McGill 2012 Refresher Course Syllabus

Program Committee

Rohan, Ivan MD, CCFP - Course Director____________________________________________Dannenbaum, David MD, CCFPLalla, Daniel E. MDCM, CCFP, FCFPLuconi, Francesca PhDMacek, Adrian MDCM, CCFPNarasiah, Lavanya MD, MSc, CCFPNazerali, Najmi MD, CCFP, FCFPSchulz, Jan MD, FRCPC, FACPZigman, Michael MDCM, FCFP

Faculty of Medicine63rd Annual Refresher Course for Family Physicians

November 26-28, 2012

Hilton Montréal Bonaventure Hotel

www.course-mcgill.caCourse Secretariat: IS Event Solutions | 607 Notre-Dame, 2nd Floor, St-Lambert, QC J4P 2K8

Telephone: 450-550-3488 ext. 114 | Fax: 514-227-5083 | E-mail: [email protected]

Course OrganizerIS Event Solutions

Isabel Stengler | PresidentProject ManagerJanique DeslauriersLogistics Manager / MarketingSabina SchamerProgramCarole LaflammeRegistration / ExhibitionPatricia DollaWebsite Support

ACKNOWLEDGEMENTS

Our thanks to the following companies for providing the 63rd Annual Refresher Course for Family Physicianswith an educational grant:

BENEFACTORS

FRIENDS

Amgen Inc.AstraZeneca & Bristol-Myers Squibb CanadaLundbeckMerckMUHC - Chronic Viral Illness ServiceNovartis Pharmaceuticals Canada Inc.Purdue PharmaTakeda CanadaValeant Canada Consumer Products

&

GENERAL INFORMATION

November 26-28, 2012 -1- McGill University - Faculty of Medicine

TABLE OF CONTENTS

General InformationGeneral Course Information . . . . . . . . . . . . . . . . . . . . . . . . . page 3Hilton Montréal Bonaventure Hotel Floor Plan . . . . . . . . . . . . page 4CME Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 5Future Refresher Course. . . . . . . . . . . . . . . . . . . . . . . . . . . . page 6Social Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 7

Exhibitor DirectoryExhibitor Listing and Floor Plan. . . . . . . . . . . . . . . . . . . . . . . page 8Exhibitor Directory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 9

Program Overview Monday, November 26 . . . . . . . . . . . . . . . . . . . . . . page 12Tuesday, November 27. . . . . . . . . . . . . . . . . . . . . . page 14Wednesday, November 28 . . . . . . . . . . . . . . . . . . . page 16

Course Faculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 18

PowerPoint Slides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 21Slides are in chronological order of the program.

Delegate Directory & CertificatesParticipant List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 366RAMQ Reimbursement Form. . . . . . . . . . . . . . . . . . . . . . . page 370Daily Certificates of Attendance . . . . . . . . . . . . . . . . . . . . page 372

Content available online at www.course-mcgill.ca

GENERAL INFORMATION


BUSINESS CENTRE

A business centre is located on the lobby level of the hotel.It will be able to handle requests for photocopies, faxes, Internet access, etc. Hours of operation are 08:00 to 17:00.

COURSE EVALUATION

A Conference evaluation form was provided upon registration. Please complete it and drop it off at the registration desk before leaving the Course. You will thenreceive your CME certificate. The Committee appreciatesyour constructive feedback.

DELEGATE HOSPITALITY

A pen was provided upon registration. Montréal maps andguidebooks are available at the hotel’s information desk.

ENVIRONMENTAL CONSIDERATIONS

We incorporated the following considerations into the planning of this Course:

• Online registration system reducing printing• Recyclable lanyard• PowerPoints available online instead of on CD• Careful meal planning to minimize waste• Condiments, milk, juices in bulk containers• Reduction of printed materials

EMERGENCY/FIRST AID

For any emergency or first aid services inside the hotel,please dial “0” for the operator from any available housephone.

INFORMATION

Should you require any assistance during the Conference,please call the registration desk via the hotel operator at514-878-2989.

LOST AND FOUND

Any lost and found items will be held at the registrationdesk for the duration of the event. For any unclaimed items after the Course, please contact ISEvent Solutions.

LUGGAGE / COAT CHECK

During the Course, whether you are staying at the HiltonMontréal Bonaventure or at a different hotel, you can leaveyour suitcases with the concierge. The Course organizers do not accept liability for any luggage left unattended and will not store any suitcases at the registration desk.

A complimentary coat check is available.

MEALS AND REFRESHMENTS

Coffee breaks and lunches will be served daily in FontaineABC. For times of service, please refer to the program section.

A light breakfast will be available in the foyer area everymorning. Please feel free to serve yourself before entering the morning session. Catering will be provided at all Educational Fora sessions.

PUBLIC NOTICE

The Hilton Montréal Bonaventure Hotel specifically and allQuebec public spaces in general are smoke-free environ-ments. Smoking is permitted only outside of buildings.

REGISTRATION

For identification and security purposes, delegates mustwear their name badges when onsite at the Hilton MontréalBonaventure Hotel.

REGISTRATION & INFORMATION DESK HOURS

Monday 07:00 – 17:00Tuesday 06:30 – 18:00Wednesday 06:30 – 16:30

GENERAL INFORMATION


GENERAL COURSE INFORMATION

EXERCISES

GENERAL INFORMATION


Carolyne DubéCarolyne's true passion is all about dreamsand their meaning. It is her mission to providea simple approach that promotes the under-standing of dreams and the importance ofgood sleep habits. Her main objective is tobring awareness to the power of dreams and the importance of good sleep.

She is a member of IASD (International Association for the Studyof Dreams), an international association of scientists studyingdreams and sleep.

She offers workshops, consultations and conferences on the un-derstanding of dreams and sleep quality. Carolyne is appreciatedfor 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 workingas a certified dance instructor for groups.

She can be reached at 514-776-9007.

NEW THIS YEAR: We are innovating the exercise breaks by offering Zumba. Delegates will have an opportunity to experiment with differentand original moves.

Zumba is the only Latin-inspired, calorie-burning dance fitness-party program that's moving millions of people toward joy and health and since 2001 has grown to become a worldwidephenomenon.

Warning: Zumba's goal is to spread the philosophy of health and happiness and of loving everything you do, especially yourworkout. It can move you in a new direction and change your life forever!

HILTON MONTRÉAL BONAVENTURE HOTEL FLOOR PLAN | CONVENTION LEVEL

STUDY CREDIT HOURS

This event is approved for up to 23.25 credits by the Officefor Continuing Health Professional Education (CHPE). TheOffice for CHPE, Faculty of Medicine, McGill University isfully accredited by the Committee on Accreditation ofCanadian Medical Education (CACME).

This program meets the accreditation criteria of the Collegeof Family Physicians of Canada for MAINPRO-M1 credits.Members of the American Academy of Family Physiciansare eligible to receive credit hours for attendance at thismeeting due to a reciprocal agreement with the College of Family Physicians of Canada.

This event is an accredited group learning activity (Section1) as defined by the Maintenance of Certification programof the Royal College of Physicians and Surgeons of Canada.

Through a reciprocal agreement between the AmericanMedical Association and the Royal College of Physiciansand Surgeons of Canada, the Office for CHPE, Faculty ofMedicine, McGill University designates this activity for AMAPRA Category 1 credit(s) up to the maximum number ofcredit hours noted above.

Each physician should claim only those hours of creditthat he/she actually spent at the educational activity. To claim your CME certificate, please sign in daily and return the completed evaluation form at the end of the Course.

CCHPE:

Lady Meredith House1110 Pine Avenue West, Room 301Montréal, Quebec H3A 1A3Tel.: 514-398-3500, Fax: 514-398-2231Email: [email protected] Web Site: http://cme.mcgill.ca

CME REIMBURSEMENT | Allowance Fund

This course qualifies for CME reimbursement for thoseQuebec physicians who meet the requirements for the fundfrom the Régie d’Assurance du Québec. To obtain anapplication form (see end of the binder) and for furtherinformation please visit the website:http://www.ramq.gouv.qc.ca/fr/professionnels/form_pro/pdf/3814.pdfDaily certificates & RAMQ form are included at the end ofthe syllabus.

DECLARATION OF POTENTIAL CONFLICT OF INTEREST

Speakers will be requested to disclose to the audienceany real or apparent conflict(s) of interest that mayhave a direct bearing on the subject matter of thisprogram.

Objectives: The aim of this course is to provide an overallreview of topics that would be of interest and relevance tofamily physicians in both rural and urban practice. Amixture of material will be presented and news breakingdevelopments in Family Medicine reviewed. Exposure tobasic topics across the entire spectrum of Family Medicinewill be ensured. A chance to brush up on “hands-on” skillswill be offered. There will be ample opportunity forinteraction with colleagues and faculty.

Methods: Short and focused didactic lectures will coverrecent developments in Family Medicine. Seventy (70)workshops will offer a choice from among a variety of basicmedical topics. Streams in Emergency Medicine, Geriatricsand Pediatrics, as well as a Hands-On stream will beoffered for those with particular needs. The workshops willallow for informal discussion and consultation with faculty.The David J.G. Tector Memorial Lecture will present an in-depth examination of an academic topic in medicine. Thefaculty includes both family physicians and specialistsaffiliated with McGill University, as well as invited speakersfrom other institutions.

GENERAL INFORMATION


CME INFORMATION

LOOKING AHEAD TO 2013

Circle your calendar for these dates!

64TH ANNUAL REFRESHER COURSEFOR FAMILY PHYSICIANS

December 2-4, 2013Hilton Montréal Bonaventure Hotel

www.course-mcgill.ca

GENERAL INFORMATION


FUTURE REFRESHER COURSE

GENERAL INFORMATION


y

SOCIAL PROGRAM

Cocktails followed by theAnnual Course Dinner & a Special Presentation

Monday, November 26, 2012 | Cocktails 18:00 Dinner 18:30 Hilton Montréal Bonaventure Hotel, Verdun room

The Course Dinner, preceded by an aperitif,will include a special presentation.

Past member of our program committee and graduate of the Family MedicineProgram at McGill University, Dr. Linda Thyer, travelled to London, England

for 2 weeks with the Canadian Olympic Team this year. The physician, anative of Montréal who was raised in Nelson, BC, was thanked graciously bythe athletes for her medical support and true belief. Her recent induction intothe McGill Sports Hall of Fame, makes her the ninth woman to be selected forthe prestigious Hall. As a distance runner, she was a three-time McGill female

athlete of the year, competed for Canada at international meets in Spain,Japan and China and won the 1994-95 BLG Award as the top female athlete

in Canadian Interuniversity Sport.

EXHIBITOR LISTING

Amgen Inc. 16

AstraZeneca 17 & 18

AstraZeneca / Bristol-Myers Squibb 21

BMO Harris Private Banking 3 & 4

Boehringer Ingelheim (Canada) Ltd. 10

Boehringer Ingelheim (Canada) Ltd. / Eli Lilly Canada 8 & 9

GlaxoSmithKline Inc. 7

Lundbeck 1

McGill Undergraduates / CHPE Office (CME) 5 & 6

Merck 11

Merck Care – Hepatitis C 2

MUHC - Chronic Viral Illness Service 20

Novartis Pharmaceuticals Canada Inc. T1

Pfizer Canada Inc. 14 & 15

Purdue Pharma 19

Takeda Canada 12

Valeant Canada Consumer Products 13

Watson Pharma Company 22 & 23

EXHIBITOR FLOOR PLAN

Watson

Lundbeck

Astra Zeneca

Boehringer Ingelheim Lilly Canada

Boehringer Ingelheim

Merck

Amgen

Valeant

Pfizer

Astra ZenecaBristol-Myers Squibb

Takeda

BMOHarris Private Banking

GlaxoSmithKline

MUHCChronic

Viral IllnessPurduePharma

McGillUndergrads / CHPE Office

MerckCare -Hepatitis C

NovartisT1

EXHIBITOR DIRECTORY


Amgen Inc. Booth # 16

Contact: Eric Arel 3745 Jean-BeraudLaval, QC H7T 0H9Tel.: 514-826-8750E-Mail: [email protected]

Biotechnology leaders

AstraZeneca Booths # 17 & 18

1004 Middlegate RoadMississauga, ON L4Y 1M4Tel.: 1-888-669-2987

AstraZeneca is a major international healthcare business engaged in theresearch, development, manufacturing and marketing of meaningfulprescription medicines; and a supplier for healthcare services. AstraZeneca isone of the world's leading pharmaceutical companies and is a leader ingastrointestinal, cardiovascular, neuroscience, respiratory, oncology andinfectious disease medicines. For more information, please visit:www.astrazeneca.ca.

AstraZeneca / Bristol-Myers Squibb Booth # 21

Contact: Isabelle Gatien42 ChevalierBlainville, QC J7C 4R7Tel.: 514-260-7282E-Mail: [email protected]

In January 2007, Bristol-Myers Squibb and AstraZeneca joined forces toresearch, develop and market highly valuable prescription drugs for type 2diabetes. The partnership focuses on global patient care, health improvementand the creation of a new vision for the treatment of type 2 diabetes.

BMO Harris Private Banking Booths # 3 & 4

Contact: Sonya Gaumond1250 René-Lévesque O., 46e étage Montréal, QC H3B 4W8Tel.: 514-877-9814

We are a creative and caring team of professionals. Our people support youwith their coordinated efforts and confident execution.

We provide a comprehensive and holistic approach to your wealthmanagement, starting first with the discovery of your goals and needs, and thencoordinated by a dedicated Client Advisor who works with you every step of theway. Our team of professionals includes specialists in a wide variety ofdisciplines such as banking, investment management, estate and trust services.We also provide family office services such as philanthropic advisors, lifestylemanagement and succession planning.

Through the strength of our partnership with BMO Financial Group, clients haveaccess to a world of financial services with the BMO family.

Boehringer Ingelheim (Canada) Ltd. Booth # 10

Contact: Carole Girard5180 South Service Rd.Burlington, ON L7L 5H4Tel.: 905-639-6000Fax: 905-639-3769E-Mail: [email protected]

Boehringer Ingelheim (Canada) Ltd. is home to more than 750 employeesincluding 170 scientists across the country. Our drug discovery focuses on sixmajor therapeutic areas: Respiratory diseases, Cardiometabolic diseases,Oncology, Neurological diseases, Immunology, and Infectious diseases. Formore information please visit our website: www.boehringer-ingelheim.ca.

Boehringer Ingelheim (Canada) Ltd. / Eli Lilly Canada Booths # 8 & 9

Contact: Lisa-Lune St-Jean LemieuxEli Lilly CanadaTel.: 450-719-0127Fax: 450-719-0279E-Mail: [email protected]

Trajenta™ (linagliptin) is a new oral therapy for adults with type 2 diabetes andis a dipeptidyl peptidase-4 inhibitors (DPP-4i). Trajenta does not require doseadjustment in patients with renal impairment.

GlaxoSmithKline Booth # 7

Contact: John Katiforis245, boulevard Armand-FrappierLaval, QC H7V 4A7 Tel.: 514-969-5627E-Mail: [email protected]

GlaxoSmithKline Inc. – one of the world’s leading research-basedpharmaceutical, vaccine and healthcare companies – is committed to improvingthe quality of human life by enabling people to do more, feel better and livelonger. In Canada, GlaxoSmithKline is a top 15 investor in research anddevelopment, contributing more than $156 million in 2008 alone. GSK isdesignated a Caring Company by Imagine Canada, and is consistentlyrecognized as one of the 50 best companies to work for in Canada. Forcompany information please visit, www.gsk.ca.

Lundbeck Booth # 1

1000 de la Gauchetière Ouest, Suite 500Montréal, QC H3B 4W5Tel.: 1-800-586-2325

Lundbeck Canada is a subsidiary of H. Lundbeck A/S, an international research-based pharmaceutical company which focuses on diseases of the Central Nervous System and most recently, oncology. Based in Montréal,Lundbeck Canada has been part of the Canadian pharmaceutical industry for more than a decade and markets products for the treatment of depression,anxiety, Alzheimer’s Disease, schizophrenia and a product for the treatment ofchronic lymphocytic leukemia and non-Hodgkin lymphoma.

EXHIBITOR DIRECTORY


EXHIBITOR DIRECTORY

McGill Undergraduates Booths # 5 & 6

Undergraduate Teaching OfficeDepartment of Family Medicine515 Pine AvenueMontréal, QC H2W 1S4Tel.: 514-398-7375, ext. 0692Fax: 514-398-4202

The Longitudinal Family Medicine Experience (LFME) is an innovative newcourse for first year McGill medical students. Through this exciting initiativebeginning in August 2013, medical students will be given early exposure toclinical care through regular sessions at a Family Physician's office. Registrationof Family Physician preceptors is now open.

CHPE Office (CME)

Contact: Jenny FazioliCHPE Office1110 Pine Avenue, Room 304Montréal, QC H3A 1A3Tel.: 514-398-3500Fax: 514-398-2231

The mission of the CHPE Office is to promote: excellence in healthcare bycontributing to the continuum of medical education including undergraduate,postgraduate and lifelong learning; lifelong learning pertinent to healthprofessionals' activities; interprofessionalism and collaboration with other CHPE stakeholders; accountability to our patients, learners and communities;innovation and critical inquiry in continuing health professional education.

Merck Booth # 11

16711 Trans Canada HighwayKirkland, QC H9H 3L1 Tel.: 514-428-7920

Merck is a global health care leader with a diversified portfolio of prescriptionmedicines, vaccines, consumer and animal health products. Merck is a leader in a broad range of areas such as cardiology, infectious diseases, respiratory,vaccines, women's health and sun care, and is focused on expanding offeringsin other areas, including virology, oncology and diabetes. Merck is one of thetop R&D investors in Canada. Based in Montréal, Québec, Merck employs over1000 people across Canada. For more information about our operations in Canada, visit www.merck.ca

Merck Care – Hepatitis C Booth # 2

Contact: Danielle Deslauriers 16711 TransCanada HighwayKirkland, QC H9H 3L1 Tel.: 514-949-0655Email: [email protected]

Merck CareTM Hepatitis is a fully integrated service offering from Merck CanadaInc., building on Merck’s long legacy of hepatitis C support in Canada.

MUHC - Chronic Viral Illness Service Booth # 20

Contact: Gino Curadeau3650 St-Urbain Street, J8.03Montréal, QC H2X 2P4 Tel.: 514-843-2090Fax: 514-843-2092E-Mail: [email protected]

Multidisciplinary team includes physicians, clinician nurses, outreach nurses,pharmacists, psychologist, psychiatrist, social workers and nutritionist in HIV,Hepatitis and HPV.

Ambulatory care services, day hospital treatments, global evaluation of complexcases, research, provincial information line for healthcare providers, provincialtherapeutic drug monitoring program.

Follow-up and innovative treatment of Hepatitis C virus.

Novartis Pharmaceuticals Canada Inc. Table # T1

Contact: Lyne Levac385 Bouchard Blvd.Dorval, QC H9S 1A9 Tel.: 514-631-6775, ext. 3584 Fax: 514-420-7441E-Mail: [email protected]

Novartis is the world’s fifth largest manufacturer of vaccines and the secondlargest producer of influenza vaccine. We are dedicated to delivering on thepromise of prevention through research, development and production ofinnovative, safe and effective vaccines. At the heart of everything we do is ourcommitment to prevent the spread of life-threatening diseases, protectvulnerable populations, and keep healthy people healthy.

Pfizer Canada Inc. Booths # 14 & 15

Contact: Colette Martin17300 TransCanada HighwayKirkland, QC H9J 2M5Tel.: 514-693-4435E-Mail: [email protected]

Pfizer Canada Inc. is the Canadian operation of Pfizer Inc, one of the world'sleading biopharmaceutical company. Pfizer discovers, develops, manufacturesand markets prescription medicines for humans and animals. Pfizer's ongoingresearch and development activities focus on a wide range of therapeutic areasfollowing our guiding aspiration... Working together for a healthier world.

Purdue Pharma Booth # 19

575 Granite CourtPickering, ON L1W 3W8Tel.: 905-420-6400Fax: 905-420-0385E-Mail: [email protected]

Purdue Pharma is dedicated to developing and providing innovative medicinesfor patients and health care professionals and to supporting quality educationfor the safe use of its products.

EXHIBITOR DIRECTORY


EXHIBITOR DIRECTORY

Takeda Canada Booth # 12

Contact: Howard Millman435 North Service Road West, 1st FloorOakville, ON L6M 4X8Tel.: 514-441-4917Email: [email protected]

Takeda is committed to striving towards better health for patients worldwidethrough leading innovation in medicine. As the largest pharmaceutical companyin Japan and a top 15 pharmaceutical company worldwide, Takeda will bring anumber of therapeutic options to Canadians in the areas of metabolic diseases,gastroenterology, oncology, cardiovascular health, CNS diseases, inflammatoryand immune disorders, respiratory diseases and pain management.

Valeant Canada Consumer Products Booth # 13

Contact: Danielle Lepage2150 boul. St-Elzéar OuestLaval, QC H7L 4A8Tel.: 514-402-6020Fax: 514-956-4206E-Mail: [email protected]

Valeant Canada Consumer Products’ most commercially successful product,COLD-FX, was developed by a team of 25 scientists and has undergone nearlya dozen clinical trials conducted at universities in both the U.S. and Canada. Theresults of eight of these trials have been published in peer-reviewed medicaljournals. In 2007 COLD-FX was granted a Natural Product Number (NPN) byHealth Canada and is officially approved to help reduce the frequency, severityand duration of cold and flu symptoms by boosting the immune system. COLD-FX has also received the highest sports-certification in the world fromNSF International, and in 2009 was chosen as the Official Cold and Flu Remedyof the 2010 Olympic and Paralympic Winter Games.

Proprietary and patented ChemBioPrint® discovery- and standardization-technology enables the development of effective and safe medicines fromcomplex natural sources, while ensuring reliable health benefits and batch-to-batch consistency.

Watson Pharma Company Booths # 22 & 23

Contact: Michael Salter2295 Bristol Circle, Unit 104Oakville, ON L6H 6P8 Tel.: 905-829-2979, ext. 4437Fax: 1-855-992-8766E-Mail: [email protected]

Watson Pharma Company is the newly formed Canadian subsidiary of WatsonPharmaceuticals, Inc. (NYSE: WPI), a leading integrated global pharmaceuticalcompany. Watson Pharma Company is engaged in the marketing, sale anddistribution of branded pharmaceutical products and biologics within theCanadian market. We are focused on delivering innovative products thataddress key therapeutic categories in Urology and Women's Health.

EXHIBITOR DIRECTORY


EXHIBITOR DIRECTORY

07:00 – 17:00 Registration Lower Lobby

07:00 – 08:20 Light Breakfast Foyer

08:20 – 10:35 PLENARY 1Morning Chair • David Dannenbaum

08:20 – 08:30 P1.1 Introduction Ivan Rohan Westmount

08:30 – 09:00 P1.2 Evaluation and Management of Syncope Vartan Mardigyan Westmount

09:00 – 09:30 P1.3 Valvular Disease: When to Refer Lawrence Rudski Westmount

09:30 – 09:35 Exercise Stretch Carolyne Dubé Westmount

09:35 – 10:05 P1.5 New Anticoagulation Drugs Vicky Tagalakis Westmount

10:05 – 10:35 P1.6 CVA Acute and Chronic Management Theodore Wein Westmount

10:35 – 11:00 Refreshment Break Fontaine ABC

11:00 – 12:00 WORKSHOPS AA-01 ER: Acute Coronary Syndromes Phyllis Vetere Fontaine DA-02 TBA TBAA-03 PEDS: Treatment and Investigations of UTI in Pediatrics Patricia Forbes Fontaine FA-04 Hands On: Practical Neck Pain Physical Examination:

Sorting out the Zebras from the Horses Mohan Radhakrishna Fontaine GA-05 Renal Failure and Use of Medications Mark Lipman Fontaine HA-06 CVA Management Theodore Wein Jacques-CartierA-07 Anticoagulation Vicky Tagalakis FundyA-08 Don’t Fall Behind the Changing Technological

Terrain for BP Measurements Brian Gore Pointe-Aux-TremblesA-09 The Link Between Hypertension and Atrial Fibrillation Luc Trudeau St-PierreA-10 Évaluation et diminution du risque CV chez les femmes

atteintes d’hypertension (in French) Guy Tremblay Longueuil

12:00 – 12:45 LUNCH!TIME EDUCATIONAL FORUM 1Moderator • David DannenbaumIncorporation of Health Care Professionals: Review Some of theUnique Ways the Professional Corporation Structure Can Be Optimized to Achieve Personal and Professional Goals for You and Your Family Joel Carrier Verdun

12:00 – 13:30 Lunch Fontaine ABC

13:30 – 14:35 PLENARY 2Afternoon Chair • Michael Zigman

13:30 – 14:00 P2.1 Ovarian Cancer Lucy Gilbert Westmount

14:00 – 14:05 Exercise Stretch Carolyne Dubé Westmount

14:05 – 14:35 P2.3 How to Respect the Rules Roger Ladouceur Westmount

PROGRAM OVERVIEW


PROGRAM " MONDAY, NOVEMBER 26, 2012A question period will follow all lectures on all days.

14:35 – 15:35 WORKSHOPS BB-01 ER: Procedures H. Mitchell Shulman St-PierreB-02 GER: Insomnia in the Elderly Michel Elie Fontaine DB-03 PEDS: O!ce Pediatric Orthopaedics - What Not to Miss Thierry E. Benaroch Fontaine EB-04 Hands On: Joint and Soft Tissue Injections Part 1 Michael Stein Fontaine FB-05 TB Reappearing - When to Think of It Mark David Palayew Fontaine GB-06 Interpretation of PFTs: Spirometry Ron Olivenstein Pointe-Aux-TremblesB-07 ECG Interpretation David Paul Kostiuk Jacques-CartierB-08 Diagnosis and Management of CKD Sameena Iqbal FundyB-09 Laboratory Tests: What to Order - Bring Your Questions Julie St-Cyr Fontaine HB-10 Planning for Your Retirement: Regulatory and

Ethical Aspects François Goulet Longueuil


16:00 – 17:00 WORKSHOPS CC-01 ER: Procedures (repeat of B-01) H. Mitchell Shulman St-PierreC-02 GER: Evaluation of Fitness to Drive Lucie Boucher Fontaine DC-03 PEDS: O!ce Pediatric Orthopaedics - What Not to

Miss (repeat of B-03) Thierry E. Benaroch Fontaine EC-04 Hands On: Joint and Soft Tissue Injections Part 2 Michael Stein Fontaine FC-05 An Introduction to Wound Care Mark Karanofsky Fontaine GC-06 Interpretation of PFTs: Spirometry (repeat of B-06) Ron Olivenstein Pointe-Aux-TremblesC-07 ECG Interpretation (repeat of B-07) David Paul Kostiuk Jacques-CartierC-08 Diagnosis and Management of CKD (repeat of B-08) Sameena Iqbal FundyC-09 Laboratory Tests: Interpretation - Bring Your Questions Julie St-Cyr Fontaine HC-10 Approach to Teenagers Alan Pavilanis Longueuil

18:00 – 22:00 COCKTAILS FOLLOWED BY THE ANNUAL COURSE DINNER & SPECIAL PRESENTATIONL'Ensemble du Square St-Louis, under the leadership of Robert O’Callaghan, will once again perform during the cocktail and dinner. There will also be a special presentation byDr. Linda Thyer, the physician for the Canadian Olympic Team 2012.An elegant four-course meal will be served. Verdun

PROGRAM OVERVIEW


PROGRAM " MONDAY, NOVEMBER 26, 2012A question period will follow all lectures on all days.



07:00 – 07:45 BREAKFAST EDUCATIONAL FORUM 2Moderator • Daniel E. LallaHyperactive Bladder and the Older Male Serge Carrier Verdun

08:00 – 09:35 PLENARY 3Morning Chair • Lavanya Narasiah

08:00 – 08:30 P3.1 Management of Psychiatric Disability Fiore Lalla Westmount

08:30 – 09:00 P3.2 Update on Alzheimer’s Disease from Asymptomatic Stage to Dementia Serge Gauthier Westmount

09:00 – 09:05 Exercise Stretch Carolyne Dubé09:05 – 09:35 P3.4 Tremor Di"erential Diagnosis Liam Durcan Westmount

09:35 – 10:35 WORKSHOPS D

D-01 ER: Ultrasound Guided Procedures Hugo Viladevall FundyD-02 GER: Pain Management in the Elderly Yoram Shir Fontaine DD-03 PEDS: Sleep Disorders in Children Evelyn Constantin Pointe-Aux-TremblesD-04 Hands On: Shoulder Exam J. Scott Delaney Fontaine FD-05 Update on Adult Vaccination Christina Greenaway Fontaine ED-06 Preventing and Managing Musculoskeletal Injuries Ian Shrier Fontaine GD-07 Depression Fiore Lalla Jacques-CartierD-08 Addictions John Sader St-PierreD-09 Sedentary Life Style Risk Factor Even in Active People Ivan Rohan LongueuilD-10 Parkinsons Early Detection Liam Durcan Fontaine H


11:00 – 12:00 WORKSHOPS E

E-01 Chronic Constipation: It’s Time to Get Moving Gaetano Morelli Fontaine DE-02 GER: How to Deal with Varicose Veins in Your Practice John Rowen Fontaine EE-03 PEDS: Common Pediatric Problems Stephen Treherne LongueuilE-04 Hands On: Knee Exam J. Scott Delaney Fontaine FE-05 Decreasing Health Disparities: Screening and Health

Promotion in Newly Arrived Migrants Christina Greenaway FundyE-06 Andropause Workshop Peter Chan Fontaine GE-07 MainPRO Credits Update Leonora Lalla Pointe-Aux-TremblesE-08 Gambling John Sader St-PierreE-09 Advanced Directives - Giving Hope in a Hopeless Situation Michael A. Dworkind Jacques-CartierE-10 Neurology Exam Liam Durcan Fontaine H

PROGRAM OVERVIEW


PROGRAM " TUESDAY, NOVEMBER 27, 2012A question period will follow all lectures on all days.

12:00 – 12:45 LUNCH!TIME EDUCATIONAL FORUM 3Moderator • Najmi NazeraliC.A.R.E. in ACS Dominique Joyal Verdun


13:30 – 15:35 PLENARY 4Afternoon Chair • Adrian Macek

13:30 – 14:00 P4.1 Vitamin D Bone and Non Bone Indications Suzanne Morin Westmount

14:00 – 14:30 P4.2 Family Travel Vaccinations Michael D. Libman Westmount

14:30 – 14:35 Exercise Stretch Carolyne Dubé

14:35 – 15:05 P4.4 Update in Contraception Cleve Ziegler Westmount

15:05 – 15:35 P4.5 CMPA - Social Media Sue Swiggum Westmount


16:00 – 17:00 WORKSHOPS FF-01 ER: Psychiatric Emergencies Hani Iskandar Jacques-CartierF-02 GER: Delirium Evaluation Eric Tremblay Fontaine DF-03 PEDS - Tongue-tie and Breastfeeding Florence Tremblay St-PierreF-04 Introduction to Ultrasound of the Lung:

A Simple Approach for the Non-Radiologist Sebastian Negrete Fontaine EF-05 Common Infections in Travelers Michael D. Libman Fontaine FF-06 Update on Cervical Cancer Screening Cleve Ziegler Fontaine GF-07 Information Services for Updating Clinical Knowledge Roland Grad Pointe-Aux-TremblesF-08 Osteoporosis Update Suzanne Morin & Ivan Rohan Fontaine HF-09 How to Prescribe Exercise in a 5 Minute O!ce Visit Ilka Lowensteyn LongueuilF-10 O!ce Practice Risk Management Sue Swiggum Fundy

17:00 – 18:00 EVENING EDUCATIONAL FORUM 4Moderator • Adrian MacekFA-CILITER Program - Quest for Optimal Care of Patientswith Atrial-Fibrillation (Fibrillation Auriculaire dans une Clinique Intégrée pour LImiTer les événEments thRombo-emboliques) Thao Huynh Verdun

PROGRAM OVERVIEW


PROGRAM " TUESDAY, NOVEMBER 27, 2012A question period will follow all lectures on all days.



07:00 – 07:45 BREAKFAST EDUCATIONAL FORUM 5Moderator • TBABenign Prostatic Hyperplasia Keith Matthews Verdun

08:00 – 10:05 PLENARY 5Morning Chair • Najmi Nazerali

08:00 – 08:30 P5.1 Update in Pain Management Mark Ware Westmount

08:30 – 09:00 P5.2 Dermatologic Manifestation of Systemic Disease Beatrice Wang Westmount

09:00 – 09:05 Exercise Stretch Carolyne Dubé

09:05 – 09:35 P5.4 The Diabetic Epidemic: Can Family Docs Halt It? Tina Kader Westmount

09:35 – 10:05 P5.5 Crystallizing the Approach to Gout and Pseudogout Michael R. Starr Westmount

10:05 – 10:30 Refreshment Break Foyer

10:30 – 11:30 WORKSHOPS GG-01 ER: Primary Immunode#ciencies: A Simple Approach Reza Alizadehfar Pointe-Aux-TremblesG-02 GER: Some Strategies for Stopping Medications in

the Elderly Louise Mallet Fontaine DG-03 PEDS: Oral Allergy Syndromes Christine McCusker Fontaine EG-04 Hands On: Practical Tips for Joint Injections Michael R. Starr Fontaine FG-05 Practical Tips for Pain Management Mark Ware Fontaine GG-06 Managing the Millennial Diabetic Tina Kader Fontaine HG-07 Practical Computing in Clinical Practice Daniel E. Lalla FundyG-08 Hands On Examination of the Lumbar Spine and Sacro-

Iliac Joint - A Family Physician’s Guide to Low Back Pain Robert Perlman Jacques-CartierG-09 Why You May Be Missing Elder Abuse in Your Practice Mark Ya"e St-PierreG-10 Syncope Bruce Campbell Longueuil

11:30 – 12:15 LUNCH!TIME EDUCATIONAL FORUM 6Moderator • Barry FineTreatment and ManagEment Approaches in Multi-FacetedDiabetes Care Stavroula Christopoulos Verdun


PROGRAM OVERVIEW


PROGRAM " WEDNESDAY, NOVEMBER 28, 2012A question period will follow all lectures on all days.

13:00 – 16:30 PLENARY 6Afternoon Chair • Daniel E. Lalla

13:00 – 13:30 P6.1 Opportunities and Challenges for Family Medicine in the 21st Century (David J.G. Tector Memorial Lecture) Howard Bergman Westmount

13:30 – 14:00 P6.2 Chemical is Not a Four-Letter Word Joseph A. Schwarcz Westmount

14:00 – 14:30 P6.3 Non Traumatic Ophthalmic Emergencies Marino Discepola Westmount

14:30 – 14:55 Exercise Stretch & Refreshment Break Carolyne Dubé Foyer

14:55 – 16:30 PLENARY 6 #cont’d$Afternoon Chair • Daniel E. Lalla

14:55 – 15:25 P6.4 Medication Interactions Jacques Turgeon Westmount

15:25 – 15:55 P6.5 Street Drugs: What’s New? Pierre-Paul Tellier Westmount

15:55 – 16:25 P6.6 Diagnosis and Treatment of Psoriasis: New Insights David Gratton Westmount

16:25 – 16:35 P6.7 Closing Remarks Ivan Rohan Westmount

PROGRAM OVERVIEW


PROGRAM " WEDNESDAY, NOVEMBER 28, 2012A question period will follow all lectures on all days.

Alizadehfar, Reza MD, FRCP(C)Assistant Professor, Division of Allergy and Clinical Immunology,Montréal Children’s Hospital, MUHC

Benaroch, Thierry MD, FRCS(C), FAAOSSite Director, Pediatric Orthopedic Surgery and TraumaProgram, Montréal Children’s Hospital, MUHC

Bergman, Howard MDProfessor and Chair, Family Medicine, McGill University

Boucher, Lucie MDProfesseur adjoint, Médecine-Gériatrie, Université de Montréal

Campbell, Bruce MD, FRCP(C)Assistant Professor of Medicine, Internal Medicine, Departmentof Medicine, St. Mary’s Hospital Center

Carrier, Joel LL.L, M.Fisc.Director, Private Wealth, Tax and Estate Planning, BMO HarrisPrivate Banking

Carrier, Serge MDAssociate Professor, Surgery, Division of Urology,McGill University

Chan, Peter MD, CM, MSc., FRCS(C), FACSDirector of Male Reproductive Medicine, Division of Urology;Associate Professor, Department of Surgery, MUHC

Chiu, Wendy MD, CM, FRCP(C)Assistant Professor (Clinical) and Physician, Division of GeriatricMedicine, Department of Medicine, McGill University; MedicalDirector, Geriatric Day Hospital, Royal Victoria Hospital, MUHC

Christopoulos, Stavroula MDAssistant Professor, Medicine, McGill University; Full Time Staff,Division of Endocrinology, Jewish General Hospital

Constantin, Evelyn MDSleep Laboratory and the Division of General Pediatrics,Montréal Children’s Hospital

Dannenbaum, David MD, CCFPProgram Committee Member; Department of Family Medicine,McGill University; Herzl Family Medicine Unit, Jewish GeneralHospital

Delaney, J. Scott MDCM, FRCP(C), FACEPResearch Director, Department of Emergency Medicine, MUHC;Team Physician, Montréal Alouettes, Impact and Cirque duSoleil

Discepola, Marino MD, DABO, FRCS(C), SMHAssistant Professor, Department of Ophthalmology, McGillUniversity, Royal Victoria Hospital, St. Mary’s Hospital

Durcan, Liam MD, FCRP(C)Assistant Professor, Department of Neurology and Neurosurgery, McGill University; Consultant Neurologist,Montréal Neurological Hospital and Institute

Dworkind, Michael A. MDAssistant Director, Herzl Family Practice Centre; Director, LivingWill Project of the Clinical Ethics Committee, SMBD-JewishGeneral Hospital; Associate Professor, Department of FamilyMedicine, McGill University

Elie, Michel MD, FRCP(C)Assistant Professor, Department of Psychiatry, McGill University;Director, Psychiatry, St. Mary’s Hospital Centre

Forbes, Patricia MB, Ch.BDirector, Spina Bifida Service; Staff Paediatrician, MontréalChildren’s Hospital; Associate Professor, McGill University

Gauthier, Serge MD, FRCP(C) (Neurology)Director, Alzheimer Disease Research Unit, McGill Center forStudies in Aging, Douglas Mental Health Research Institute;Professor, Departments of Neurology and Neurosurgery,Psychiatry, Medicine, McGill University

Gilbert, Lucy MD, MSc., FCFPProfessor, Department of Obstetrics and Gynecology; Director,Gynecological Oncology, Department of Oncology, McGillUniversity; Director of Gynecologic Cancer Service, Women’sHealth Mission of McGill, MUHC

Gore, Brian MDDirector of Professorial Services, Donald Berman MaimonidesGeriatric Centre, McGill University

Goulet, François MD, MA (Educ), CMFCLFDirecteur adjoint, Développement professionnel continu (DPC),Collège des Médecins du Québec; Clinical Professor, FamilyMedicine, Université de Montréal

Grad, Roland MD, MSc., FCFPAssociate Professor, Department of Family Medicine, McGill University

Gratton, David MD, FRCP(C)Associate Professor, Medicine, Dermatology, McGill University

Greenaway, Christina MD, FRCP(C), MSc.Associate Professor of Medicine, Department of Medicine,McGill University; Staff Physician, Department of Medicine,Jewish General Hospital; Project Director, Division of InfectiousDiseases, Division of Epidemiology, Lady Davis Institute

Huynh, Thao MDCardiologist, Montréal General Hospital; Associate Professor of Medicine, Royal Victoria Hospital

Iskandar, Hani MDMedical Chief, Intensive Care Unit, Emergency, BriefIntervention Unit, Electroconvulsive Therapy Unit; Coordinator,Continuing Medical Education, Douglas Institute; AssociateProfessor, Department of Psychiatry, McGill University

Iqbal, Sameena MDProgram Director, Nephrology Fellowship Program, RoyalVictoria Hospital, MUHC

PROGRAM OVERVIEW


COURSE FACULTY

Joyal, Dominique MDInterventional Cardiologist; Assistant Professor, Medicine, McGillUniversity; Division of Cardiology, Jewish General Hospital

Kader, Tina MD, FRCP(C), CDEAssistant Professor, Department of Medicine, McGill University;Certified Diabetes Educator

Karanofsky, Mark MD, CM, CCFP Faculty Lecturer, Department of Family Medicine, McGillUniversity

Kostiuk, David Paul MDFaculty of Medicine, McGill University

Ladouceur, Roger MD, MSc., CCMF, FCMFAssociate Professor, Family Medicine, Faculty of Medicine,Université de Montréal; Associate Editor, Canadian FamilyPhysician; Family Practitioner, Centre hospitalier de Verdun

Lalla, Daniel E. MDCM, FCFP Program Committee Member; Faculty Lecturer, McGill FamilyMedicine, McGill University; Coordinator, Cowansville MedicalClinic

Lalla, Fiore MDPsychiatrist; Medical Director of Psychiatric Services West ofMontréal

Lalla, Leonora MDCM, CCFPFaculty Lecturer and Undergraduate Program Director,Department of Family Medicine, McGill University; FamilyPhysician, Family Medicine Centre, St. Mary’s Hospital

Libman, Michael D. MDDepartment of Medical Microbiology and Division of InfectiousDisease, MUHC; Associate Professor, Faculty of Medicine, McGillUniversity

Lipman, Mark MDChief, Division of Nephrology, Jewish General Hospital;Associate Physician-in-Chief, Department of Medicine, McGillUniversity

Lowensteyn, Ilka PhDClinical Research Director, McGill Comprehensive HealthImprovement Programme; Medical Scientist, Montréal GeneralHospital Research Institute; Adjunct Assistant Professor, McGillUniversity

Luconi, Francesca PhDAssistant Dean and Academic Associate, Continuing HealthProfessional Education, Faculty of Medicine, McGill University

Macek, Adrian MDCM, CCFPProgram Committee Member; Assistant Professor, Departmentof Family Medicine, McGill University; Cowansville Medical Clinic

Mallet, Louise BSc.Pharm, PharmD., CGPProfessor in Clinical Pharmacy, Faculty of Pharmacy, Universitéde Montréal; Clinical Pharmacist in Geriatrics, Royal VictoriaHospital, MUHC

Matthews, Keith MD, FRSC(C)Assistant Professor, Division of Urology, St. Mary’s HospitalCenter; McGill University Director

Mardigyan, Vartan MD, FRCP(C)Assistant Professor of Medicine, Cardiology/Arrhythmia, McGillUniversity

McCusker, Christine MD, MSc.Associate Professor, Pediatrics, Montréal Children’s Hospital,MUHC; Research Director, Meakins-Christie Laboratories;Director, Clinical Immunology Laboratory, McGill University

Morelli, Gaetano MD, FRCP(C)Director of Gastroenterology, St. Mary’s Hospital; Staff Physician,MUHC; Assistant Professor, Medicine, McGill University

Morin, Suzanne MD, MSc, FRCP, FACPDirector, Internal Medicine Clinic, Montréal General Hospital;Associate Professor, Department of Medicine, McGill University

Narasiah, Lavanya MD, MSc., CCFPProgram Committee Member; Family Practitioner, Programmerégional d’accueil et d’intégration des demandeurs d’asile

Nazerali, Najmi MD, CCFP, FCFPProgram Committee Member; Assistant Professor, Departmentof Family Medicine, University of British Columbia

Negrete, Sebastian MDCMFamily Physician, Department of Family Medicine, MUHC;Secondary Care Division, MUHC Lachine Campus

Olivenstein, Ron MD, FRCP(C)Associate Professor, Medicine, McGill University; MedicalDirector, Montréal Chest Institute, MUHC

Palayew, Mark David MDCM, FRCP(C)Assistant Professor, Respiratory Diseases, McGill University

Pavilanis, Alan MD, CM, CCFP, FCFP, Dip.Epi.Director, Family Medicine Centre, St. Mary's Hospital Centre;Associate Professor, Family Medicine, McGill University

Perlman, Robert BSc. MDCM, CCFP, FCFP, AMEDirector, Mediservice; Attending Physician; Associate Professor,Department of Family Medicine, Jewish General Hospital, McGillUniversity

Radhakrishna, Mohan MD, FRCP(C), Dip. Sport MedAssistant Professor, Physical Medicine and Rehabilitation, McGillUniversity

Rohan, Ivan MD, CCFPAssociate Dean CHPE; Assistant Professor, Family MedicineDepartment, Faculty of Medicine, McGill University

Rowen, John MD, CCFPEmergency, St. Mary’s Hospital; Assistant Professor, FamilyMedicine, McGill University

Rudski, Lawrence MD, FACC, FASEAssociate Professor, Medicine, McGill University; Director ofNon-Invasive Cardiology, Jewish General Hospital

PROGRAM OVERVIEW


COURSE FACULTY

Sader, John MD, BSc., ASAM-certified, ABAMAssociate Professor, Department of Family Medicine, McGillUniversity

Schulz, Jan MD, FRCP(C), FACPProgram Committee Member; Associate Professor, Departmentof Medicine, McGill University

Schwarcz, Joseph A. PhDDirector, Office for Science and Society, McGill University

Shir, Yoram MDAssociate Member, Pharmacology and Therapeutics, MontréalGeneral Hospital; Professor of Anesthesia, Edwards Chair inClinical Pain; Director, Alan Edwards Pain Management Unit,MUHC

Shrier, Ian MD, PhD, Dip. Sport Med, FACSM Associate Professor, Department of Family Medicine, McGillUniversity; Associate Professor, Centre for Clinical Epidemiology,Jewish General Hospital

Shulman, H. Mitchell MDCM, FRCP(C), CSPQ Assistant Professor, Department of Surgery, McGill University;Associate Professor, Family Medicine, St. Mary's Hospital Centre;Attending Physician, Emergency Room, Royal Victoria Hospital,MUHC

St-Cyr, Julie MDCM, FRCP(C)Director, Biochemistry Department, St. Mary’s Hospital Centre;Assistant Professor, Department of Pathology, McGill University;Consultant Biochemistry Laboratory, CHL, Ste-Agathe

Starr, Michael R. MD, FRCP(C)Assistant Professor, Department of Rheumatology, Faculty ofMedicine, McGill University

Stein, Michael MDCM, FRCP(C)Assistant Professor, Department of Rheumatology, Faculty ofMedicine, McGill University

Swiggum, Sue FRCP(C)Senior Physician Risk Manager, Education Department RiskManagement Services, CMPA

Tagalakis, Vicky MDAssociate Professor, Department of Medicine, McGill University;Research Scientist, Centre for Clinical Epidemiology, Lady DavisInstitute for Medical Research; Attending Physician, Departmentof Medicine, Jewish General Hospital

Tellier, Pierre-Paul MDAssociate Professor, Department of Family Medicine; Director of Student Health, McGill University

Treherne, Stephen MD, BSc.,Medicine, McGill University

Tremblay, Eric MDAssistant Professor, Department of Family Medicine; MedicalDirector, International Medical Graduates Program, McGillUniversity; Attending Physician, Intensive Care Unit, St. Mary’sHospital

Tremblay, Florence MD, CFPCFaculty Lecturer, Family Medicine, McGill University; AssistantDirector, Family Medicine Center, St. Mary’s Hospital

Tremblay, Guy MD, FCPrincipal Investigator, CHA, Department of Medicine, Centrehospitalier universitaire, Hôpital Saint-Sacrement

Trudeau, Luc MDAssistant Professor, Division of Internal Medicine, CardiovascularPrevention Centre, Jewish General Hospital

Turgeon, Jacques B.Pharm, PhDProfessor, Faculty of Pharmacy, Université de Montréal; Directorof Research, Research Centre, CHUM

Vetere, Phyllis MD, CCFP, EMAttending Physician, Montréal General Hospital, MUHC, RoyalVictoria Hospital

Viladevall, Hugo MD, CM, CCFP (EM)Faculty Lecturer, Family Medicine, McGill University; EmergencyPhysician, Intensivist, St. Mary’s Hospital

Wang, Beatrice MD, FRCP, CSPQ, FAADAssistant Professor, Department of Medicine, Dermatology,McGill University; Director, Melanoma Clinic, Department ofOncology, Royal Victoria Hospital, MUHC

Ware, Mark MD, MSc.Director, Clinical Research, MUHC; Departments of Anesthesiaand Family Medicine, Pain Clinic

Wein, Theodore MD, FRCP(C)Assistant Professor, Department of Neurology andNeurosurgery, Montréal General Hospital

Yaffe, Mark MD, MCIScProfessor, Family Medicine, McGill University, St. Mary’s Hospital

Ziegler, Cleve MD, FRCS(C), CSPQAssistant Professor, Department of Ob/Gyn, McGill University;Attending Physician, Department of Ob/Gyn, SMBD–JewishGeneral Hospital

Zigman, Michael MDCMProgram Committee Member; Department of Family Medicine,Jewish General Hospital

PROGRAM OVERVIEW


COURSE FACULTY

Notes :

Monday, November 26 Lawrence Rudski 09:00-09:30PL.1-3 Valvular Disease: When to Refer Westmount






Notes :

Monday, November 26 Vicky Tagalakis 09:35-10:05PL.1-5 New Anticoagulation Drugs Westmount






Notes :

Monday, November 26 Theodore Wein 10:05-10:35PL.1-6 CVA Acute and Chronic Management Westmount


Monday, November 26 Theodore Wein 10:05-10:35PL.1-6 CVA Acute and Chronic Management Westmount



Monday, November 26 Theodore Wein 10:05-10:35PL.1-6: HANDOUT CVA Acute and Chronic Management Westmount







Monday, November 26 Phyllis Vetere 11:00-12:00A-01 ER – Acute Coronary Syndromes Fontaine D


Monday, November 26 Phyllis Vetere 11:00-12:00A-01 ER – Acute Coronary Syndromes Fontaine D


Monday, November 26 Patricia Forbes 11:00-12:00A-03 PEDS: Treatment and Investigations of UTI in Pediatrics Fontaine F


Notes :

Medical or Clinical Guideline MUHC

Medication included No Medication included

THIS IS NOT A MEDICAL ORDER

Title: Montreal Children’s Hospital Guideline for the Management of First Urinary Tract Infection (UTI)

This guideline is attached to:

INTRODUCTION UTIs are a common cause of fever in children. In the past, there was concern that a significant number of children with UTI would go on to develop renal scarring and ultimately hypertension and chronic renal failure. (Craig 2000, Coulthard 2008, Jodal 2006, Piepsz 2001 [K]) Vesicoureteral reflux (VUR) was considered an important contributor to end-stage renal disease. Guidelines were developed (AAP 1999 [S]) emphasizing imaging and the importance of appropriate antibiotic treatment. (Hoberman 1999 [N,Q] New AAP Guideline (Aug 2011 [O]) modifies some of their previous conclusions on imaging and prophylaxis. Over the last 30-40 years, accumulated evidence and experience has resulted in a better knowledge of outcomes, the role of VUR, treatment regimens, and therefore a rethinking of existing guidelines. However, there is no consensus, each centre developing its own recommendations. The recommendations in this guideline have been developed at the Montreal Children’s Hospital (MCH) starting with a review of the NICE UK guidelines (2007 [S, O]) followed by an extensive review of the current literature up to 2011. The format followed is similar to that developed by Cincinnati Children’s Hospital Medical Centre in 2006, though the conclusions and reference list are those of the MCH. These guidelines will apply to the majority of first UTIs, but are not a substitute for clinical judgment and experience. The references are coded based on Publication Types of PubMed (2011), as follows:

A. Case-control studies B. Clinical trial C. Cohort studies D. Comment E. Comparative study F. Congresses G. Cross-sectional studies H. Editorial I. Evaluation studies J. Follow-up studies

K. Guideline L. Letter M. Meta-analysis N. Multicenter studies O. Practice guideline P. Prospective studies Q. Randomised controlled trial R. Retrospective studies S. Review T. Validation studies

X. Local expert consensus

M

Monday, November 26 Patricia Forbes 11:00-12:00A-03 : HANDOUT PEDS: Treatment and Investigations of UTI in Pediatrics Fontaine F


































Notes :


Monday, November 26 Mohan Radhakrishna 11:00 – 12:00A-04 Hands On: Practical Neck Pain Physical Examination: Sorting out the Zebras from the Horses Fontaine G

Notes :

Monday, November 26 Mark Lipman 11:00-12:00A-05 Renal Failure and Use of Medications Fontaine H


Notes :

Monday, November 26 Theodore Wein 11:00-12:00A-06 CVA Management Jacques-Cartier








Monday, November 26 Brian Gore 11:00-12:00A-08 Don’t Fall Behind the Changing Technological Terrain for BP Measurements Pointe-Aux-Trembles


Monday, November 26 Brian Gore 11:00-12:00A-08 Don’t Fall Behind the Changing Technological Terrain for BP Measurements Pointe-Aux-Trembles


Monday, November 26 Luc Trudeau 11:00-12:00A-09 The Link Between Hypertension and Atrial Fibrillation St-Pierre






Notes :

Monday, November 26 Guy Tremblay 11:00-12:00A-10 Évaluation et diminution du risque CV chez les femmes atteintes d’hypertension Longueuil








Monday, November 26 Roger Ladouceur 14:05-14:35PL.2-3 How to Respect the Rules Westmount






Notes :

Monday, November 26 H. Mitchell Shulman 14:35-15:35B-01 ER - Procedures St-Pierre


Monday, November 26 H. Mitchell Shulman 14:35-15:35B-01 ER - Procedures St-Pierre



Monday, November 26 H. Mitchell Shulman 14:35-15:35B-01: HANDOUT ER - Procedures St-Pierre

ER: Common Procedures

H. Mitchell Shulman MDCM, FRCPC, CSPQ

Assistant Professor, Department of Surgery, McGill University;

Associate Professor, Family Medicine, St. Mary's Hospital Centre;

Attending Physician, Emergency Room, Royal Victoria Hospital

This workshop focuses on some techniques that will get you and your

patient out of trouble. We will concentrate on the ABC’s:

Airway: cricothyroidotomy and other tricks to deal with a difficult airway;

Breathing: chest tube placement and management;

Circulation: venous cutdowns and intraosseous line placement.

Cricothvroidotomy

Inability to intubate the trachea is the primary indication for creating a surgical airway;

specifically where oral/nasal endotracheal intubation is impossible.

For example: obstruction / facial trauma / severe hemorrhage / laryngeal

fracture / laryngospasm / laryngeal stenosis / etc.

A) Surgical

Contra-indications:

1. Age: Should not be performed in children less than 5 years of age (needle

cricothyroidotomy instead); ? in children from 5 to 10 years (note: ATLS says 12);

2. Pre-existing laryngeal pathology: cancer, inflammation, infection;

3. Inexperience with the technique!!!!!

4. Anatomical distortion;

5. Coagulopathy (!!!!!)

Technique:

The cricothyroid membrane (approx. 10 mm high; 22 mm. wide) spans the space between

the thyroid cartilage superiorly and the cricoid cartilage inferiorly. The vocal cords are at

least 1 cm above the membrane. The superior cricothyroid vessels (branches of the

superior thyroid artery) run transversely across the upper 1/3 of the membrane, which is

why you’re supposed to try and enter the membrane through the inferior 1/3. The anterior

jugular veins run vertically laterally.

The key is to be prepared in advance. Have a kit of some sort already set up, checked on

a regular basis and somewhere where you and your staff can find it quickly (for example:

with your intubation kit). It need not be very elaborate. A scalpel (#11 blade); a cuffed

tracheostomy tube (ID 6.5 or 7 e.g. #4 Shiley) are the minimum. If you want to use one of

the prepared kits just make certain you’ve practiced with it in advance!

Surgically prep the site as time and circumstances allow. Identify the laryngeal

prominence “Adam’s apple” and the hyoid bone above it. If you are right-handed: stand

on the patient’s right side and use the thumb and the middle finger of the left hand to

grasp the upper poles of the thyroid cartilage. The left index finger rests on cricothyroid

membrane. Incise the skin vertically in the midline down to the membrane.

Recheck your landmarks.


-2-

Leave the left index finger at the most inferior pole of the thyroid cartilage then incise the

membrane transversely in the inferior 1/3 of the membrane at least 1.5 cm long. Remove

the scalpel, insert a tracheal hook for traction or use a hemostat by introducing it into the

incision and then opening it to introduce the tracheostomy tube (whose balloon you of

course remembered to check before you started the procedure!).

Remove the dilator, inflate the balloon and ventilate the patient.

Confirm the tube’s position (auscultate, chest x-ray).

B) Percutaneous “Needle” Tracheal Ventilation

Method of choice in children.

Contraindications:

!!Be careful with partial airway obstruction and especially with complete airway

obstruction. Pneumothorax and worse can happen if there is complete expiratory

obstruction.

Technique:

With the patient supine, identify the landmarks and prep and anesthetize the area as the

situation allows. Puncture the skin with a # 12 or #14 gauge catheter-over-the-needle

attached to a 10 ml. syringe in the midline, directly over the cricothyroid membrane at an

angle of 45 degrees caudally, aspirating as the needle is advanced. The aspiration of air

indicates entry into the tracheal lumen. At that moment advance the catheter while

gently withdrawing the stylet. Connect to oxygen at 15L/min. Chest movement controls

the time that oxygen flows into the patient (a maximum of 1 second allowing 4 seconds

for passive exhalation). Secure the catheter and confirm its position (auscultation,

chest x-ray).

If coughing is a problem, instill 2 ml 4% lidocaine through the catheter.

Chest Tubes

A) Tube Thoracostomy: to evacuate an abnormal accumulation of air or fluid from the

normally closely approximated visceral and parietal pleura. The rate of collection and the

amount that has accumulated will determine the extent of the problem!

Important clinical point:

a pneumothorax is most easily seen in a full expiration view on CXR.

Indications:

Any pneumothorax if the patient is: on a ventilator / going to surgery / must be

transported / open “sucking” chest wound / tension / bilateral / increasing.

Otherwise as per usual criteria.

Contraindications:

Are there really any? Need for immediate thoractomy? Clotting dysfunction?

Multiple pleural adhesions / scarring?


-3-

Technique:

Set the patient up properly with an IV line in place, breathing 100% oxygen, oxygen

saturation / EKG / BP monitoring applied. Measure the distance the tube will have to

travel and mark the chest tube in advance (the tip will be at the apex of the lung). This

will tell you how far in the tube will need to go. Prepare your water seal / suction

apparatus.

Use the biggest available tube for trauma (36 – 42 Fr.); an 18 – 22 Fr. for a

pneumothorax. The patient is in the semi-Fowler or in the lateral decubitus position with

the arm placed out of the way. Find the 5th intercostal space (usually at the level of the

nipple or the inferior scapular border), midaxillary line. Prep and anesthetize the patient

as time and circumstances allow. Remember that you can use the anesthetic needle to

confirm your diagnosis. Incise the skin and subcutaneous tissues approximately 3 times

the width of the chest tube directly over the rib 1 interspace below the rib that the tube

will eventually pass over. Use a curved hemostat to dissect the intercostals muscles and

to puncture the pleura just above the upper edge of the rib. Use a gloved finger to check

the incision (clear any adhesions and avoid puncturing the lung, liver, heart, spleen, etc.

etc.). Grasp the end of the chest tube with a curved clamp and advance it posteriorly and

superiorly into the pleural space. Make certain that the last hole of the chest tube is well

within the parietal pleura. Check the position of the tube (“fogging”, air movement, x-

ray). Suture the tube in place and apply a sterile waterproof dressing.

Important things to remember:

Never re-adjust a tube by advancing it (although it can be withdrawn if necessary).

Do not irrigate a tube.

To avoid re-expansion pulmonary edema (risk is increased after the rapid evacuation of a

large {>1000 ml}, long-standing {> 72 hours}effusion) remove the fluid in a slow, step-

wise fashion.

B) Needle Thoracentesis

Indications: Remember to think of it in the patient who presents in P(ulseless) E(lectrical)

A (ctivity) and /or with chest trauma.

Technique:

Prepare the patient as before. Prep and anesthetize as appropriate. Insert a #14 gauge

over-the-needle catheter attached to a syringe just above the rib into the second

intercostal space, mid-clavicular line on the side of the pneumothorax. Aspirate as much

air as you can (if necessary remove the syringe!). Place a proper chest tube. If no air

escapes or the procedure provides no relief think of:

Pericardial tamponade / myocardial contusion / myocardial infarction /

air embolus / etc.




Venous Cutdown

The easiest site is the distal saphenous vein just medial and superior to the medial

maleolus.

Contraindications

a. previous use of that vein (vein stripping, CABG);

b. phlebitis;

c. cellulitis at the site;

d. significant trauma to that extremity;

e. severe venous obstructive disease;

Technique:

Immobilize the leg. Prep and drape and anesthetize as time and the situation permit.

Apply a tourniquet at the mid-leg. Use a transverse skin incision approximately 2 cm

long going through all the layers of the skin (subcutaneous fat should be visible through

the incision). Insert with the concavity of the clamp upward a small “mosquito” hemostat

into the wound and advance scooping up all the tissue. Separate out the vein. At this point

you can either catheterize it as you would any vein or place sutures under the vein; make

a small incision with scissors or a scalpel and advance a catheter into the vein securing

it in place with the proximal suture. Remove the tourniquet. Tie off the distal vein using

the other suture. Close the wound and protect the line.

Important clinical point: Flow is directly proportional to the radius of the tube (raised to

the 4th power) and inversely related to the tube length and the fluid’s viscosity.

Intraosseous

Any substance that can be given intravenously can be given intraosseously. It is wise to

dilute hypertonic, alkaline, or otherwise irritating substances and administer them more

slowly if the situation permits.

Contraindications:

Compromised insertion site (infected / burn / ipsilateral facture). Osteogenesis imperfecta

/ osteopetrosis.


For volume infusion its use is usually limited to children < 5 years of age. However….

The needle tip must be directed away from the joint space and the epiphyseal plate.

Technique:

In children there are 2 commonly recommended sites:

a. proximal tibia (anteromedical flat surface) 1 – 3 cm below and medical to the tibial

tuberosity;

b. distal femur 2 – 3 cm above the epicondyles in the midline directed cephalad at an

angle of 10 – 15 degrees from the vertical.


-5-

In adults:

Distal tibia at the ankle (1 cm above the superior margin of the medial maleolus).

Remember in an adult to use an external pressure bag or pressure device delivering 300

mm Hg to the solution bag.

Immobilize the leg. Prep and anesthetize as time and the situation allow. Use an

intraosseous or bone marrow needle and with the obturator still in place insert at the

chosen site. Once the periosteum is reached redirect the needle at a 45 – 60 degree angle

away from the adjacent joint and advance with a rotating action. When the needle

“pops” into the marrow space remove the obturator, attach an empty syringe and aspirate.

The needle should be able to stand securely. Use a second sterile syringe filled with

normal saline to flush while you palpate the extremity. If a subcutaneous or subperiosteal

fluid collection develops remove the needle, apply pressure to the site and try elsewhere.

When you no longer need the site, remove the catheter and apply local pressure and

appropriate wound care as you would normally for any IV site.


the aspirated blood / bone marrow can be used for a chemstrip / routine biochemistry /

paCO2 / pH / blood culture / type and crossmatch but NOT a complete blood count.

This is a valuable but temporary alternative to intravenous access. It must be replaced.



Notes :


Monday, November 26 Thierry E. Benaroch 14:35-15:35B-03 PEDS – Office Pediatric Orthopaedics – What Not to Miss Fontaine E











Monday, November 26 Thierry E. Benaroch 14:35-15:35B-03: HANDOUT PEDS – Office Pediatric Orthopaedics – What Not to Miss Fontaine E






Notes :

Monday, November 26 Michael Stein 14:35-15:35B-04 Hands On – Joint and Soft Tissue Injections Part 1 Fontaine F



Monday, November 26 Michael Stein 14:35-15:35B-04 Hands On – Joint and Soft Tissue Injections Part 1 Fontaine F

Monday, November 26 Ron Olivenstein 14:35-15:35B-06 Interpretation of PFTs: Spirometry Pointe-Aux-Trembles


Monday, November 26 Ron Olivenstein 14:35-15:35B-06 Interpretation of PFTs: Spirometry Pointe-Aux-Trembles


Monday, November 26 Sameena Iqbal 14:35-15:35B-08 Diagnosis and Management of CKD Fundy



Monday, November 26 Sameena Iqbal 14:35-15:35B-08 Diagnosis and Management of CKD Fundy


Monday, November 26 Julie St-Cyr 14:35-15:35B-09 Laboratory Tests: What to Order – Bring Your Questions Fontaine H







Monday, November 26 François Goulet 14:35-15:35B-10 Planning for Your Retirement: Regulatory and Ethical Aspects Longueuil






Notes :

Monday, November 26 Lucie Boucher 16:00-17:00C-02 GER – Evaluation of Fitness to Drive Fontaine D






Notes :

Monday, November 26 Michael Stein 16:00-17:00C-04 Hands On – Joint and Soft Tissue Injections Part 2 Fontaine F


Monday, November 26 Michael Stein 16:00-17:00C-04 Hands On – Joint and Soft Tissue Injections Part 2 Fontaine F


Monday, November 26 Mark Karanofsky 16:00-17:00C-05 An Introduction to Wound Care Fontaine G






Notes :

Please refer toworkshop B-06

Monday, November 26 Ron Olivenstein 16:00-17:00C-06 Interpretation of PFTs: Spirometry (repeat of B-06) Pointe-Aux-Trembles


Notes :

Please refer toworkshop B-08

Monday, November 26 Sameena Iqbal 16:00-17:00C-08 Diagnosis and Management of CKD (repeat of B-08) Fundy


Notes :


Monday, November 26 Julie St-Cyr 16:00-17:00C-09 Laboratory Tests: Interpretation – Bring Your Questions Fontaine H







Tuesday, November 27 Fiore Lalla 08:00-08:30PL.3-1 Management of Psychiatric Disability Westmount


Tuesday, November 27 Fiore Lalla 08:00-08:30PL.3-1 Management of Psychiatric Disability Westmount


Tuesday, November 27 Serge Gauthier 08:30-09:00PL.3-2 Update on Alzheimer’s Disease from Asymptomatic Stage to Dementia Westmount






Notes :

Tuesday, November 27 Liam Durcan 09:05-09:35PL.3-4 Tremor Differential Diagnosis Westmount






Notes :


Tuesday, November 27 Hugo Viladevall 09:35-10:35D-01 ER – Ultrasound Guided Procedures Fundy

Tuesday, November 27 Hugo Viladevall 09:35-10:35D-01 ER – Ultrasound Guided Procedures Fundy



Tuesday, November 27 Yoram Shir 09:35-10:35D-02: HANDOUT GER – Pain Management in the Elderly Fontaine D

PREVENTING & MANAGING MUSKULOSKELETAL INJURIES

Ian Shrier MD, PhD, Dip Sport Med, FACSM

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.



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 for Injury Prevention

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.



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)

Notes :


Tuesday, November 27 J. Scott Delaney 09:35-10:35D-04: HANDOUT Hands On – Shoulder Exam Fontaine F









Notes :

Tuesday, November 27 Fiore Lalla 09:35-10:35D-07 Depression Jacques-Cartier


Tuesday, November 27 Fiore Lalla 09:35-10:35D-07 Depression Jacques-Cartier


Tuesday, November 27 John Sader 09:35-10:35D-08 Addictions St-Pierre








Tuesday, November 27 Ivan Rohan 09:35-10:35D-09 Sedentary Life Style Risk Factor Even in Active People Longueuil






Notes :

Tuesday, November 27 Liam Durcan 09:35-10:35D-10 Parkinsons Early Detection Fontaine H









Tuesday, November 27 Gaetano Morelli 11:00-12:00E-01 Chronic Constipation: It’s Time to Get Moving Fontaine D





Notes :


Tuesday, November 27 John Rowen 11:00-12:00E-02: HANDOUT GER - How to Deal with Varicose Veins in Your Practice Fontaine E











Tuesday, November 27 Stephen Treherne 11:00-12:00E-03 PEDS - Common Pediatric Problems Longueuil






Notes :


Tuesday, November 27 J. Scott Delaney 11:00-12:00E-04: HANDOUT Hands On – Knee Exam Fontaine F















Tuesday, November 27 Peter Chan 11:00-12:00E-06 Andropause Workshop Fontaine G






Notes :

Tuesday, November 27 Michael A. Dworkind 11:00-12:00E-09 Advanced Directives - Giving Hope in a Hopeless Situation Jacques-Cartier


Tuesday, November 27 Michael A. Dworkind 11:00-12:00E-09 Advanced Directives - Giving Hope in a Hopeless Situation Jacques-Cartier


Tuesday, November 27 Liam Durcan 11:00-12:00E-10 Neurology Exam Fontaine H








Tuesday, November 27 Dominique Joyal 12:00-12:45EDUCATIONAL FORUM 3 C.A.R.E. in ACS Verdun


Tuesday, November 27 Dominique Joyal 12:00-12:45LUNCH EDUCATIONAL FORUM 3 C.A.R.E. in ACS Verdun


Tuesday, November 27 Dominique Joyal 12:00-12:45LUNCH EDUCATIONAL FORUM 3 C.A.R.E. in ACS Verdun


Notes :

Tuesday, November 27 Suzanne Morin 13:30-14:00PL.4-1 Vitamin D Bone and Non Bone Indications Westmount






Notes :

Tuesday, November 27 Michael D. Libman 14:00-14:30PL.4-2 Family Travel Vaccinations Westmount


Tuesday, November 27 Michael D. Libman 14:00-14:30PL.4-2 Family Travel Vaccinations Westmount


Tuesday, November 27 Cleve Ziegler 14:35-15:05PL.4-4 Update in Contraception Westmount










Notes :

Tuesday, November 27 Hani Iskandar 16:00-17:00F-01 ER - Psychiatric Emergencies Jacques-Cartier










Notes :

Tuesday, November 27 Eric Tremblay 16:00-17:00F-02 GER – Delirium Evaluation Fontaine D






Notes :


Tuesday, November 27 Florence Tremblay 16:00 – 17:00F-03 PEDS - Tongue-tie and Breastfeeding St-Pierre





Notes :

Tuesday, November 27 Sebastian Negrete 16:00-17:00F-04 Introduction to Ultrasound of the Lung: A Simple Approach for the Non-Radiologist Fontain E


Tuesday, November 27 Sebastian Negrete 16:00-17:00F-04 Introduction to Ultrasound of the Lung: A Simple Approach for the Non-Radiologist Fontain E



Tuesday, November 27 Michael D. Libman 16:00-17:00F-05 Common Infections in Travelers Fontaine F


Tuesday, November 27 Michael D. Libman 16:00-17:00F-05 Common Infections in Travelers Fontaine F

Tuesday, November 27 Cleve Ziegler 16:00-17:00F-06 Update on Cervical Cancer Screening Fontaine G






Notes :

Tuesday, November 27 Roland Grad 16:00-17:00F-07 Information Services for Updating Clinical Knowledge Pointe-Aux-Trembles






Notes :

Tuesday, November 27 Ilka Lowensteyn 16:00-17:00F-09 How to Prescribe Exercise in a 5 Minute Office Visit Longueuil


Tuesday, November 27 Ilka Lowensteyn 16:00-17:00F-09 How to Prescribe Exercise in a 5 Minute Office Visit Longueuil


Tuesday, November 27 Thao Huynh 17:00-18:00EDUCATIONAL FORUM 4 FA-CILITER Program - Quest for Optimal Care of Patients with Atrial-Fibrillation Verdun






Notes :

Wednesday, November 28 Keith Matthews 07:00-07:45EDUCATIONAL FORUM 5 Benign Prostatic Hyperplasia Verdun






Notes :


Wednesday, November 28 Keith Matthews 07:00-07:45EDUCATIONAL FORUM 5: HANDOUT Benign Prostatic Hyperplasia Verdun
































Wednesday, November 28 Mark Ware 08:00-08:30PL.5-1 Update in Pain Management Westmount


Wednesday, November 28 Mark Ware 08:00-08:30PL.5-1 Update in Pain Management Westmount

Wednesday, November 28 Mark Ware 08:00-08:30PL.5-1: HANDOUT Update in Pain Management Westmount


























































Notes :


Wednesday, November 28 Tina Kader 09:05-09:35PL.5-4 The Diabetic Epidemic: Can Family Docs Halt It? Westmount





Notes :

Wednesday, November 28 Reza Alizadehfar 10:30-11:30G-01 ER: Primary Immunodeficiencies: A Simple Approach Pointe-Aux-Trembles






Notes :


Wednesday, November 28 Louise Mallet 10:30-11:30G-02 GER – Some Strategies for Stopping Medications in the Elderly Fontaine D





Notes :


Wednesday, November 28 Louise Mallet 10:30-11:30G-02:HANDOUT GER – Some Strategies for Stopping Medications in the Elderly Fontaine D
































Wednesday, November 28 Christine McCusker 10:30-11:30G-03 PEDS - Oral Allergy Syndromes Fontaine E


Wednesday, November 28 Christine McCusker 10:30-11:30G-03 PEDS - Oral Allergy Syndromes Fontaine E


Wednesday, November 28 Michael R. Starr 10:30-11:30G-04: HANDOUT Hands On – Practical Tips for Joint Injections Fontaine F












Wednesday, November 28 Tina Kader 10:30-11:30G-06 Managing the Millenial Diabetic Fontaine H








Wednesday, November 28 Robert Perlman 10:30 – 11:30G-08 Hands On Examination of the Lumbar Spine and Sacro-Iliac Joint - Jacques-Cartier

A Family Physician’s Guide to Low Back Pain

Notes :


Wednesday, November 28 Mark Yaffe 10:30-11:30G-09 Why You May be Missing Elder Abuse in Your Practice St-Pierre





Notes :


Wednesday, November 28 Bruce Campbell 10:30-11:30G-10: HANDOUT Syncope Longueuil

Notes :


Wednesday, November 28 Stavroula Christopoulos 11:30-12:15EDUCATIONAL FORUM 6 Treatment and ManagEment Approaches in Multi-Faceted Diabetes Care Verdun








Wednesday, November 28 Marino Discepola 14:00-14:30PL.6-3 Non Traumatic Ophthalmic Emergencies Westmount





Notes :


Wednesday, November 28 Jacques Turgeon 14:55 – 15:25PL.6-4 Medication Interactions Westmount





Notes :


Wednesday, November 28 Pierre-Paul Tellier 15:25-15:55PL.6-5 Street Drugs: What’s New? Westmount








Wednesday, November 28 David Gratton 15:55-16:25PL.6-6 Diagnosis and Treatment of Psoriasis: New Insights Westmount





Notes :

Abergel, HeidiMontréal, QC

Adams, RobertAlexandria, ON

Akriotis, VanScarborough, ON

Alavi, ShaziaCambridge, ON

Albert, AndrewBurks Falls, ON

Albert, DeborahBurks Falls, ON

Albright, BenMontréal, QC

Alexopoulos, KarenGuelph, ON

Alipour, ShahryarBrossard, QC

Alper, DeborahMontréal, QC

Arcelin, KatiaMontréal, QC

Archambault, MaryseLac Beauport, QC

Aspler, AvivaCôte-St-Luc, QC

Assayag, Yan RaphaelMontréal, QC

Auger, MarcRivière-Bleue, QC

Babakifard, KatayounQuébec, QC

Balendra, HaranMontréal, QC

Barab, TamilaOutremont, QC

Barezpour, MohammadrezaMont-Royal, QC

Barrs, GaryWestmount, QC

Beauchesne, ChristianGranby, QC

Bedkowska, AnnaVerdun, QC

Beintema, ChristenaToronto, ON

Bernatchez, AnneBrossard, QC

Bernstein, RobertDollard-des-Ormeaux, QC

Berthiaume, RenéeTrois-Rivières, QC

Bienkowski, HalinaAmherst, NS

Bienkowski, KrzysztofAmherst, NS

Blach, PeterCornwall, ON

Blonde, YvonneOttawa, ON

Boersma, RobertArnprior, ON

Bouchard, JacquesLa Malbaie, QC

Bouhadana, MichaelMontréal, QC

Bourbonnais, AnneFarnham, QC

Bourkas, Angelo-EdouardMontréal, QC

Boyle, StefanPetawawa, ON

Brind'Amour, ThomasOutremont, QC

Brohovici, Liviu SorelMontréal, QC

Bronet, SandyMontréal, QC

Brophy, MaureenSmiths Falls, ON

Brouillette, LyneBaie-Comeau, QC

Brown, BernardCandiac, QC

Bruckert, BarbaraMontréal, QC

Bruemmer, AurelMontréal, QC

Buchanan, Gordon StuartSt-André Avellin, QC

Caldareri, CarmeloOutremont, QC

Caron, JoannaMontréal, QC

Carrasco, JulianMistissini, QC

Cartwright, PierreÉtang-du-Nord, QC

Cha, CharlieToronto, ON

Chahine, DanielleBelleville, ON

Champagne, PierreQuébec, QC

Chan, GraceOttawa, ON

Chatterjee, ManjulaBrossard, QC

Chettiar, Ramen V.Grand Falls, NB

Ciuntu, IoanaMontréal, QC

Clement, JacquesMontréal, QC

Coelho, RamonaLondon, ON

Cohen, HowardKirkland, QC

Cohen, StevenKirkland, QC

Cohen Taussky, TamiaMontréal, QC

Comeau, MargeryWestmount, QC

Constance, KristelSaint-Hubert, QC

Coombs, RobinWestmount, QC

Cooper, AlecQuébec, QC

Cooper, StewartWinston-Salem, NC, USA

Cordeau, KaryneQuébec, QC

Cosman, CatherineLac Brome, QC

Côté, PatriciaSt-Laurent, QC

Cruvellier, PaulMontréal, QC

Dallaire, DianeMontréal North, QC

Dannenbaum, DavidMontréal, QC

Dansereau, Jean-YvesMont Saint-Hilaire, QC

Dashkovsky, MarinaMontréal, QC

De Ladurantaye, AlainChute-à-Blondeau, ON

Decker, AdrianaVerdun, QC

Deliana, DanilaMamaroneck, NY, USA

DeMarsh, JohnVernon River, PE

Desbois, NathalieCarlisle, ON

Desmeules, JeanCowansville, QC

Doherty, SeanShawville, QC

Doiron, NadiaMontréal, QC

Doulas, Vasilios BillMontréal, QC

Dowdall, MaryMontréal, QC

Dwyer, LynnSt. John’s, NL

Eaton, DavidWheatley, ON

Eliosoff, RonaldOttawa, ON

Elman, ElyssaWestmount, QC

Engo, MichaelLaSalle, QC

Erb, JohnLansdowne, ON

Estevez, WendyMontréal, QC

Farrell, GerardSt. John’s, NL

Ferdinandus, ElizabethDollard-des-Ormeaux, QC

Ferland, ChristianVerdun, QC

Ferrier, CatherineMontréal, QC

Fine, BarrySaint-Georges, QC

Finestone, DebraDollard-des-Ormeaux, QC

Finkelstein, JonathanSt-Laurent, QC

Fournier, ClaudeBrossard, QC

Fuks, MariaCôte-St-Luc, QC

GENERAL INFORMATION


PARTICIPANT LIST

Gagnon, CatherineRivière-Bleue, QC

Gallant, MarcActon Vale, QC

Garneau, MélanieBaie-Comeau, QC

Gauthier, GillesGaspé, QC

Gérin, CamilleMontréal, QC

Gérin-Lajoie, MichèleMontréal, QC

Gladki, NataliaMontréal, QC

Glaser, StuartMontréal, QC

Golgoon, MichaelPointe-Claire, QC

Gomide, Jose GeraldoBrooklin, ON

Gordon, BenjaminDollard-des-Ormeaux, QC

Goulard, Jean-FrancoisBathurst, NB

Grant, IanRothesay, NB

Greenberg, MichaelMontréal, QC

Hansenberger, DeanMontréal, QC

Harvey, Pierre-ClaudeSept-Iles, QC

Hazan, ArielCôte-St-Luc, QC

Hermin, OrlyMontréal, QC

Herssen-Edery, FannyHampstead, QC

Heyding, RobertToronto, ON

Heymans, GerryRussell, ON

Ho-Wo-Cheong, EmmaBeaconsfield, QC

Hogenbirk, BarbPointe-Claire, QC

Hope, PaulaMontréal, QC

Howell, OscarSt. John’s, NL

Hryniowski, RonHudson, QC

Hubert, IsabelleSt-Lazare, QC

Hyland, DeniseSt. John’s, NL

Iancu, AndreeaHudson, QC

Ince-Cushman, DanielWestmount, QC

Ingram, EmilyOutremont, QC

Iny, RobertBelleville, ON

Ionescu, Loretta-VivianneMontréal, QC

Irwin, D. JunePointe-Claire, QC

Jacques, Marc-AndréMontréal, QC

Jagan, SarvaBrossard, QC

Jansen, KurtMontréal, QC

Jast, Z.M.Montréal, QC

Jobin, NicolasBaie-Comeau, QC

Juras, AudreyMontréal, QC

Kahwajian, LoriMontréal, QC

Kalin, MichaelCôte-St-Luc, QC

Karas, MariaPointe-Claire, QC

Kealy, Walter W.Levack, ON

Kerner, SarahMontréal, QC

Khadilkar, MadhusudanMontréal, QC

Khakee, SamMontréal, QC

Kirkham, WilliamEphrata, WA, USA

Klein, BenjaminMontréal, QC

Klincewicz, StephenAmbler, PA, USA

Klvana, JacquelineBrossard, QC

Korin, TamaraWestmount, QC

Kovitch, IngridWestmount, QC

Kremer, BernardoMontréal, QC

Kuganathan, GirudihaVaudreuil-Dorion, QC

L'Heureux, ChristianDrummondville, QC

Lacroix, ChantalOttawa, ON

Lacroix, MarcQuébec, QC

Lalla, DanielCowansville, QC

Lalonde, Jean-SergeGatineau, QC

Lam, LoanMont-Royal, QC

Lam, Margaret Man-HoaBrossard, QC

Lamarche, MauriceShawville, QC

Leahy, JamesWindsor, NS

Lee, DennisToronto, ON

Lee, JessicaMontréal, QC

Lem, HarryWest Vancouver, BC

Liebich, Anne-MarieMontréal, QC

Lin, RobertoMontréal, QC

Livingston Jean, JoseSt-Lin-Laurentides, QC

Lorber, EstelleSt-Laurent, QC

Luconi, FrancescaMontréal, QC

Luger, SherryMontréal, QC

MacDonald, ChristopherCampbellton, NB

Macek, AdrianCowansville, QC

Main, JeffCambridge, ON

Malec, ElizabethMontréal, QC

Manoli, SabrineDollard-des-Ormeaux, QC

Mason, JoanBrossard, QC

Mazzarelli, MarkLaSalle, QC

McCarty, TaraSt-Lazare, QC

Mehta, JagdishDollard-des-Ormeaux, QC

Menard, JacquesGatineau, QC

Mercer, GregStephenville, NL

Mercer, WadeBay Bulls, NL

Michel, PierreBrossard, QC

Mir, SagharMontréal, QC

Mitchell, GregorLachute, QC

Mogharrabi, MehranSault Ste.Marie, ON

Moini, JohnVerdun, QC

Monahan, BarbaraMontréal, QC

Moradi Zirkohi, AtbinVerdun, QC

Morin, CarlOttawa, ON

Morris, RandiMontréal, QC

Morrison, CynthiaArnprior, ON

Mout, JulieWest Brome, QC

Muboyayi, RomainOrleans, ON

Nadeau, MichelMontréal, QC

Narasiah, LavanyaBrossard, QC

Nastase, CristinaMontréal, QC

GENERAL INFORMATION


PARTICIPANT LIST

Nataros, AlexanderMontréal, QC

Nazerali, NajmiVancouver, BC

Neamt, ElenaPierrefonds, QC

Nguyen, Cong-NghiemWestmount, QC

Nituch, NathalieMontréal, QC

Obrigavitch, GregPrince Albert, SK

Onyekwelu, OnyemaMontréal, QC

Ouellet, GillesGranby, QC

Ouimet, FranceBrossard, QC

Paiement-Lamothe, AnieRouyn-Noranda, QC

Panet, DianeMagog, QC

Paquet, ChristineFatima, QC

Paquette, EricTimmins, ON

Parent, AndréQuébec, QC

Parent, LorneOttawa, ON

Parrot, BenoitQuébec, QC

Perley, MichaelWoodstock, NB

Perrotta, RosalbaMontréal, QC

Peters-Mainville, DagmarBeaconsfield, QC

Poitevin, DavidSault Ste.Marie, ON

Polson, GeorgeSte-Anne-de-Bellevue, QC

Poulin, DanielChâteauguay, QC

Quao, NiiMontréal, QC

Ramsey, PatriciaNewMaryland, NB

Regnier, LauraOrleans, ON

Reid, ShelleyOttawa, ON

Rideout, GaryMount Pearl, NL

Ritchie, JanetMontréal, QC

Rivilis, JeffreyTown of Mount-Royal, QC

Rivington, JenniferArnprior, ON

Roberts, BernardMarystown, NL

Robillard, AndréeSaint-Télesphore, QC

Rohan, IvanMontréal, QC

Rokni, FarinVerdun, QC

Rona, MaryMontréal, QC

Rothman, AnnMontréal, QC

Rotman, LaurieScarborough, ON

Saba, Samir EdouardPierrefonds, QC

Scheim, AlyssaDollard, QC

Schnare, TedOttawa, ON

Schulz, JanMontréal, QC

Scotland, CynthiaMontréal, QC

Sedighi, Seyed MahdiSainte-Geneviève, QC

Séguin, Jean-FrançoisL'Ange-Gardien, QC

Simard, LouisChicoutimi, QC

Singer, TamaraMontréal, QC

Smeja, HelenPierrefonds, QC

Smith, SarahMontréal, QC

Steel, GailMontréal, QC

Stiharu, SimonaPierrefonds, QC

Still, JanetOttawa, ON

Still, SusanMontréal, QC

Ta, DianaVal d'Or, QC

Tafler, KarenMontréal, QC

TalaIghil, KahinaMontréal, QC

Taylor, JohnChapleau, ON

Telfer, ChristineRiverview, NB

Teodorescu, CristinaLaSalle, QC

Tewfik, Yvette-NellyMontréal, QC

Thai, Khanh-LinhSaint-Laurent, QC

Thorstad, KellyMontréal, QC

Tozer, NancyPointe-Claire, QC

Trattner, RaquelPointe-Claire, QC

Tremblay, LouiseKirkland, QC

Tremblay, LucBrossard, QC

Tremblay, MarinoRawdon, QC

Tremblay, RogerCornwall, ON

Trinh, Bich H.Kirkland, QC

Truchon, ValeryOutremont, QC

Truong, CatherineBrossard, QC

Tsakalaki, AnnaGatineau, QC

Tsoulos, PanagiotisMontréal, QC

Turcotte, JeanValcourt, QC

Uhthoff, PeterOttawa, ON

Uhthoff Munro, SylviaOttawa, ON

Valois, LucieMascouche, QC

Vanasse, CatherineSherbrooke, QC

Versteeg, ElmyreToronto, ON

Virmani, AchlaBrossard, QC

Walker, AngelaCarignan, QC

Wasser, PninaWestmount, QC

Welik, LenHudson, QC

Whiteman, AvramWestmount, QC

Willoughby, PaulWoodstock, ON

Wolanski, RenéeCôte-St-Luc, QC

Yaremko, MarieMontréal West, QC

Yiannakis, GeorgiaMontréal, QC

Zaharia, Anne-GabrielleMontréal, QC

Zigman, MichaelMontréal, QC

GENERAL INFORMATION


PARTICIPANT LIST

Notes :

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Notes :

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McGill 2012 Refresher Course Syllabus

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