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D’Arcy Little, MD, CCFP, FRCPC, Medical Director, JCCC and www.healthplexus.net
I am pleased to introduce the next edition of the Journal of Current Clinical Care. In this edition.
Dr. Shabbir M.H. Alibhai presents An Update on Cancer Screening in Older Adults. More than one-half of new cancers and over 70% of cancer deaths occur in adults age 65 or older. Systematic screening has been associated with reductions in cancer-related mortality for a variety of cancers, including breast, cervical, and colorectal cancer. Prostate cancer screening remains more controversial despite the recent publication of two large randomized trials of screening. In this article, he reviews evidence-based guidelines for cancer screening in adults and discusses the limitations of screening studies with respect to older adults.
Drs. Fatemeh Akbarian, Hatim Al Lawati, and Mohammad Ali Shafiee review an Approach to Proteinuria in Adults and Elderly. Proteinuria can create one of the greatest challenges in primary practice, especially in the geriatric population. It is typically detected by dipstick urinalysis, an ordinary, non-invasive test. This article will review the clinical significance of proteinuria in adults, especially in the elderly population, and provide a practical diagnostic approach in addition to a summary of non-specific antiproteinuric therapy.
In his article, Choosing a First-line Drug for Older Adults with Hypertension: An Evidence-Based Approach Dr. James M. Wright discusses choosing the optimal first-line drug for patients with hypertension that must address a hierarchy of treatment goals: reduction in mortality and morbidity, efficacy in lowering blood pressure, ensuring tolerability, and minimizing cost. This article examines the evidence for the different classes of first-line antihypertensive drugs in light of these four goals.
Drs. Andrew M. Johnson, H. Christopher Hyson, and Kaitlyn P. Roland review the Identification and Management of Impulse Control Disorders Among Individuals with Parkinson's Disease. Although Parkinson's disease is primarily considered to be a motor disorder, it has inarguable effects on cognition and personality. Treatment options for impulse control disorders tend to revolve around dopamine agonist dose reduction or cessation.
I hope you enjoy this issue of JCCC. We look forward to your comments and your article submissions.
Related Terms:
Fatemeh Akbarian, MD, Research Fellow, University of Toronto, Toronto, ON.
Hatim Al Lawati, MD, FRCPC, Cardiology Resident, Division of Cardiology, Faculty of Medicine, University of Toronto, Toronto, ON.
Mohammad Ali Shafiee, MD, FRCPC, General Internist, Nephrologist, Department of Medicine, Toronto General Hospital, University Health Network; Clinician Teacher, University of Toronto, Toronto, ON.
Abstract
Proteinuria can create one of the greatest challenges in primary practice, especially in the geriatric population. It is typically detected by dipstick urinalysis, an ordinary, non-invasive test. Proteinuria is frequently a marker of unsuspected kidney disease, progressive atherosclerosis or a systemic disease. There is a strong correlation between urinary protein excretion and progression of renal failure. Furthermore, Proteinuria is a strong and independent predictor of increased risk for cardiovascular disease and death, especially in people with diabetes, hypertension, chronic kidney disease, and the elderly. This article will review the clinical significance of proteinuria in adults, especially in the elderly population, and provide a practical diagnostic approach in addition to a summary of non-specific antiproteinuric therapy.
Keywords: Proteinuria, Microalbuminuria, Macroalbuminuria, elderly, Risk Factor.
Michael Gordon, MD, MSc, FRCPC, FRCP Edin, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System; Professor of Medicine, University of Toronto, Toronto, ON.
Abstract
Not all families work in harmony. Health care providers look to families for direction and support for those we care for especially when the patient is no longer able to make decisions for themselves. This is usually the result of a medical condition that affects the brain such as dementia, a common occurrence in those who require long-term care. When there is conflict between family members, health care and social service professionals must use their best communalization skills and sensitivities to help families resolve their differences so that the best possible care can be provided to those they love.
Keywords: sibling rivalry, conflict, decision-making.
An interview of Dr. Barry Goldlist with Dr. Ron Keren, the founder and chair of CCD
Dr. Ron Keren, MD, FRCPC
Dr. Ron Keren was born and raised in Vancouver and received his medical degree at the University of Tel-Aviv, Israel. Dr. Keren completed his residency training in Psychiatry at the University of Maryland, where he also completed a clinical fellowship in Geriatric Psychiatry.
Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
Mainpro+® Overview
James M. Wright, MD, PhD, CRCP(C), Professor, Departments of Anesthesiology, Pharmacology & Therapeutics and Medicine, University of BC, Coordinating Editor, Cochrane Hypertension Review Group, Vancouver, BC.
Abstract
Choosing the optimal first-line drug for patients with hypertension must address a hierarchy of treatment goals: reduction in mortality and morbidity, efficacy in lowering blood pressure, ensuring tolerability, and minimizing cost. This article examines the evidence for the different classes of first-line antihypertensive drugs in light of these four goals. The evidence indicates that first-line low-dose thiazides are better than or equivalent to other antihypertensive drug classes for each of the goals of therapy in both people with hypertension in general and in older adults ≥ 60 years of age.
Keywords: hypertension, thiazide, first-line, older adults, evidence-based.
Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
Mainpro+® Overview
Andrew M. Johnson, PhD, Associate Professor, School of Health Studies, Faculty of Health Sciences, The University of Western Ontario,
London, ON.
H. Christopher Hyson, MD, FRCPC, Assistant Professor of Neurology, Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON.
Kaitlyn P. Roland, MSc, Research Assistant, Interdisciplinary Graduate Studies, The University of British Columbia Okanagan, Kelowna, BC.
Abstract
Although Parkinson’s disease is primarily considered to be a motor disorder, it has inarguable effects on cognition and personality. The cluster of neuropsychiatric sequelae known as impulse-control disorders has been of particular interest in recent years, perhaps owing to the potentially disastrous effects that such behaviors can have on individuals and families. Research has suggested that impulse control disorders are significantly more prevalent among individuals with Parkinson’s disease, particularly with regards to pathological gambling and hypersexuality, and has further suggested that these disorders are significantly and substantively affected by the use of dopamine agonists. Treatment options for impulse control disorders tend to revolve around dopamine agonist dose reduction or cessation. The use of psychosocial strategies, or deep-brain stimulation of the subthalamic nucleus may also be considered in the management of patients with impulse control disorders.
Keywords: Impulse control disorders, Parkinson’s disease, dopamine agonists service use.
Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
Mainpro+® Overview
Shabbir M.H. Alibhai, MD, MSc, FRCP(C), Staff Physician, University Health Network, Toronto, ON, Canada, Assistant Professor, Departments of Medicine and Health Policy, Management, and Evaluation, University of Toronto, Research Scientist, Canadian Cancer Society
Abstract
More than one-half of new cancers and over 70% of cancer deaths occur in adults age 65 or older. Systematic screening has been associated with reductions in cancer- related mortality for a variety of cancers, including breast, cervical, and colorectal cancer. Prostate cancer screening remains more controversial despite the recent publication of two large randomized trials of screening. Although guidelines are beginning to address cancer screening specifically among the growing group of seniors age 70 or older, there is virtually no guidance on estimating remaining life expectancy or considering competing causes of mortality (e.g. comorbid medical illness) in this age group. In this article, I review evidence-based guidelines for cancer screening in adults and discuss the limitations of screening studies with respect to older adults. I have also highlighted new evidence and substantive updates to guidelines since the last publication on cancer screening in Geriatrics & Aging five years ago.
Keywords: cancer screening, aged, mass screening.
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