mallet 10:30 – 11:30 G-02 GER: One Minute to Prescribe, One Million Minutes to Discontinue: Fontaine F Ten Questions to Ask December 5-7, 2011 -231 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Louise Mallet 10:30 – 11:30 G-02 GER: One Minute to Prescribe, One Million Minutes to Discontinue: Fontaine F Ten Questions to Ask December 5-7, 2011 -232 - McGill University - Faculty of Medicine Wednesday, December 7 Louise Mallet 10:30 – 11:30 G-02 GER: One Minute to Prescribe, One Million Minutes to Discontinue: Fontaine F Ten Questions to Ask December 5-7, 2011 -233 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Christine McCusker 10:30 – 11:30 G-03 PEDS: Oral Allergy Syndromes St-Pierre December 5-7, 2011 -235 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Christine McCusker 10:30 – 11:30 G-03 PEDS: Oral Allergy Syndromes St-Pierre December 5-7, 2011 -236 - McGill University - Faculty of Medicine Wednesday, December 7 Ian Shrier 10:30 – 11:30 G-04 Hands On: Prescribing Home Exercises - Principles and Pitfalls Fundy Components of Musculoskeletal Rehabilitation An injury occurs when the stress applied to the tissue is greater than the tissue can withstand. Injuries themselves cause swelling, pain and spasm, which lead to deficits in range of motion, strength, endurance, power and proprioception. Together, these deficits lead to an increased probability of re-injury (and decreased performance) because the tissue can no longer absorb the same amount of stress. Therefore, the objective of rehabilitation exercises is to reduce the risk of re-injury by returning the body to its previous level of function. While the tissue is healing, we also try to decrease the stress applied to the tissue (e.g. bracing) to a level that the injured tissues can absorb. Exercises should be specific to the individual because not all individuals with the same injury have the same pattern of functional deficits. The relative importance of range of motion, strength, endurance, power and balance during rehabilitation will depend on the particular context. In general, range of motion used to be considered the most important (and still is by many), but recent studies suggest that strength, endurance and proprioception are likely more important in most cases. All exercises must be started at a level that is easy for the patient, and progressed appropriately. In general, exercises should be pain-free but there are exceptions, especially among patients who misinterpret muscle soreness as pain. Further, exercise programs should be demonstrated to the patient because improperly done exercises might put too much or too little stress on the injured tissue. To know if someone is doing their exercises properly, the exercises should be reviewed at each visit. Because exercises need to be changed as the muscles become stronger and the range of motion changes, each new exercise has to be reviewed after it is given. In general, all of this can be done within 5 min during a patient visit. Injury rehabilitation should be based on these simple basic physiology principles, which necessitate a patient-centered, not injury-centered approach. Finally, one needs to be aware that patients often have limited time, and recommending even 30 min of rehabilitation exercises daily is not usually helpful; most successful rehabilitation programs require only 10-20 min per day. Range of Motion Almost every injury is associated with swelling and a decrease in mobility. Furthermore, the muscle spasm that occurs to protect and stabilize the area will also limit range of motion. If the ROM is limited, then any force that causes further movement past this limit will cause a re-injury. Muscle length or ROM is also important for performance. If a muscle contracts against a tight antagonist muscle, then the contracting muscle must generate more force (consume more energy) to create motion. In addition, when a muscle is required to generate a higher force, it cannot shorten as quickly. Therefore, someone with tight muscles may not be able to run as fast, and may fatigue more easily. Muscle Strength, Endurance and Power Strength is proportional to cross-sectional area, and an injury may decrease cross-sectional area. However, this does not usually occur. For example, there was a speed skater that competed in the Olympics one year after lacerating her buttock muscle down to the iliac crest. Her surgeon had told her that she would never be able to compete again because the laceration extended the depth of the entire muscle. The reason she was able to return to the elite level was because the cross-sectional area of the muscle was never damaged. Although her muscle lost the ability to shorten to the same extent as before, the magnitude was an insignificant amount. December 5-7, 2011 -237 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Ian Shrier 10:30 – 11:30 G-04 Hands On: Prescribing Home Exercises - Principles and Pitfalls Fundy Any force applied to the injured tissue may exacerbate the damage that already exists. Therefore, strengthening needs to occur gradually through a progressive resistance program. Finally, most passive rehabilitation techniques like massage, chiropractic, osteopathy, acupuncture, etc. can increase the range of motion of joints by decreasing muscle spasm and perhaps decreasing adhesions between tissues that limit movement. However, the only way to increase power, strength, and endurance is with exercises. Proprioception Proprioception information is generated from muscle spindles, golgi tendon organs and ligaments. It is therefore impaired after any injury to these tissues. Because our movement is created through central programming from the brain, it is essential that the brain know exactly where the different limb segments are at any one moment. For example, a slight deviation in the angle of supination at foot strike will cause an ankle sprain if the body weight is too lateral to the calcaneus. Again, most passive rehabilitation techniques like massage, chiropractic, osteopathy, acupuncture, etc. will do nothing to restore proprioception; specific exercises are needed. General Training Principles The principles guiding exercise rehabilitation are the same as those guiding exercise in general. Briefly, there are four aspects to training and the mnemonic is FITT for frequency, intensity, type and timing. In addition, Technique should be added to the list. In general, when prescribing rehabilitation exercises, the exercises should be pain-free. There are exceptions to this, but they are used at a more advanced level. To obtain a training effect, the exercises need to be performed at least three times per week, and preferably daily (exercise at high intensity would no longer be daily). In addition, the exercises should be equally spaced throughout the week, as opposed to three days in a row. The intensity (e.g. weights, speed of running) should be started very light, and increased gradually as tolerated. The type of exercise should mimic the specific movements of the activities that are required by the person. Therefore, a person who plays soccer needs to train jogging, sprinting, cutting and movements that mimic kicking a ball. The duration of the exercise generally refers to how long they should exercise. In the context of resistance training, this refers to the number of sets and repetitions (and rest between sets) for each exercise prescribed. Range of Motion Exercises For a variety of reasons, different muscles require different durations of stretch to achieve a training effect. In general, most exercise professionals recommend holding a stretch somewhere between 10-60 seconds and repeating it 2-3 times (repeating more than 3 times adds benefit, but not usually enough to warrant the extra time). Another option is to individualize the treatment. The patient stretches the muscle until a slight tension is felt. The patient then holds the position until they no longer feel the stretch, and then they increase the stretch slightly until they feel slight tension again. If the range of motion is not increasing over the course of 1-2 weeks, the patient may be doing the stretches improperly (too easy or too hard), or the limited range of motion may be due to continued muscle spasm for other reasons. Resistance Exercises: Strengthening, Endurance and Power The key to resistance exercises is fatiguing the muscle. The most common program is 3 sets of 10 repetitions with a 1-min break between sets (i.e. 10 repetitions, 1-min rest, 10 repetitions, 1-min rest, 10 repetitions) for each exercise. This is because it represents a balance between a focus on strength (e.g. 5 sets of 4-6 repetitions with 2-min rest) and a focus on endurance (2 sets of 20-30 repetitions with 30-s break). However, for any individual patient, one may wish to focus on strength or endurance and adjust accordingly. Power exercises (moving against a resistance very rapidly) are prescribed for power athletes but are not often used for the general public because they do not participate in these types of activities. December 5-7, 2011 -238 - McGill University - Faculty of Medicine Wednesday, December 7 Ian Shrier 10:30 – 11:30 G-04 Hands On: Prescribing Home Exercises - Principles and Pitfalls Fundy When performing resistance exercises, the muscle usually first shortens against resistance, which is called positive exercise in the gyms and concentric exercise in physiology. In addition, the muscle also works as it is lengthening while the weight is let down. This is called negative exercise in the gym, or eccentric exercise in physiology. Current theory is that the eccentric component is the most important for rehabilitation of muscle and tendon injuries. This is because almost all muscle strains occur during eccentric activity, and therefore have to be trained in this regard. It is important to emphasize that resistance exercises should generally be pain free (again, there are exceptions). Although some professionals insist on isometric or concentric exercises prior to eccentric exercises, there is no danger with eccentric exercises if they are done at an intensity that does not cause pain, and this is almost always possible. Proprioception Exercises Just as one can stretch to increase range of motion, and work with resistance to increase strength, endurance or power, there are specific exercises to increase proprioception and balance. The simplest exercises are to stand on one leg with the eyes open. When this is easily done for 1-2 min, the subject can try standing on one leg with their eyes closed. More advanced exercises would include having them stand on one leg while they catch a ball thrown to the side of them, or doing hops forward, sideways and backwards. In rehabilitation clinics, unstable surfaces such as foam pads or “wobble boards” are used to further enhance training. Which Exercises to Do? The most important rehabilitation exercises for each patient are those that target the particular functional disability that they have. Therefore, the priority is guided by what the clinician finds during the physical exam. For those with less experience, just test the muscle in all directions without resistance (range of motion) and with resistance (strength). Movements that have restricted range of motion are stretched, and movements that are weak or cause pain with resisted motion are strengthened. For those with more experience and a stronger understanding of biomechanics, exercises are also prioritized on strengthening accessory muscles away from the local site of injury that are involved in combined movements. For example, a weak hip abductor can cause excessive knee valgus and therefore patello-femoral pain. Suggested Readings 1. Holmich P, Uhrskou P, Ulnits L, Kanstrup IL, Nielsen MB, Bjerg AM, et al. Active physical training for long-standing adductor-related groin pain. Lancet 1999;353:439-43. (A comparison of strengthening vs. stretching) 2. Kendall FP, McCreary EK. Muscles Testing and Function. Baltimore: Williams & Wilkins 2002. (Provides information on how to test the strength and range of motion of all muscles) 3. Shrier I. When and who to stretch. Gauging the benefits and drawbacks for individual patients. Phys Sportsmed 2005;33(3):22-6. (Practical information on stretching exercises) December 5-7, 2011 -239 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Tina Kader 10:30 – 11:30 G-06 Prediabetes and Early Type 2 Diabetes Fontaine H W h ere A re We in 2011? Prediabetes is an important condition to identify and follow. The workshop will discuss what is the definition and treatment of prediabetes. Focus will be on lifestyle as the primary prevention tool with medications discussed as an option for patients who progress. Early diabetes is a common entity in the family practice setting. How to manage early patients will be discussed in the workshop. Topics to be discussed will be metformin agent failure and how aggressive to be with lipids and blood pressure management in this population. Focus also will be on women in the reproductive years; New studies such as hapo and Metformin in gestational diabetes have questioned our current diagnostic strategy of GDM and whether oral agents are safe or not in pregnancy. cda guidelines 2008 dpp program Hapo study MIG study December 5-7, 2011 -241 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Tina Kader 10:30 – 11:30 G-06 Prediabetes and Early Type 2 Diabetes Fontaine H Where Are We in 2011? December 5-7, 2011 -242 - McGill University - Faculty of Medicine Wednesday, December 7 Tina Kader 10:30 – 11:30 G-06 Prediabetes and Early Type 2 Diabetes Fontaine H Where Are We in 2011? December 5-7, 2011 -243 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Tina Kader 10:30 – 11:30 G-06 Prediabetes and Early Type 2 Diabetes Fontaine H Where Are We in 2011? December 5-7, 2011 -244 - McGill University - Faculty of Medicine Wednesday, December 7 Tina Kader 10:30 – 11:30 G-06 Prediabetes and Early Type 2 Diabetes Fontaine H Where Are We in 2011? December 5-7, 2011 -245 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Tina Kader 10:30 – 11:30 G-06 Prediabetes and Early Type 2 Diabetes Fontaine H Where Are We in 2011? December 5-7, 2011 -246 - McGill University - Faculty of Medicine Wednesday, December 7 Tina Kader 10:30 – 11:30 G-06 Prediabetes and Early Type 2 Diabetes Fontaine H Where Are We in 2011? December 5-7, 2011 -247 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Cleve Ziegler 10:30 – 11:30 G-08 Update in Cervical Cancer Screening Mont-Royal December 5-7, 2011 -249 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Cleve Ziegler 10:30 – 11:30 G-08 Update in Cervical Cancer Screening Mont-Royal December 5-7, 2011 -250 - McGill University - Faculty of Medicine Wednesday, December 7 Cleve Ziegler 10:30 – 11:30 G-08 Update in Cervical Cancer Screening Mont-Royal December 5-7, 2011 -251 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Jan Schulz 10:30 – 11:30 G-10 Hands On: Laboratory Investigation in Rheumatology Côte-St-Luc December 5-7, 2011 -253 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Jan Schulz 10:30 – 11:30 G-10 Hands On: Laboratory Investigation in Rheumatology Côte-St-Luc December 5-7, 2011 -254 - McGill University - Faculty of Medicine Wednesday, December 7 Mario Talajic 11:30 – 12:15 EDUCATIONAL FORUM 5 Canadian Approaches to Stroke Pr Evention in Atrial Arrhythmia S (CASES) Le Portage December 5-7, 2011 -255 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Mario Talajic 11:30 – 12:15 EDUCATIONAL FORUM 5 Canadian Approaches to Stroke Pr Evention in Atrial Arrhythmia S (CASES) Le Portage December 5-7, 2011 -256 - McGill University - Faculty of Medicine Wednesday, December 7 Mario Talajic 11:30 – 12:15 EDUCATIONAL FORUM 5 Canadian Approaches to Stroke Pr Evention in Atrial Arrhythmia S (CASES) Le Portage December 5-7, 2011 -257 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Mario Talajic 11:30 – 12:15 EDUCATIONAL FORUM 5 Canadian Approaches to Stroke Pr Evention in Atrial Arrhythmia S (CASES) Le Portage December 5-7, 2011 -258 - McGill University - Faculty of Medicine Wednesday, December 7 Jean Zigb y 13:00 – 13:30 PLENARY 6.1 Green M edicine: Th e P oly-Dividen d P rinc iple Westmount So the objectives of this talk are: 1) To sensitize you to the magnitude of the impact of the health care sector on the environment 2) To illustrate how to use the multiple dividend principle to maximize the net positive health impact of your interventions So what is green medicine? Why is it important? Let me tell you a story about a prominent hematologist/oncologist in Sweden, Dr. Karl Henrick Robert who in the early 80’s during his research into carcinogenesis, realized that it was going to be impossible to protect humans from increasingly toxic exposures due to human causes if we continued to deal with potential toxins the way they did then in Sweden, and we still do in Canada: testing individual molecular suspects of toxicity, one chemical at a time, in isolation from others. Instead he researched a proactive way of getting at a sustainable solution by asking a question: “What makes a living system sustainable?” This question he submitted to a vast array of top scientists in Europe from every major basic and biological science and, after over 50 revisions, arrived by consensus at series of behavioral patterns governing all healthy and biologically diverse ecosystems. What was striking was it wasn’t what these ecosystems did that was most important, because the list of those things was too long to count, but what they DIDN’T do, and those things were described through principles of thermodynamics, amongst the most irrefutable laws we have in science. These “system conditions” are still agreed upon today and are the foundation of what is known as the Natural Step System!. So what are these? Sustainable Systems DON’T: 1) Increase in concentrations of novel substances rapidly 2) Erode physically the biological systems that support them 3) Increasingly sequester resources among a minority of individuals Healthy systems cannot have increasing concentrations of novel chemicals over short periods of time. Chemicals are tested for their systemic toxicity and synergy constantly but can only successfully integrate if introduced gradually, and increasing concentrations is a sign the system’s capacity has been overwhelmed. December 5-7, 2011 -259 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Jean Zigby 13:00 – 13:30 PLENARY 6.1 Green Medicine: The Poly-Dividend Principle Westmount A healthy ecosystem does not degrade its own supporting or neighboring environments through physical means. It doesn’t remove large swaths of neighboring wetland or forest, and doesn’t dam up neighboring rivers.) Finally, Darwinian evolution happens quite slowly most often, and in stable (healthy) ecosystems, there is systematic and overwhelming cooperation within and between species, despite our focus on the competition, meaning that most species are not deprived of their nutrients, and rates of extinction are not very high. These conditions were called the System Conditions for Sustainability for any biological system, human or otherwise, and the whole theory was named the Natural Step System. It has been disseminated and used throughout the world successfully to help change the way companies, municipalities and countries plan things to become more healthful. Disrespect of these principles is what is common to all failing ecosystems and communities. ---- What does that mean for us doctors? These System Conditions really are just a boiling down of all our beloved determinants of all health to their simplest elements. And the Natural Step System just states that you have to support these determinants and not undermine them. So what is green medicine? It it medical practice that, while trying to achieve a specific health goal (treating the infection, preventing the MI) supports the most determinants of health while and undermines the fewest. That is a fancy way of stating: it is the most efficient medicine possible. Well isn’t that what we are all doing? I mean, we all know what the determinants of health are: our social connections, our financial support, our education, our socio/political structure, and yes, our environments (PLURAL): the source of food, clean air, water, and exposure to natural spaces and biodiversity. Of course we practice keeping in mind these things! Or do we? Well, due to time constraints I am only going to give you one example, that of the London Health Science Centre in London Ontario. 3 health centers, they performed what’s called an ecological footprint, that is they used some very conservative calculations to describe home much biologically healthy land and water (in overall area) it takes to provide all of the energy and resources and absorb the waste in order to provide the health services in these facilities for one year. The results were: about 400 square kilometers per hospital. Twice the entire arable land area of Canada or over 500,000 square kilometers is needed to continue providing JUST THE HOSPITALS in Canada. Now, thankfully, we in primary care are probably doing better than that but the literature is sparse on us. December 5-7, 2011 -260 - McGill University - Faculty of Medicine Wednesday, December 7 Jean Zigby 13:00 – 13:30 PLENARY 6.1 Green Medicine: The Poly-Dividend Principle Westmount So how can you practice green medicine and lower the massive stress we are putting on our natural systems: By using the multiple dividend principle. This principle states: to achieve the most advantageous outcome for a patient (or any organism) choose the intervention that will address the issue while maximally supporting the greatest variety of determinants of health, and negatively affecting the least. (Interventions have to synergize with health determinants to become sustainable.) In nature, its often not the size of the punch of a solution that’s the most important, but whether it will do the job while helping the organism maintain its food source, its safety, adaptability and community cohesion well enough to procreate. Things have to support each other in multiple fashions or the organism becomes much less resilient. For our patients, this means we have to simultaneously alleviate not just the individual’s sickness with our interventions, but their access to healthy environments, improved spiritual and psychological state, family relationships, mobility, financial stability and community resilience. That’s right… Pearls for practicing Sustainably: 1) Nothing beats exercise. And of all exercised to prescribe, the pinnacle is active transport. All pts should be prescribed increasing active transport (walking, riding, skateboarding, etc.) for any and all needs if possible. Well documented synergistic benefits from exercise, increased work efficiency, increased awareness of the community, decreased costs across the board, decreased social isolation, decreased air pollution, decreased accidents, the list goes on and on… 2) It is appropriate to prescribe activities or diet for the entire family. In some cases the solution has to be for the entire community. Addressing boroughs can be extremely time efficient as it can lead to infrastructure changes. 3) Prescription has hierarchy of sustainability: If relatively equal evidence: Prescribe stopping before starting something else. Start safe, biodegradable home remedies next, then locally made solutions, then standard store-bought pharmaceutical products. 4) Influencing behaviors is the most sustainable option, and we have to make our use of time in the clinic represent that through appropriate history taking and counseling more than prescribing drugs. You have to be motivated and motivational. 5) You need to know about a person’s life to practice sustainably, know the whole person, and home visits often facilitate this. 6) When you see your local drug/medical supply rep, ask how their products and their company processes can better sustain the determinants of health in your area (local employment, environmentally responsible products, improve health education as opposed to drug education.) Without us asking, they will not improve significantly. December 5-7, 2011 -261 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Jean Zigby 13:00 – 13:30 PLENARY 6.1 Green Medicine: The Poly-Dividend Principle Westmount 7) Paramedical, complementary and alternative practitioners may have much to offer, as their therapies often touch different realms of a patient’s life, particularly with respect to bodily therapies (like massage, exercise, osteopathy, physio, acupuncture). These have to be balanced with the impact on a patient’s finances. 8) Many pts’ determinants of health are relatively fixed UNLESS we are willing to advocate for them. Look towards the Direction of Public Health, we have a great team in MTL. Call your local borough, call the city, join a group like CAPE and any of these may help you support your patients and their environment. That is green medicine. Now it was not our fault that we were not taught this in medical school, but it is rapidly becoming our fault that we are not practicing more sustainably, because the resources exist for us to learn how to influence this. Advocacy for determinants of health isn’t specifically paid for yet by the RAMQ in many situations, and we may have to change that if we want to practice the greenest medicine, but you don’t have to wait until that happens to catch the wave and witness the results… Resources: Canadian coalition for Green Health Care (www.greenhealthcare.ca) Health Care Without Harm (www.noharm.org) Canadian Association of Physicians for the Environment (www.cape.ca) December 5-7, 2011 -262 - McGill University - Faculty of Medicine Wednesday, December 7 Alex Ferenczy 13:30 – 14:00 PLENARY 6.2 New Paradigm for Cervical Cancer Screening Westmount Say Goodbye to Screening Cytology December 5-7, 2011 -263 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Alex Ferenczy 13:30 – 14:00 PLENARY 6.2 New Paradigm for Cervical Cancer Screening Westmount Say Goodbye to Screening Cytology December 5-7, 2011 -264 - McGill University - Faculty of Medicine Wednesday, December 7 Alex Ferenczy 13:30 – 14:00 PLENARY 6.2 New Paradigm for Cervical Cancer Screening Westmount Say Goodbye to Screening Cytology December 5-7, 2011 -265 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Daniel Lalla & Maurice Anidjar 14:00 – 14:30 PLENARY 6.3 Panel Discussion: Utility of PSA Screening Westmount December 5-7, 2011 -267 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Isabelle Leblanc 14:45 – 15:15 PLENARY 6.4 The Debate on Euthanasia Westmount Can Bioethics Help Clarify the Issues? December 5-7, 2011 -269 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Isabelle Leblanc 14:45 – 15:15 PLENARY 6.4 The Debate on Euthanasia Westmount Can Bioethics Help Clarify the Issues? December 5-7, 2011 -270 - McGill University - Faculty of Medicine Wednesday, December 7 Mark Ware 15:45 – 16:15 PLENARY 6.6 Medical Marijuana Westmount December 5-7, 2011 -271 - 62 nd Annual Refresher Course for Family Physicians Wednesday, December 7 Mark Ware 15:45 – 16:15 PLENARY 6.6 Medical Marijuana Westmount December 5-7, 2011 -272 - McGill University - Faculty of Medicine Faculty of Medicine 62 ND ANNUAL REFRESHER COURSE FOR FAMILY PHYSICIANS DECEMBER 5-7, 2011 Delegate Directory & Certificates DOCUMENTATION PARTICIPANT LIST Abrahams, Heather Bocking, Jacqueline Chan, Grace Eghtesadi, Marzieh Montréal, QC Montréal, QC Ottawa, ON Montréal, QC Abtahi, Forough Boersma, Rob Chen, Marie-Luce Eliev, Sonia Kirkland, QC Arnprior, ON Mont-Royal, QC Gracefield, QC Aina, Judy Boshouwers, Marie-Louise Chettiar, Ramen (Ramasami) Elliott, Bonney Montréal, QC Havre-aux-Maisons, QC Grand Falls, NB Ottawa, ON Al Ahmadi, Abdullah Bosse, Natasha Condé, Jean Joseph Elman, Elyssa Jeddah, Saudi Arabia Montréal, QC Val d'Or, QC Westmount, QC Alavi, Shazia Bouchard, Jacques Constance, Kristel Engo, Michael Cambridge, ON La Malbaie, QC Brossard, QC LaSalle, QC Alper, Deborah Boulet, Sylvie Coombs, Robin Eniojukan, Rachel Montréal, QC Lachine, QC Westmount, QC Chateauguay, QC Arcelin, Katia Bourassa, Claude Cooper, Stewart Estevez, Wendy Montréal, QC Magog, QC Winston-Salem, NC, United States Montréal, QC Aspler, Aviva Boyer, Marc Cormier, Natalie Falls, Elizabeth Côte-St-Luc, QC Lorraine, QC Amos, QC St. Bruno-de-Montarville, QC Auger, Marc Boyle, Stefan Cosman, Catherine Fazekas, Arpad G. Rivière-Bleue, QC Petawawa, ON Knowlton, QC Montréal, QC Babakifard, Katayoun Brooks, Douglas Cossette, Louis Ferland, Christian Quebec, QC Sault Ste. Marie, ON Longueuil, QC Verdun, QC Barab, Tamila Brooks, Peter Côté, Nathalie Fernandez, Nestor Outremont, QC Stratford, ON Outremont, QC Toronto, ON Barabé, Serge Brophy, Maureen Côté, Rémi Fine, Barry Shawinigan-sud, QC Kars, ON Chambly, QC Saint-Georges, QC Barbeau, Paul-Émile Brosseau, Martine Couturier, Lise Finkelstein, Jonathan Duhamel-Ouest, QC Boucherville, QC Saint-Laurent, QC St-Laurent, QC Barrs, Gary Brouillette, Lyne Czaharyn, Anthony Fitch, Tamara Westmount, QC Baie-Comeau , QC Kirkland, QC Côte-St-Luc, QC Baylis, Penny-Jane Brown, Bernard Dagher, Eric Folkerson, Curtis Montréal, QC Candiac, QC Montréal, QC Ste. Cecile de Masham, QC Beauchesne, Christian Brown, Carolyn Dalton, Douglass Fontaine, Geneviève Granby, QC Montréal, QC Montréal, QC Mont St-Hilaire, QC Beaudry, Nicole Bruemmer, Aurel Dannenbaum, David Fuks, Maria Montréal Ouest, QC Montréal, QC Montréal, QC Montréal, QC Belanger, Gisele Buchanan, Gordon S. De Ladurantaye, Alain Gagnon, Catherine Ottawa, ON St. André Avellin, QC Chute-à-Blondeau, ON Rivière-Bleue, QC Béliveau, Johanne A. Buddo, Susan De Luca, Angelo Garneau, Melanie Saint-Lambert, QC Montréal, QC Montréal, QC New Richmond, QC Belzile, Robert Burr, Carla de Pokomandy, Alexandra Gauthier, Gilles Gatineau, QC Kingston, ON Montréal, QC Gaspé, QC Berjat, Vanessa Caldareri, Carmelo Desbois, Nathalie Gerin, Camille Verdun, QC Outremont, QC Carlisle, ON Montréal, QC Bernstein, Robert Cameron, Clare Desmeules, Jean Gervais, Annie Dollard-des-Ormeaux, QC Cambridge, ON Cowansville, QC St-Jean, QC Birss, John Caron, Marie-Josée Desrosiers, Louise Geukjian, S. K. Greg Cambridge, ON Montréal, QC Hockessin, DE, United States Ormstown, QC Blach, Peter Carroll, Paul J. Diep, Bich Ngoc Ghazigian, Taline Montréal, QC Montréal, QC Montréal, QC Dollard-des-Ormeaux, QC Black, Barbara A. Cartwright, Pierre Dobrowolski, Marek Giannakis, Photios Montréal, QC Étang-Du-Nord, QC Ottawa, ON Laval, QC Block, Wendell Cha, Charlie Dowdall, Mary Glaser, Stuart Toronto, ON Toronto, ON Montréal, QC Montréal, QC Blondeau, Hélène Chabot, Danielle Eaton, David Golgoon, Michael Québec, QC Lorraine, QC Wheatley, ON Pointe-Claire, QC December 5-7, 2011 -273 - 62 nd Annual Refresher Course for Family Physicians DOCUMENTATION PARTICIPANT LIST Gordon, Benjamin Jast, Z.M. Lamontagne, Huguette Martel, Pierre Montréal, QC Montréal, QC Ottawa, ON Longueuil, QC Gordon, W. Earl Jeanmart, Cécile Lamontagne, René Massey, Ephraim Woodlawn, ON Québec, QC Ottawa, ON Montréal, QC Gore, Brian Jobin, Nicolas Laurin, Carroll Mazzarelli, Mark Montréal, QC Baie-Comeau, QC Mont-Royal, QC Beaconsfield, QC Gorin, Ian John, Moini Lazarovic, Jacob McCallum, Robert Saint-Laurent, QC Verdun, QC Sunrise, FL, United States Kitchener, ON Grunbaum, Beatrice Johnston, James Gregory Lazzara, Frank T. McCarty, Tara Côte-St-Luc, QC Simcoe, ON LaSalle, QC St Lazare, QC Guillemette, Chantal Jones, Suzanne LeBel, Tania McComiskey, Alan Havre-Saint-Pierre, QC Brossard, QC Ottawa, ON Stephenville, NL Guttman, Dahlia Kalin, Michael Leduc, Geneviève Mehta, Jagdish Côte-St-Luc, QC Côte-St-Luc, QC Montréal, QC Dollard-des-Ormeaux, QC Guy, Roger Karayan, Lina Léger, Francine Meisels, Monica Westmount, QC Montréal, QC Mont-Saint-Grégoire, QC Québec, QC Haddad, Ben Kassab, François Legresley, Conrad Menard, Jacques Ville St-Laurent, QC Saint-Jean sur Richelieu, QC Shediac, NB Gatineau, QC Harczy, Martha Kealy, Walter Lem, Harry Ménard, Danielle Ottawa, ON Levack, ON West Vancouver, BC Amos, QC Harvey, Claudette Kerner, Sarah Lessard, Louise Mercer, Greg Iles-de-la-Madeleine, QC Montréal, QC Montréal, QC Stephenville, NL Harvey, Pierre-Claude Khadilkar, Madhusudan Likhite, Fern Minz, Gabriel Sept-Îles, QC Montréal, QC Plattsburgh, NY, United States Dorval, QC Heyding, Robert Khakee, Sam Louvaris, James Mitchell, Gregor Toronto, QC Montréal, QC Toronto, QC Lachute, QC Heymans, Gerry A. khazandar, Fatimah Lu, Paul Morin, Carl Russell, ON Montréal, QC Winnipeg, MB Ottawa, ON Honickman, Debbie Klein, Benjamin Luckow, David Morris, Randi Toronto, QC Montréal, QC Montréal, QC Montréal, QC Hope, Paula Klein, Jack Luger, Sherry Morrison, Cindy Montréal, QC Kirkland, QC Montréal, QC Arnprior, ON Hubert, Isabelle Korin, Tamara Luterman, Rosalind Mout, Julie St-Lazare, QC Westmount, QC Montréal, QC West Brome, QC Hurtubise, Séverine Krotecki, Lech Macek, Adrian Narasiah, Lavanya Montréal, QC Ormstown, QC Cowansville, QC Brossard, QC Hyland, Denise Kuganathan, Girudiha MacGeachy, Fiona Nattel, Celia St. John's, NL Vaudreuil-Dorion, QC Dollard-des-Ormeaux, QC Westmount, QC Ince-Cushman, Daniel Kwiatkowski, Chris Machado, Ricardo Nazerali, Najmi Montréal, QC Huntsville, ON Montréal, QC Vancouver, BC Ingram, Emily Kyle, Beverley Macleod, Carol Neamt, Elena Outremont, QC Beaconsfield, QC Montréal, QC Montréal, QC Ionescu, Loretta-Vivianne Lacroix, Daniel MacLeod, John Nghiem, Dung Ile-Bizard, QC Moose Creek, ON Toronto, QC Pointe-Claire, QC Ith, Bun Hor Ladores, Mina Maheshwari, Anil Nica-Danes, Doina Laval, QC Montréal, QC Cambridge, ON Montréal, QC Jackson, John Lafrenière, Marie-Chantal Mahood, Robert Noël-Beau, Noémie Lachine, QC Montréal, QC Montréal, QC Amos, QC Jacques, Marc-André Lalla, Daniel E. Main, Jeff Ocasiones, Carmencita Montréal, QC Cowansville, QC Waterloo, ON Laval, QC Jagan, Sarva Lalonde, Jean-Serge Malec, Elizabeth Osborne, Perry Saint Lambert, QC Gatineau, QC Montréal, QC Baie Verte, NL Jansen, Kurt Lam, Loan Marmor, Goldie Oulianine, Karen Montréal, QC Mont-Royal, QC Montréal, QC Montréal, QC December 5-7, 2011 -274 - McGill University - Faculty of Medicine DOCUMENTATION PARTICIPANT LIST Padan, Callie Rideout, Gary Shuldiner, Sam Van Sterthem, Marie-Josée Montréal, QC Mount Pearl, NL Côte-St-Luc, QC Pincourt, QC Pagliarulo, Giovanni Rivilis, Jeffrey Sims, Louise Versteeg, Elmyre Terrebonne, QC Montréal, QC Cambridge, ON Toronto, QC Panet, Diane Robson, Mark Singerman, Jonathan Viens, Chantale Sherbrooke, QC Arnprior, ON Hampstead, QC Montréal, QC Paquet, Christine Rohan, Ivan Smeja, Christina Vrahas, Voula Fatima, QC Montréal, QC Montréal, QC Pierrefonds, QC Parayre, Michel Rokni, Farin Son, Forina Weka Lungunga, Charles Rouyn-Noranda, QC Verdun, QC Ile-Bizard, QC Bathurst, NB Parent, Lorne Rona, Mary St-Onge, Benoit Welik, Leonard Ottawa, ON Montréal, QC Trois-Rivières, QC Hudson, QC Parsons, William Rothman, Ann St-Pierre, Maurice White, Debrah Ste-Anne-de-Bellevue, QC Montréal, QC Montréal, QC Montréal, QC Pepin, Céline Rotili, Silvana Stanley, Donald Whiteman, Avram Glenburnie, ON Ottawa, ON Nobleboro, ME, United States Westmount, QC Peters-Mainville, Dagmar Routh, John Steg, Doris Whiteman, Gabriel Beaconsfield, QC Port Hope, ON Montréal, QC Montréal, QC Picard, France Roy, Christine Steibelt, Roslyn Willoughby, Paul Amos, QC Drummondville, QC Pointe-Claire, QC Woodstock, ON Podavin, Joey Roy, Michelle Stephenson, Linda Winter, Alexander Chisasibi, QC Montréal, QC Saint John, NB Ottawa, ON Poirier, Éric Roy, Nadine Stiharu, Simona Wong, Su Ling Sept-Ïles, QC Dieppe, NB Pierrefonds, QC Lachine, QC Poitevin, David Rubenstein, Heather Tanferna, Rosaria Yankova, Sylvia Sault Ste Marie, ON Côte-St-Luc, QC Terrebonne, QC Kingston, ON Polson, George Rubin, Gordon Taylor, John D. Yaremko, Marie Ste-Anne-de-Bellevue, QC Montréal, QC Chapleau, ON Montréal West, QC Prévost, Sylvie Saba, Samir Edouard Tehranifar, Mitra Zabian, Randa Mercier, QC Pierrefonds, QC Mont-Royal, QC St-Constant, QC Psyharis, Chrysanthi Sabin, Norman Tewfik, Yvette-Nelly Zaklos, Mayor Ile-Bizard, QC Montréal, QC Montréal, QC Montréal, QC Pye, Mary Sairam, Ashwin Thai, Khanh-Linh Zigman, Michael Ottawa, ON Town of Mount-Royal, QC Saint-Laurent, QC Montréal, QC Quao, Nii Salazar-Oldrich, Trinidad Thomas, David Montréal, QC Beaconsfield, QC Port aux Basques, NL Quesada, Michel Saoud, Fahimy Toma, Nicola Le Creusot, France Verdun, QC Montréal, QC Racine, Maurice Satenstein, Gary Touzel, Liz Champlain, NY, United States Wakefield, QC Napanee, ON Ramsey, Patricia Saul, Mark Touzel, Tom New Maryland, NB Masham, QC Napanee, ON Ratner, Jack Scheim, Alyssa Tremblay, Jacques Montréal, QC Mount Royal, QC Montréal, QC Regimbal, Marc Schnare, Ted Tremblay, Marino Gatineau, QC Ottawa, ON Rawdon, QC Reid, Shelley Schulz, Jan Tremblay, Roger Ottawa, ON Montréal, QC Cornwall, ON Réjean, Nappert Schwarcz, Deborah Turcotte, Jean Gatineau, QC Montréal, QC Valcourt, QC Riano, Margarita Sedighi, Seyed Mahdi Uhthoff, Peter Saint-Laurent, QC Tehran, Iran Ottawa, ON Riche, Cyril Seidler, Christine Valois, Lucie St. John's, NL Callander, ON Mascouche, QC December 5-7, 2011 -275 - 62 nd Annual Refresher Course for Family Physicians RAMQ Form CERTIFICATE OF ATTENDANCE This is to certify that the undersigned has attended the continuing medical education activity entitled: 62 nd Annual Refresher Course for Family Physicians on December 5, 2011 Hilton Montréal Bonaventure Hotel, Montréal, Québec Participant’s Name (printed) : Participant’s Signature: Study Credit Hours: (for maximum number of 7.25 credits for the day) IVAN ROHAN MD, CCFP COURSE DIRECTOR This event is an accredited group learning activity (Section 1) as defined by the Maintenance of Certification program of the R oyal College of Physicians and Surgeons of Canada 23 hours. This program meets the accreditation criteria of the College of Family Physicians of Canada and has been accredited f or the 23 MAINPRO-M1 credits. The Centre for CCHPE, Faculty of Medicine, McGill University designates this educational activity for a maximum of 23 Category 1 credits towards the AMA Physicians Recognition Award. EACH PHYSICIAN SHOULD CLAIM ONLY THOSE CREDITS THAT HE/SHE ACTUALLY SPENT IN THE ACTIVITY. The McGill Centre for the CCHPE is accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS) as an accre diting body for continuing medical education activities for physicians. Participants eligible to receive AMA Physicians Recognition Award credits can claim the AMA PRA Cate gory 1 credits through a reciprocal agreement. Participants eligible to receive Prescribed Credit Hours from the AAFP can claim the credits through a reciprocal agreement. CERTIFICATE OF ATTENDANCE This is to certify that the undersigned has attended the continuing medical education activity entitled: 62 nd Annual Refresher Course for Family Physicians on December 6, 2011 Hilton Montréal Bonaventure Hotel, Montréal, Québec Participant’s Name (printed) : Participant’s Signature: Study Credit Hours: (for maximum number of 8.25 credits for the day) IVAN ROHAN MD, CCFP COURSE DIRECTOR This event is an accredited group learning activity (Section 1) as defined by the Maintenance of Certification program of the R oyal College of Physicians and Surgeons of Canada 23 hours. This program meets the accreditation criteria of the College of Family Physicians of Canada and has been accredited f or the 23 MAINPRO-M1 credits. The Centre for CCHPE, Faculty of Medicine, McGill University designates this educational activity for a maximum of 23 Category 1 credits towards the AMA Physicians Recognition Award. EACH PHYSICIAN SHOULD CLAIM ONLY THOSE CREDITS THAT HE/SHE ACTUALLY SPENT IN THE ACTIVITY. The McGill Centre for the CCHPE is accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS) as an accre diting body for continuing medical education activities for physicians. Participants eligible to receive AMA Physicians Recognition Award credits can claim the AMA PRA Cate gory 1 credits through a reciprocal agreement. Participants eligible to receive Prescribed Credit Hours from the AAFP can claim the credits through a reciprocal agreement. CERTIFICATE OF ATTENDANCE This is to certify that the undersigned has attended the continuing medical education activity entitled: 62 nd Annual Refresher Course for Family Physicians on December 7, 2011 Hilton Montréal Bonaventure Hotel, Montréal, Québec Participant’s Name (printed) : Participant’s Signature: Study Credit Hours: (for maximum number of 7.5 credits for the day) IVAN ROHAN MD, CCFP COURSE DIRECTOR This event is an accredited group learning activity (Section 1) as defined by the Maintenance of Certification program of the R oyal College of Physicians and Surgeons of Canada 23 hours. This program meets the accreditation criteria of the College of Family Physicians of Canada and has been accredited f or the 23 MAINPRO-M1 credits. The Centre for CCHPE, Faculty of Medicine, McGill University designates this educational activity for a maximum of 23 Category 1 credits towards the AMA Physicians Recognition Award. EACH PHYSICIAN SHOULD CLAIM ONLY THOSE CREDITS THAT HE/SHE ACTUALLY SPENT IN THE ACTIVITY. The McGill Centre for the CCHPE is accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS) as an accre diting body for continuing medical education activities for physicians. Participants eligible to receive AMA Physicians Recognition Award credits can claim the AMA PRA Cate gory 1 credits through a reciprocal agreement. Participants eligible to receive Prescribed Credit Hours from the AAFP can claim the credits through a reciprocal agreement.