british columbia medical journal, december 2010 full issue

December 2010; 52: 10Pages 493- 548

www.bcmj.org

Long-term follow-upof childhood cancer

survivors in BC

Revisiting rectal cancermanagement in BC

COHP: Children and youth

Proust: William McLaren, MD

Captain Vancouver and medicinein the Age of Sail

Lights, camera, surgery!

Annual indexes

contentsA R T I C L E S

504 The need for long-term follow-up of childhood cancersurvivors in British ColumbiaLauren MacDonald, MSc, Chris Fryer, FRCPC, Mary L. McBride, MSc,

Paul C. Rogers, FRCPC, Sheila Pritchard, FRCPC

510 Revisiting rectal cancer management in British ColumbiaP. Terry Phang, MD, R. Cheifetz, MD, C.J. Brown, MD,

C.E. McGahan, MSc, Manoj Raval, MD

O P I N I O N S

496 EditorialsLinked, tagged, or poked: What’s your status? David R. Richardson, MD

(496); Geriatric denial, Lindsay M. Lawson, MD (497)

498 CommentSetting the stage for the next several years, Ian Gillespie, MD

499 Personal ViewColorectal cancer screening, Gwen Isaacs, MD (499)

Abbreviations, Robert Shepherd, MD (500)

534 Special FeatureCaptain Vancouver and medicine in the Age of Sail, Gerry Greenstone, MD

546 Back PageProust questionnaire: William J. McLaren, MD

D E P A R T M E N T S

501 BCMD2BLights, Camera, Surgery: Take 2, Kristin DeGirolamo, BSc, Ida Molavi, BSc

503 Council on Health PromotionAre routine child health visits really necessary? The state of children’sdevelopment in BC, Wilma Arruda, MD

30%

Cert no. SW-COC-002226

Established 1959

ON THE COVER: Survivorsof childhood and adoles-cent cancer often have in complete recollection oftheir treatment and limitedknowledge of the risks theymay face. The authors ex -plain the need for a pro-gram that bridges the gapbetween pediatric treat-ment and ongoing adultcare. The gold ribbon is theofficial ribbon of childrenwith cancer. Article beginson page 504.

Artwork by Jerry Wong

ECO-AUDIT:Environmental benefits of using recycled paperUsing recycled paper made with post-consumer waste and bleached without the useof chlorine or chlorine compounds results inmeasurable environmental benefits. We arepleased to report the following savings.1399 pounds of post-consumer waste usedinstead of virgin fibre saves:• 8 trees• 760 pounds of solid waste• 837 gallons of water• 1091 kilowatt hours of electricity (equivalent:

1.4 months of electric power required by theaverage home)

• 1382 pounds of greenhouse gases (equivalent: 1119 miles traveled in the average car)

• 6 pounds of HAPs, VOCs, and AOX combined• 2 cubic yards of landfill space

December 2010Volume 52• Number 10

Pages 493–548

JANUARY/FEBRUARY

My difficulty with C. difficile (Cimolai)

Pharmacological interventions for traumatic brain injury (Talsky, Pacione, Shaw, et al.)

upcoming articles

494 BC MEDICAL JOURNAL VOL. 52 NO. 10, DECEMBER 2010 www.bcmj.org

495

© British Columbia Medical Journal, 2010. All rights reserved. No part of this journal may be re-produced, stored in a retrieval system, or transmitted in any form or by any other means—elec-tronic, mechanical, photocopying, recording, or otherwise—without prior permission inwriting from the British Columbia Medical Journal. To seek permission to use BCMJ material in anyform for any purpose, send an e-mail to [email protected] or call 604 638-2815.

The BCMJ is published 10 times per year by the BC Medical Association as a vehicle forcontinuing medical education and a forum for association news and members’ opinions. The BCMJis distributed by second-class mail in the second week of each month except Jan uary and August.

Prospective authors should consult the “Guidelines for Authors,” which appears regularly in the Jour-nal, is available at our web site at www.bcmj.org, or can be obtained from the BCMJ office.

Statements and opinions expressed in the BCMJ reflect the opinions of the authors and not nec-essarily those of the BCMA or the institutions they may be assoicated with. The BCMA does not as-sume responsibility or liability for damages arising from errors or omissions, or from the use ofinformation or advice contained in the BCMJ.

The BCMJ reserves the right to refuse advertising.

SubscriptionsSingle issue ................................................................................................................................$8.00Canada per year........................................................................................................................$60.00Foreign (surface mail) ..............................................................................................................$75.00

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#115–1665 West Broadway, Vancouver, BC, Canada V6J 5A4Tel: 604 638-2815 or 604 638-2814 Fax: 604 638-2917E-mail: [email protected] Web: www.bcmj.org contents

Advertisements and enclosures carry no endorsement of the BCMA or BCMJ.

EDITORDavid R. Richardson, MD

EDITORIAL BOARDDavid B. Chapman, MBChB

Brian Day, MBSusan E. Haigh, MD

Lindsay M. Lawson, MDTimothy C. Rowe, MBCynthia Verchere, MD

EDITOR EMERITUSWillem R. Vroom, MD

MANAGING EDITORJay Draper

PRODUCTION COORDINATORKashmira Suraliwalla

EDITORIAL ASSISTANTTara Lyon

COPY EDITORBarbara Tomlin

PROOFREADERRuth Wilson

COVER CONCEPT & ARTPeaceful Warrior Arts

DESIGN AND PRODUCTIONOlive Design Inc.

PRINTINGMitchell Press

ADVERTISINGOnTrack Media

Tel: 604 [email protected]–70 E. 2nd Ave.

Vancouver, BC V5T 1B1

ISSN: 0007-0556

D E P A R T M E N T S ( c o n t i n u e d )

514 BC Centre for Disease ControlSmoky air and respiratory health in the 2010 forest fire season, British ColumbiaCatherine Elliott, MD, Tom Kosatsky, MD

515 WorkSafeBCEvidence-based treatment of chronic painKukuh Noertjojo, MD, Craig Martin, MD, Celina Dunn, MD

517 2010 Author Index

520 2010 Subject Index

529 Guidelines for Authors

530 PulsimeterBC Family Physician of the Year: Dr Ronald Wilson (530); Free insurance?Lori Moffat (530); Anti-cholesterol drugs could help prevent seizures (531);

Physicians: Protect yourself, P.R.W. Kendall, MBBS (531); New provincialbreast health strategy (531); Canadian nutrition labeling initiative (531);

Ovarian cancer prevention: Practice changes (532); Participants sought forlandmark health study (532); SFU speeds bacterial testing in rural India(532); Dance wins writing award (533)

533 In MemoriamDr Trevor J.G. ThompsonPatricia O’Meara

538 Calendar

541 Classifieds

544 Advertiser Index

547 Club MD

495www.bcmj.org VOL. 52 NO. 10, DECEMBER 2010 BC MEDICAL JOURNAL

BC MEDICAL JOURNAL VOL. 52 NO. 10, DECEMBER 2010 www.bcmj.org496

Iguess I shouldn’t have been sur-

prised when the earnest reporter

called. With all the attention our

revised and updated web site had been

garnering it made sense that the Globeand Mail would want to run an arti-

cle.1 However, I’d never been inter-

viewed before and this made me a lit-

tle nervous.

G&M Is it true that your web site now

has new interactive features?

DRR Yes. [Gee, this is easier than I

thought.]

G&M And that the New EnglandJournal of Medicine and Lancet have

been copying some of your web site

features?

DRR No comment.

G&M How did you come up with the

brilliant idea of online story com-

menting, allowing for physician feed-

back and conversations?

DRR No idea.

G&M Is there any way I can get

myself in to the “People” section,

which features current physician-

related content, In Memoriam, and

presidential interviews? I can’t believe

it also contains author profiles and

video interviews so that BC physi-

cians can learn more about their col-

leagues, get more information about

how articles are written, and read

BCMJ author biographies.

DRR I can’t believe it either, and no

you can’t get in as you are a pathetic

little reporter and not an incredibly

good-looking physician like I am.

G&M What an excellent idea to

include video content linked to clini-

cal stories, such as surgical videos and

author interviews. This will be a huge

draw to readers of the print issue. I

hear you’ve got content available on

YouTube, making your videos search-

able by keyword, adding yet another

valuable source of referral traffic to

the BCMJ site.

DRR Of course. [I really think I am

getting a handle on this interview

thing.]

G&M Here at the Globe and Mail we

are amazed by the brilliance of the

BCMJ.org Health Notes.

DRR Aw, shucks.

G&M I see that the Health Notes sec-

tion of the web site provides physi-

cians with reliable information that

they can pass along to their patients. I

think it’s mind blowing that the public

will be able to access these resources.

DRR If you think this is mind blow-

ing then maybe you should get out

more. Have you heard of sex?

G&M Would you like to comment on

your use of social media?

editorials

Linked, tagged, or poked: What’s your status?DRR I’m certain I’m in favor of it.

G&M Do you think social media will

be helpful in building web site traffic,

thereby enhancing awareness of BCMJcontent? It appears your new web site

has been designed with these strate-

gies in mind; incorporating RSS feed

capability, a BCMJ blog, and links to

the BCMJ’s Twitter and Facebook

pages.

DRR Yes, it has. [Did I just get called

a twit?]

G&M You must be excited that with

the launch of your new site, phy sicians

can come to bcmj.org to weigh in on

hot issues, creating a community that

will attract new and repeat visits to see

what people are saying on the site.

DRR How do you know all this stuff?

G&M I read your news release.

DRR We did a news release?

—DRR

www.bcmj.org

Note

1. Apart from the facts about our rad website, my editorial has no basis in reality.

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bcmj.org The online homeof BC physicians

www.bcmj.org VOL. 52 NO. 10, DECEMBER 2010 BC MEDICAL JOURNAL 497

Never before has our society

included in its ranks so many

individuals over the age of 65;

being in your 90s is no longer a feat—

over 100 is the new prize. This shift

in demographics is partly due to bet-

ter preventive measures such as im -

proved nutrition and decreased smok-

ing, and partly to better management

of chronic diseases, especially cardio-

vascular disease. Many seniors are

keeping fit and managing to live by

the mantra, “age is just a number.”

However, physiologically age is

not just a number but a very reliable

predictor of future health problems.

For example, many of us forget that

one of the biggest risk factors for can-

cer is age itself. The same can be said

for hip fracture. In spite of this, sen-

iors continue to challenge previously

held notions of appropriate behavior

for their age, and seniors’ increased

levels of activity and involvement are

the beneficial result of the belief that

age is just a number.

Balanced against this benefit is the

risk of geriatric denial—denying risks

to the extent that this denial has nega-

tive effects on health and lifestyle. Let

me give some examples.

• A retiree opting for a pension plan

with higher income but no spousal sur-

vivor benefit; good idea until sudden

death several years into retirement.

• An individual with severe osteo-

porosis ignoring advice to remove

obstacles in the home known to

increase the risk of falls with the

comment, “I just won’t fall.”

• A senior with dizziness and several

falls refusing to use a walker out of

the home because “it makes me look

old.”

• Another senior who, upon losing a

driver’s licence because arthritis

prevents looking over either shoul-

der, declares, “I just won’t back up.”

Denial and ignoring the age factor

can be beneficial, and somehow we

all will need to work out where on the

continuum we balance these factors

against the reality of getting older. As

I approach becoming eligible for my

Old Age Pension, I find myself in -

creasingly aware of being caught in

this optimism/pessimism conundrum.

Maybe that’s because the balance

point differs among individuals and

shifts with time.

Use your body and use your brain

for as long as you can. Acknowledge

that running today may have to switch

over the years to cycling or walking,

but that the important thing is remain-

ing active. The Sudoku puzzle may

editorials

Geriatric denialtake longer to solve, but keep at it.

And remember, maybe the best

mantra is, “Plan for the worst and hope

for the best.”

—LML

Now we’re here for you 24 hrsa day, seven days a week.

Call at 1-800-663-6729 or for more information about our new services, visitwww.physicianhealth.com.


The Board of Directors recently

held a very successful strategic

planning workshop in which

we discussed five themes: prevention

services, improved access to care, im -

proved IT solutions, quality enhance-

ment for both patients and physicians,

and relationship with government.

Although the Board saw fit to not

pursue further governance proposals,

choosing instead to make incremental

changes, we did endorse a proposal

for several forums. Already held was

the surgical forum—the next three

will be the medical, the diagnostic,

and then the GP forum. Each of the

four forums will be repeated in the

months ahead, likely including health

authority and Ministry of Health Serv-

ices representation.

We find that using a forum is a

very useful format to discuss better

approaches to delivering health care,

integrating services, and improving

collaboration. For instance, at the sur-

gical forum about 20 physicians rep-

resenting GPs, emergency physicians,

hospitalists, anesthesiologists, and a

spectrum of surgical specialists were

engaged in discussions on advances in

IT and PSP training modules. The dis-

cussions allowed for plenty of inge-

nuity in problem-solving and high-

lighted current sticking points.

At the strategic planning work-

shop we debated a number of ideas

and concepts falling within the five

themes that will affect all physicians

at some point:

• Reforming health care. Our Min-

istry of Health Services, the BCMA,

and CMA have plans to ensure the

health care system is efficient and

sustainable in the long term. We are

all moving quickly—probably no -

where faster than here in BC. All

physicians remain very busy and

face complex issues, but with a sense

of greater optimism. How do we

adapt to these changes?

• Solo practice. Many physicians pre-

fer an individual practice; however,

they may be left in the dust unless

they also engage in a “virtual group

practice.”

• Information technology. Electronic

information systems such as EMRs,

CHARD (the Community Health and

Resource Directory), and applica-

tions for our PDAs and office com-

puters are continually picking up

momentum for both GPs and spe-

cialists. Although true interoperabil-

ity is likely a couple of years away,

incentives are available for early

adoption, so don’t wait too long!

• Preparing for retirement. Given that

approximately 50% of our profession

is over the age of 50, preparation for

retirement is a concern, not just for

us, but for our patients as well. Infor-

mation technology can help by pro-

viding a smooth exit strategy in the

form of an electronic summary pass -

ed on to the patient or to the next

physician. On the social side, we

need to cultivate more opportunities

for physicians who may be thinking

of retirement, but who are not ready

to fully retire, to continue to con-

tribute meaningful involvement in

the health care system and to use their

considerable wisdom and experi-

ence.

• The I word. Integration frequently

comes up as a topic of discussion in

visioning exercises. In this case we

focused on a seamless flow between

acute care and community care and

better service to high-needs popula-

tions, including those with addic-

tions. Building on the lessons from

H1N1 influenza last year, we need

to better connect primary care with

public health and emergency pre-

paredness.

These advances will not occur with

the 0100 fee item—new funding meth-

ods that are “population based” will

expand. As Divisions of Family Prac-

tice makes excellent progress, spe-

cialists are keen to explore how they

can best be involved in these commu-

nity-focused solutions. Successful

ventures will favor simplicity and

keeping score of health outcomes and

satisfaction. With increasing collabo-

ration among health care profession-

als, community service groups and

other health care providers, those who

don’t participate may feel more and

more isolated and less involved at the

collaborative care roundtable.

It is truly a pleasure working on

your behalf with the excellent staff at

the BCMA. This is an exciting time in

strategic planning. Hanging on the

wall in my BCMA office is Robert

Bateman’s print Sheer Drop—Moun-tain Goats, which reminds me of the

unpredictable challenges we all can

face in many areas of life—yet there

is so much reason for appreciation and

optimism.

As the end of 2010 approaches,

however you celebrate the holiday

season, I send you wishes for good

times with family and friends, peace

and reflection on the wonders of love

and nature, and blessings for whatev-

er spiritual belief enriches your life.

For those of you on call, may it also be

a time of satisfaction while you serve

the needs of others. Best wishes for a

happy and healthy 2011.

—Ian Gillespie, MD

BCMA president

Setting the stage for the next several years

comment

Visit

www.gpscbc.ca Visit

www.gpscbc.ca


Colorectal cancerscreeningThis letter is in regard to screening for

colorectal cancer. I live and work in

BC, so I am reporting on the situation

in this province, but I am sure it

applies nationwide in Canada.

Colorectal cancer is the fourth

most common cancer in Canada today.

There are 2400 new cases diagnosed

in BC every year. The province is cur-

rently developing a study to test the

effectiveness of yearly hemoccult in

preventing colorectal cancer. So far

the evidence suggests that yearly hem -

oc cult decreases the incidence of cur-

able cancer by, at best, 40%. Col on -

oscopy is not currently recommended

as a screening test, but studies have

shown that screening colonoscopy

begun at the age of 50 and done every

10 years after that decreases the risk

of colorectal cancer by at least 80%.

That’s a difference of 40% or 960

cases per year that could be prevented

with screening colonoscopies.

I was recently at a medical confer-

ence in Portland, Oregon. The presen-

tation on colorectal cancer suggested

that the standard of care for preven-

tion of colo rectal cancer should be reg-

ular screening colonoscopies. Hemoc -

cult tests were to be used only on

patients who refused colonoscopy.

Un fortunately, the gastroenterologists

in BC are far too busy to perform

screening colonoscopies, and our

provincial health plan does not cover

that procedure anyway. I was recently

visiting my sister in England, and

there colon oscopies are done by spe-

cially trained nurses. It is not difficult

to persuade patients to have a screen-

ing colonos copy if it’s paid for and if

they can be assured that, if they under-

go this 30-minute test, they are almost

assured of never developing colon

personal view

Letters for Personal View are welcomed.They should be double-spaced and lessthan 300 words. The BCMJ reserves theright to edit letters for clarity and length.Letters may be e-mailed ([email protected]), faxed (604 638-2917), or sentthrough the post.

Continued on page 500

The EMR for BC Specialists

7% of General Surgeons 7% of Internists 8% of Dermatologists 8% of Neurosurgeons 9% of Otolaryngologists 10% of Neurologists

13% of Surgical Specialists 13% of Urologists 13% of Ophthalmologists 19% of Endocrinologists 21% of Thoracic Surgeons 22% of Obstetricians & Gynecologists 25% of Orthopaedic Surgeons 29% of Plastic Surgeons 35% of Gastroenterologists 42% of Nephrologists

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cancer. In stead of wasting limited

health care re sources on studies of the

usefulness of hemoccults, we should

be training nurses to do colonoscopies

and making this a covered procedure

so that we can begin screening all Can -

adians for colon cancer. This would

cause an enormous decrease in the

incidence of this cancer and would be

a huge saving of health care dollars

that would have been spent on the care

of colon cancer patients.

I think the BCMA should take a

stand on this issue and try to bring

about changes in the health care sys-

tem so that nurses can be trained to do

colonoscopies, provincial health plans

will cover the procedure, and Canadi-

ans will become informed of the ben-

efits of routine colonoscopy to pre-

vent colon cancer.

—Gwen Isaacs, MD

Victoria

AbbreviationsOne ophthalmologist sent me a con-

sultation letter saying that she was go -

ing to do HRT on a patient. Another

ophthalmologist wrote that our patient

has CME. In my dialect, HRT is hor-

mone replacement therapy, and CME

is continuing medical education. I

have to write a letter to the specialist

to find out what he or she means.

One of my professors disliked

abbreviations and told the following

story: A man ran toward a bus stop as

the bus pulled up and got on just in

time. Panting, he sat down beside a

woman and said, “TGIF.” She looked

at him and said, “Ess aitch eye tee.”

Taken aback, the man said, “I’m sorry,

I guess you didn’t know what I said. I

said, “TGIF.” That means, “Thank God

it’s Friday.” The woman said, “I know

that. What I said was, “Sorry honey,

it’s Thursday.”

Please, if you are writing to some-

one who is not in your specialty, write

out in full any technical term (TT) the

first time, before you use the abbrevi-

ation for the TT on its own.

—Robert Shepherd, MD

Victoria

personal view

Continued from page 499

INVESTOR LOSS RECOVERY GROUP INVESTOOR LOSS RECO Y GROUPRRYOVE P

Call for nominationsThe CMA is seeking nominations

for the 2011 Sir Charles Tupper

Award for Political Action. The

award is presented to recognize a

member of the CMA MD-MP

Contact Program or CMA mem-

ber who has demonstrated exem-

plary leadership, commitment,

and dedication to the cause of

advancing the policies, views, and

goals of the CMA at the federal

level though grassroots advocacy

efforts.

For more information or to

sub mit a nomination, visit www

.cma.ca/tupper-award.

great learning experience and the per-

fect summer project for me. I really

enjoyed being in the operating room

and learning from mentors as they

were all very willing to teach us. I made

some great contacts this summer.”

The first year for Lights, Camera,

Surgery—2009—involved 13 medical

students from UBC. The students made

19 videos on surgical and medical top-

ics ranging from circumcision to exci-

sional biopsy. The video ExcisionalBi opsy won the 2009 Best Surgical

Education Video at OPSEI Rounds.

Three videos were made in con-

junction with the BC Patient Safety

and Quality Council and were submit-

ted to the 2009 Golden Safety Pin

Competition presented at the Canadi-


Kristin DeGirolamo,BSc(Pharm), Ida Molavi, BSc

Lights, Camera, Surgery is a

novel educational project out of

the Office of Pediatric Surgery

Evaluation and Innovation (OPSEI)

that engages medical students in film-

ing surgical procedures and preparing

instructional videos. The purpose of

this project is to create educational

videos that medical students and resi-

dents may view to learn and review

various procedures. It is also a way

to build interest in surgical careers

among medical students and introduce

them to the operating room.

Mr Damian Duffy, the executive

director of OPSEI, says Lights, Cam-

era, Surgery is a chance to “give jun-

ior medical students the opportunity

to experience surgical services first

hand. Most medical students haven’t

had the opportunity to be in the oper-

ating room until now, so that’s our pri-

mary motivation. The second is giv-

ing the students a direct role in the

development of surgical videos as

education resources.”

Lights, Camera, Surgery was cre-

ated by the OPSEI team, which in -

cludes Mr Damian Duffy, Dr Geof-

frey Blair, Dr John Masterson, and

two student captains each year; Mr

Simon Jones and Mr Tyler Fraser

were student captains in 2009, and

Mr Kelvin Kwan and Mr Chris Wu

are student captains in 2010.

Dr Blair previously used videos to

teach surgical residents and says that

the idea for combining video teaching

tools and getting medical students into

the OR came together naturally. Stu-

dents act as project managers who cre-

ate the storyboard and script, film the

procedures, edit, narrate, and finally

produce 5- to 7-minute instructional

videos. Once produced, these videos

become teaching tools for future med-

ical students and residents.

Lights, Camera, Surgery provides

a unique experience for both students

and mentors. Dr Blair, pediatric sur-

geon at BC Children’s Hospital and

one of the project mentors, explains:

“The students know more about how

to produce a video and the surgical

mentors know more about the surgical

procedure, so it’s a symbiotic student-

mentor relationship. The mentors

become better teachers, it’s fun, and it

captures the imaginations and enthu-

siasm of mentors and students alike.”

In addition to being a valuable

learning tool, Lights, Camera, Surgery

provides a unique opportunity for

medical students to interact with doc-

tors outside of the traditional teaching

environment. Ms Anu Ghuman, one

of the UBC medical students on this

year’s team, says, “The project was a

bcmd2b

This article has been peer reviewed.

Ms DeGirolamo and Ms Molari are Univer-sity of British Columbia medical students inthe class of 2013.

Lights, Camera, Surgery: Take 2A unique program brings junior medical students together with mentors to create educational videos.


Visit

www.gpscbc.ca Visit

www.gpscbc.ca

web extra

Watch the video Excisional Biopsyat bcmj.org.

bcmj.org

Dr Cynthia Verchere explains the surgery she is about to perform in the video Excisional Biopsy.

an Healthcare Safety Symposium. The videos were

Needlestick Injuries: Prevention and Protocol, The OpenGowning and Gloving Technique, The Closed Gowningand Gloving Technique, and Teaching Safe Sharps Han-dling in the Operating Room. All received honorable

mentions at the symposium.

The Lights, Camera, Surgery project was also pre-

sented at the Western Student Medical Research Forum

in Carmel, California, in January 2010 as well as the

Canadian Association of the Pediatric Surgeons Meeting

in Sas k atoon in September.

This year the team consisted of nine UBC medical

students and one undergraduate science student from

UBC. Lights, Camera, Surgery introduced palliative care

videos to the lineup of surgical and medical procedures in

conjunction with the Providence Health Care Palliative

Team. Various medical, surgical, and palliative care video

ideas were completed during an 8-week period over sum-

mer break. The palliative care videos included TopicalOpioids for Painful or Fungating Wounds and VoluntaryWithdrawal of Dialysis. The surgical videos included

Congenital Diaphragmatic Hernia Repair, ArterialSwitch Procedure, Lapro scopic G Tube Placement, and

Setting and Casting a Fracture.

Mr Tin Jasinovic, one of the students, says, “I learned

a lot about organizational preparedness for making videos

that at first seem simple but require a lot of thought before

the video is completed. This was a great experience and

one that I will definitely remember for a long time.”

The video Safe Surgery Checklist by Dr Geoffrey

Blair, Ms Kristin De Girolamo, Ms Ida Molavi, and Mr

Ian Wilson won the Golden Safety Pin Award at the Cana-

dian Healthcare Safety Symposium in Halifax this Octo-

ber. Two other videos from the 2010 project, Hands forHealth and Scrubbing In, both by Ms Jennifer Yam, Mr

Steven Rathgeber, and Dr Monica Langer, were also pre-

sented at the symposium.

There is one more year of funding from the Teaching

and Learning En hancement Fund at UBC remaining for

the project. Plans for next year are currently in the works,

with interest from other procedure-based specialties such

as radiology, nursing, obstetrics, and gynecology.

The videos are available online on Medicol for access

by UBC students, faculty, and residents. Medicol can be

accessed at www.med.ubc.ca/medicol/ with a campus-

wide login.

Acknowledgments

OPSEI is funded by BC Children’s Hospital Foundation at BC Chil-dren’s Hospital. These films were made possible through vitalcompetitive funding from the Teaching and Learning Enhance-ment Fund at the University of British Columbia.


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It is the last week of August. I am

seeing Susan (a fictitious patient)

in my office as a referral from her

family doctor. Susan is about to start

kindergarten and her mom is worried

about her daughter’s asthma. I ask a

few questions about Susan’s general

health and development and examine

her. She has not attended preschool

and her mom reports that she is very

shy and she cried when she went to

her new school for a visit. Susan has

not learned her numbers or letters and

cannot yet print her name. When she

does eventually speak, her words were

soft and hard to understand. It is

becoming clear that Susan is not ready

for kindergarten.

Almost one-third of BC children

eligible for kindergarten are not devel-

opmentally ready. Such children are

described by Dr Clyde Hertzman as

having “developmental vulnerabili-

ty.” They exhibit significant delays in

their physical, socio-emotional, or

language-cognitive development. A

child’s early development, of course,

has a significant influence upon that

child’s health, well-being, learning,

and behavior, and the effect spans the

child’s life course. Here are some facts

about the state of children’s develop-

ment in British Columbia:

• “Today only 71% of BC children

arrive at kindergarten meeting all

the developmental benchmarks they

need to thrive both now and in the

future.”1

• “29% are developmentally vul ner-

able.”1

• “At three times what it could be, the

current vulnerability rate signals

that BC now tolerates an unneces-

sary brain drain that will dramati-

cally deplete our future stock of

human capital.”1

• Childhood vulnerability is rising. In

53 of 59 BC school districts, 30.35%

of kindergarten children were vul-

nerable, up from 28.5% in 2008/9.2

• “Unnecessary early vulnerability in

BC is costing the provincial econo-

my a sum of money that is 10 times

the total provincial debt load.”1

• Vulnerable children come from all

walks of life. It is a middle-class

problem, not just poverty related.1

• Most childhood vulnerabilities are

avoidable and preventable.3

Helping children to be as healthy

as they can be is hardly a new concept.

The public health movement (1880–

1920) brought in reforms that had an

immediate and positive effect on the

well-being of Canadian children and

“came to regard youngsters as its most

important clients.”4 With prevention

as the aim, the movement led to the

establishment of two specialized serv-

ices: one targeting infants and the

other targeting school-age children.

By the end of World War One, English

Canadians came to recognize that

intervention needed to occur prior to

age six, and physicians, along with

social workers, teachers, and psychol-

ogists, began to focus on the preschool

years as well as the school-age years.

Canada emerged as a nation charac-

council onhealth promotion

Are routine child health visits really necessary? The state of children’s development in BC

terized as having a “preoccupation

with training its infants and preschool-

ers for proper citizenship.”5

A century later our own govern-

ment acknowledges and has planned

action to reduce childhood vulnerabil-

ity. In the report, 15 by 15: A Compre-hensive Policy Framework for EarlyHuman Capital Investment in BC, it is

recognized that supporting children in

their early years is crucial. The report

illustrates the importance of early

human capital investments, and as a

result the Government of British

Columbia’s 2009 Strategic Plan com-

mitted to “lowering the provincial rate

of early vulnerability to 15% by fiscal

year 2015/16.”1

Healthy children are more likely

to become healthy adults, thereby con-

tributing to the future workforce and

economy; as we so often hear, chil-

dren are our future. Through routine

health assessments, family physicians

will, no doubt, encounter children with

developmental issues that merit con-

cern. By way of a systematic approach,

family physicians are perfectly posi-

tioned to identify and assess children

with developmental vulnerability and

assist in providing interventions that

will ultimately lead to a reduction in

this vulnerability. The American Aca -

demy of Pediatrics, for example, rec-

ommends children be seen routinely

for “health supervision” visits. The

timing and purpose of each visit is

well detailed in the AAP Policy State-

ment and clearly organized in the AAP

publication Bright Futures: Guidelines

This article has not been peer reviewed.

Almost one-third of BC children eligible

for kindergarten are notdevelopmentally ready.


Visit

www.gpscbc.ca Visit

www.gpscbc.ca


ABSTRACT: Many survivors of child-

hood cancer have incomplete knowl-

edge of their past treatment and are

unaware of the risks they may face,

including long-term negative health

consequences such as second can-

cers, cardiovascular disease, and

infertility. These late effects are pre-

dominantly the result of radiation,

anthracycline therapy, and alkylator

therapy. Currently there is no formal

program for long-term care of British

Columbians who have survived can-

cer in childhood or adolescence. A

program is needed to provide life-

long health surveillance, counseling,

and a registry for this population.

Such a program would also provide

GPs with current and relevant rec-

ommendations for follow-up care

and support the shared goals of the

federally funded Canadian Partner-

ship Against Cancer and the BC Can-

cer Agency.

In British Columbia there are ap -

proximately 3000 patients aged 17

years or older who are survivors of

childhood cancer (diagnosed before

the age of 17 years). Each year an

additional 120 or more patients “grad-

uate” to become adult survivors of

childhood cancer. There is increasing

evidence that although children, ado-

lescents, and young adults diagnosed

with cancer have an improved sur-

vival rate, many survivors face long-

term negative health, educational, and

social consequences of their cancer

experience.1-5 Many of these survivors

are unaware of the specific cancer

therapy they received earlier in life

and do not know that they may face

significant long-term risks to their

health and well-being.2,6-8 These “late

effects” may not become apparent

until many years after treatment. The

most serious health risks are late

recurrence of disease, as well as sec-

ond cancers, cardiovascular disease,

and endocrinological and neuropsy-

chological abnormalities. In 2003 the

American Institute of Medicine iden-

tified the need for a systems approach

to the health care needs of survivors of

childhood cancer and made specific

recommendations.9 The National

Can cer Institute’s Office of Cancer

Survivorship identified programs in

existence in 2006 for long-term fol-

low-up for pediatric cancer.10 Unfor-

tunately, only one such program was

identified in Canada, the Provincial

Pediatric Oncology AfterCare Program

through the Pediatric Oncology Group

of Ontario.

Late effectsLong-term sequelae in survivors of

childhood cancer are predominantly

secondary to radiation, anthracycline

therapy, and alkylator therapy. Late

effects of cancer treatment are not

unique to survivors of childhood can-

cer, but they are usually more severe

than those experienced by survivors

of adult cancer, as the cancer treat-

ment is received during periods of

growth and development. Knowledge

of health risks has resulted in changes

in therapy to obviate untoward effects.

The need for long-termfollow-up of childhood cancersurvivors in British ColumbiaInitiating a prospective surveillance system and follow-up registrywould contribute to the health and well-being of British Columbianswho have received cancer treatment as children or adolescents.

Lauren MacDonald, BScH, MSc, Chris Fryer, FRCPC, Mary L. McBride, MSc, Paul C. Rogers, FRCPC, Sheila Pritchard, FRCPC

Ms MacDonald is a research scientist inthe Cancer Control Research Program atthe BC Cancer Agency in Vancouver, BritishColumbia. Dr Fryer is a consultant pediatricand radiation oncologist at BC Children’sHospital (BCCH) in Vancouver. Ms McBrideis a research scientist in the Cancer ControlResearch Program at the BC CancerAgency. Dr Rogers is a consultant pediatriconcologist at BCCH. Dr Pritchard is a con-sultant pediatric oncologist at BCCH.This article has been peer reviewed.


For example, radiation therapy is

now rarely used in the treatment of

Hodg kin disease in children, and the

recommended maximum total dose of

an thra cylines has been significantly

reduced. However, it is not yet known

how increasing the intensity of thera-

py currently used and new or innova-

tive cancer treatments may affect the

observed late effects. This lack of

knowledge of future long-term side

effects provides further rationale for

lifelong surveillance of survivors at

risk. It is important to emphasize that

not all childhood cancer survivors are

at risk for late effects and therefore

surveillance recommendations should

be risk-based. Surveillance also pro-

vides an opportunity to undertake re -

search into host factors such as genet-

ic polymorphisms that may make an

individual more susceptible to late

sequelae.11

Surveillance practice in BCIn BC most adult survivors of child-

hood cancer have been discharged

from cancer care programs and are not

followed by physicians knowledge-

able about their health risks. They are

no longer being cared for by a pedia-

trician and the majority do not require

the specialist care of an oncologist.

While pediatric and radiation oncolo-

gists are the most knowledgeable

health care providers concerning the

late sequelae of cancer therapy in chil-

dren, it is inappropriate for them to

provide life-long surveillance.

In our health care system, the gen-

eral practitioner is in the best position

to carry out surveillance of late health

problems and comorbid conditions,

promote follow-up care, and counsel

patients on lifestyle issues. Given the

complexity of diagnosis and treat-

ment-specific late effects, GPs need to

be provided with current and relevant

information on the risks and recom-

mendations for follow-up care and

new knowledge about late effects of

cancer therapy as it becomes avail-

able. In order to ensure quality life-

long care, it is also essential to obtain

feedback and maintain a database re -

garding late health problems as they

develop in order to assess longer-term

risks and new problems as they arise

among the survivor population. A

systematic follow-up program is

need ed to link pediatricians, oncolo-

gists, and GPs through surveillance

clinics to ensure successful transition

of childhood cancer survivors from

treatment and recovery to survivor

care.10 Currently in BC there is no sep-

arate funding available to support

such a program, nor is there appropri-

ate re imbursement for GPs to under-

take surveillance and prevention. This

considerable deficiency must be ad -

dressed given that the unique needs

of childhood cancer survivors in BC

require an effective province-wide

survivor follow-up program and post-

cancer care from GPs.

Health risksSurvivors of childhood cancer face

a number of health risks, including

a second malignancy, recurrence of

their original disease, fertility and

ob stetrical problems, and posttraum -

atic stress disorder.

Second tumorsStudies show that survivors of child-

hood malignancy have a three to ten

times increased risk of developing a

second malignancy compared with

the general population.12,13 Radiation

ex posure increases the risk for brain

tumors, breast cancer, thyroid cancer,

bone tumors, and soft tissue sarcoma.

Exposure to alkylating agents and the

topoisomerase II inhibitors increases

the risk for myeloid malignancy and

myelodysplastic syndromes.14

Basu and colleagues reported the

cumulative incidence of breast cancer

among female survivors of Hodgkin

disease who received radiation to the

chest region in their teenage years was

19% by 25 years after diagnosis, ris-

ing to 24% by 30 years and to 35% by

40 years after diagnosis.15 The expect-

ed cumulative incidence of breast can-

cer in the matched general population

is 10%. This gives a risk of treatment-

related breast cancer developing in one

in four female survivors of Hodg kin

disease treated with chest irradiation

within 40 years of initial diagnosis.

Goshen and colleagues reported that

survivors of childhood leukemia who

The need for long-term follow-up of childhood cancer survivors in British Columbia

Survivors of childhood cancer face a

number of health risks, including a second

malignancy, recurrence of their original

disease, fertility and ob stetrical problems,

and posttraumatic stress disorder.

received low-dose cranial irradiation

have a 15% risk of developing benign

meningiomas within 20 years of ini-

tial diagnosis, while Strojan and col-

leagues reported an 8% cumulative

incidence at 25 years following high-

dose cranial irradiation.16,17 These tu -

mors are often asymptomatic—a con-

cern because surgical cure can only be

achieved with early diagnosis.

The Childhood, Adolescent, Young

Adult Cancer Survivorship Research

Program (CAYACS) is a population-

based study utilizing BC Cancer Agen -

cy and BC Children’s Hospital data

linked to provincial databases for the

examination of long-term outcomes

of cancer survivors diagnosed before

age 25.18 CAYACS reported 55 second

malignant neoplasms among a popu-

lation-based cohort of 2322 5-year

survivors diagnosed in BC before 20

years of age; 15 of these neoplasms

were found in males and 40 in fe -

males.19 The mean age at diagnosis

of a second malignant neoplasm was

27 years and the mean time from the

original diagnosis was 15 years. The

increased cumulative prevalence of

second malignant neoplasms over the

normal population was 1.3% at 15

years, 2.5% at 20 years, and 4% at 25

years. The most common second ma -

lignancies were breast cancers (18%),

thyroid cancers (18%), and central

nervous system tumors (15%). This is

consistent with the experience from

other countries.12,13

Premature deathSurvivors of childhood cancer have a

reduced life expectancy when com-

pared with the general population.20

CAYACS data reveal that the stan-

dardized mortality rate is nine times

that observed for age- and sex-matched

controls in the general BC popula-

tion.21 However, 77% of the observed

deaths (139/181) were due to recur-

rence of the subjects’ original disease,

8% were related to second malignan-

cies, and only 12% were not cancer

related, with cardiovascular causes

being the most common. The cause of

death was unknown in 3% of cases.21

The CAYACS data confirm what other

childhood cancer survivor study data

show—that, after cancer, cardiovas-

cular disease, most likely related to

radiation or chemotherapy, is the prin-

cipal cause of death in survivors of

childhood cancer.22 Total anthracy-

cline dose tolerated by adults can be

associated with cardiac failure when

given to children.23-25 Furthermore,

there is accumulating evidence that

progressive cardiac dysfunction may

manifest itself up to 22 years after

treatment.26 Radiation to the heart and

great vessels can also result in prema-

ture coronary disease or vascular dam-

age, increasing the risk of cerebrovas-

cular accidents.27

Gonadal and fertility effects Male and female fertility can be im -

paired by exposure to radiation and

high doses of chemotherapy, particu-

larly alkylating agents.28

Females. The ovaries may be dam-

aged if in or adjacent to the radiation

field. High doses of radiation or alky-

lator exposure in the prepubertal child

may result in primary ovarian failure,

while lower doses may result in nor-

mal development of puberty and men-

struation but premature menopause,

which can occur at any age from mid-

teens onwards.28,29 Methods for preser-

vation of female fertility are limited

but include ovarian shielding or trans-

posing (repositioning the ovaries out

of the radiation field) during radia-

tion; ovarian suppression with GnRH

analogs during chemotherapy (this is

experimental and not currently accept-

ed practice);30 oocyte cryopreserva-

tion for postpubertal females only

(requires ovarian stimulation over at

least 2 weeks prior to starting chemo -

therapy or radiation, so it is not usual-

ly possible for acute malignancies in

adolescents); cryopreservation of ovar-

ian tissue (this is experimental and so

far unsuccessful); and embryo cryo -

preservation (requires ovarian stimu-

lation and a partner and has both moral

and ethical implications).

Males. Testicular function is also

extremely sensitive to radiation and

high-dose alkylating agents. Radia-

tion doses greater than 600 cGy in

boys can cause permanent azosper-

mia.28 The doses of alkylating agents

often used for Hodgkin disease may

also permanently impair spermatoge-

nesis. Methods for fertility preserva-

tion in males include shielding of the

testes during radiation, which is done

whenever possible; sperm banking for

patients with Tanner stage 4 or higher;

surgical sperm retrieval if patient is

Tanner stage 4 but unable to produce

a semen sample; and testicular tissue

pres ervation for prepubertal boys (this

is experimental and so far unsuccess-

ful).

Other late effectsEvery organ system can be affected by

radiation and chemotherapy, especial-

ly during early developmental years.


Total anthracycline

dose tolerated by

adults can be

associated with

cardiac failure when

given to children.


The endocrine system is suscepti-

ble to a number of late effects. Adreno-

corticotropic hormone deficiency sec-

ondary to pituitary lesions or cranial

radiation may occur and can result in

death from a simple upper respiratory

infection.31 Irradiation to the thyroid

gland results in a very high incidence

of hypothyroidism.32 Cranial radiation

and chemotherapy have been linked

to an increased incidence of obesity in

survivors of childhood leukemia.33

An increased incidence of miscar-

riages, complications during delivery,

and low birth weight infants are relat-

ed to pelvic radiation.34,35

Late deafness, poor educational

outcomes, psychological effects such

as posttraumatic stress disorder, and

impaired quality of life have all been

reported.36-38

Health care utilizationNot surprisingly, CAYACS data show

these late morbidities result in in creas -

ed health care utilization with respect

to physician visits, hospitalizations,

and outpatient procedures.39,40 Among

survivors, 24% had at least one subse-

quent hospitalization compared with

13% of age- and gender-matched con-

trols. Overall, demand for physician

visits, hospitalizations, and outpatient

services were greatest among sur-

vivors of a brain tumor, female sur-

vivors, and older survivors.

RecommendationsA program providing lifelong health

surveillance, counseling, and an on -

going registry for adult survivors of

childhood and adolescent cancer is

greatly needed in BC in accordance

with the Institute of Medicine recom-

mendations.9 Currently there is no

formal program for long-term care of

this population. Many adult survivors

have incomplete knowledge regard-

ing their past diagnoses, treatment,

and risks for significant future health

problems.8 This fact, together with the

extensive evidence for late effects of

childhood cancer, and the observed

excess health services utilization, in -

dicates an increased need for a com-

prehensive follow-up care strategy.

It is important to impart knowledge

to primary health care providers and

autonomy to cancer survivors by using

BC-specific data to develop risk-based

follow-up guidelines that address the

special needs of these patients.

Initiation of a prospective surveil-

lance system and follow-up registry

would contribute to the health and

well-being of adult survivors by pre-

venting or ameliorating late effects.

The recommendations for surveillance

monitoring of cancer survivors varies

slightly with country and re sources,

making it important to generate a set

of uniform, evidence-based guide-

lines appropriate to the situation in

BC. This will not only provide stan-

dards of follow-up care, but enable

ongoing evaluation of the guidelines

and effectiveness of any intervention-

al health action. This will also assist in

identifying late-onset health issues

related to newer therapies. Such a sur-

veillance system should be lifelong

and based on the latest evidence avail-

able. This type of program will pro-

vide a positive reinforcement mecha-

nism through annual contact, and

empower the patient to make any rec-

ommended changes in lifestyle.

Lifelong surveillance should be

supported by an ongoing registry for

adult survivors of childhood cancer to

provide vital facts regarding diagno-

sis, treatment, and risk category for

late effects, while providing the means

for quantifying the extent and severity

of any subsequent health problems in a

longitudinal population-based fashion.

Health care providers and institu-

tions have professional, ethical, and

legal responsibilities to inform pa -

tients, not only of the known risks

associated with therapy at the time of

diagnosis, but also the risks revealed

as new information becomes available.

Surveillance monitoringAll adult survivors of childhood can-

cer in BC, together with their primary

health care providers, should be given

a medical summary including details

of their diagnosis and therapy. They

should also be counseled regarding

anticipated health risks by nurse prac-

titioners or physicians knowledgeable

about late sequelae.9 Survivors should

be asked to consent to annual contact

(directly, via their primary health care

provider, or both) for follow-up of

their health. Risk-based guidelines

should be made available to patients

and health care professionals. In the

interim, the following general recom-

mendations are provided to address

the most important potential late seque-

lae in survivors of childhood cancer:

• All survivors should receive educa-

tion on healthy lifestyle to minimize

the added effects of obesity on car-

diovascular disease and the risk of

malignancy associated with obesity.

• Survivors who received anthracy-

clines should have echocardiograms

to measure ejection fraction and

fractional shortening, and ECG mon-

i toring every 5 years, and be advised

regarding the latest “healthy heart”

recommendations.25,41

• Females who received radiation to

the chest region should have mam-

mography or MRI breast screening

starting at age 25.42-45

• Survivors who received radiation to

the brain should be screened for

benign meningiomas by MRI start-

ing at 10 years posttreatment.

• Survivors who received radiation to

the brain or thyroid should be screen -

ed for thyroid nodules with ultra-

sounds of the neck starting at 5 years

posttreatment, and monitored for

thyroid function with T4 and TSH.



Fertility counseling andobstetric monitoringFemale survivors should be counseled

regarding their risk for infertility and

premature menopause. Monitoring for

ovarian reserve to predict early meno -

pause is important but is not easy.

Although changes in menstrual histo-

ry and an increase in follicle-stimulat-

ing hormone are easily monitored, the

abnormalities indicating impending

ovarian failure occur late. Serial antral

follicle count by ultrasound is more

accurate but time-consuming and not

readily available. Measurement of anti-

müllerian hormone (AMH) reflects

the primordial follicle number and is a

more reliable method to monitor ovar-

ian reserve; however, testing for AMH

is only available at private laborato-

ries in BC and is expensive.28 Males

should also be counseled regarding

risk for infertility. Fortunately, assess-

ment of male fertility is more easily

achieved by measuring the number

and quality of sperm in a semen sample.

Females who received anthracy-

clines need close cardiac monitoring

during pregnancy as they are at risk

for anthracycline-induced cardiac

failure. Those who received pelvic

radiation are at risk for early pregnan-

cy loss and premature delivery due to

uterine insufficiency and also require

close obstetric monitoring.34,35

ConclusionsA program that provides survivors of

childhood cancer with lifelong health

surveillance, counseling, and a fol-

low-up registry is needed in BC. If

adequately funded, such a program

would improve the knowledge, health,

and well-being of survivors of child-

hood cancer, and provide GPs with

current and relevant recommenda-

tions for follow-up care. Such a pro-

gram would also support the shared

goals of the federally funded Canadi-

an Partnership Against Cancer and the

BC Cancer Agency: to reduce the inci-

dence of cancer and the number of

cancer-related deaths, and to improve

the quality of life for those living with

cancer.

Acknowledgments

Grants for this project were provided bythe Canadian Institute for Health Research,the Canadian Cancer Society ResearchInstitute, and the Canadian Cancer SocietyBC and Yukon Division.

Competing interests

None declared.

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24. Hudson MM, Rai SN, Nunez C, et al. Non-invasive evaluation of late anthracyclinecardiac toxicity in childhood cancer sur-vivors. J Clin Oncol 2007;20:3635-3643.

25. Kremer LC, van Dalen EC, Offringa M, etal. Anthracycline-induced clinical heartfailure in a cohort of 607 children: Long-term follow-up study. J Clin Oncol 2001;19:191-196.

26. Brouwer CA, Gietema JA, van den BergMP, et al. Long-term cardiac follow-up insurvivors of malignant bone tumour. AnnOncol 2006;17:1586-1591.

27. Shankar SM, Marina N, Hudson MM, etal. Monitoring for cardiovascular diseasein survivors of childhood cancer: Reportfrom the Cardiovascular Task Force ofthe Children’s Oncology Group. Pedi-atrics 2009;121:e387-396.

28. Levine J, Canada A, Stern CJ. Fertilitypreservation in adolescents and youngadults with cancer. J Clin Oncol 2010[Epub ahead of print].

29. Wallace WH, Thomson AB, Saran F, et al.

Pediatr Blood Cancer 2004;42:604-610.39. McBride ML, Page J, Broemeling AM, et

al. Physician visits among survivors ofchildhood and young adult cancer inBritish Columbia, Canada: A CAYACSreport. Presented at the International Pri-mary Care and Cancer Research GroupMeeting, Edinburgh, UK, 24-25 April2008.

40. Bradley N, Lorenzi M, Abanto Z, et al.Hospitalizations 1998-2000 in a BritishColumbia population-based cohort ofyoung cancer survivors: Report of theChildhood/Adolescent/Young Adult Can-cer Survivors (CAYACS) Research Pro-gram. Eur J Cancer 2010;46:2441-2448.

41. Steinherz LJ, Graham T, Hurwitz R, et al.Guidelines for cardiac monitoring of chil-dren during and after anthracycline ther-apy: A report of the Cardiology Commit-tee of the Children’s Cancer Study Group.Pediatrics 1992;89:942-949.

42. Lalonde L, David J, Trop I. Magnetic res-onance imaging of the breast: Currentindications. Can Assoc Radiol J 2005;56:301-308.

43. DeMartini W, Lehman C. A review of cur-rent evidence-based clinical applicationsfor breast magnetic resonance imaging.Top Magn Reson Imaging 2008;19:143-150.

44. Trecate G, Vergnaghi D, Manoukian S, etal. MRI in the early detection of breastcancer in women with high genetic risk.Tumori 2006;92:517-523.

45. Lee CH, Dershaw DD, Kopans D, et al.Breast cancer screening with imaging:Recommendations from the Society ofBreast Imaging and the ACR on the useof mammography, breast MRI, breastultrasound, and other technologies forthe detection of clinically occult breastcancer. J Am Coll Radiol 2010;7:18-27.


Predicting age of ovarian failure after radi-ation to a field that includes the ovaries.Int J Radiat Oncol Biol Phys 2005;62:738-744.

30. Blumenfeld Z, Avivi I, Eckman A, et al.Gonadotropin-releasing hormone ago-nist decreases chemotherapy-inducedgonadotoxicity and premature ovarianfailure in young female patients withHodgkin lymphoma. Fertil Steril 2008;89:166-173.

31. Rose SR, Danish RK, Kearney NS, et al.ACTH deficiency in childhood cancer sur-vivors. Pediatr Blood Cancer 2005;45:808-813.

32. Constine LS, Donaldson SS, McDougallIR. Thyroid dysfunction after radiothera-py in children with Hodgkin’s disease.Cancer 1984;53:878-883.

33. Oeffinger KC, Mertens AC, Sklar CA, etal. Obesity in adult survivors of childhoodacute lymphoblastic leukemia: A reportfrom the Childhood Cancer SurvivorStudy. J Clin Oncol 2003;21:1359-1365.

34. Winther JF, Boice JD, Svendsen AL, etal. Spontaneous abortion in a Danish pop-ulation-based cohort of childhood cancersurvivors. J Clin Oncol 2008;26:4340-4346.

35. Reulen RC, Zeegers MP, Wallace WH, etal. Pregnancy outcomes among adult sur-vivors of childhood cancer in the BritishChildhood Cancer Survivor Study. Can-cer Epidemiol Biomarkers Prev 2009;18:2239-2247.

36. Kolinsky DC, Hayashi SS, Karzon R, et al.Late hearing loss: A significant compli -cation of cancer survivors treated withcisplatin containing regimens. J PediatrHematol Oncol 2010;32:119-123.

37. Lorenzi M, McMillan AJ, Siegel LS, et al.Educational outcomes among survivorsof childhood cancer in British Columbia,Canada: Report of the Childhood/Ado-lescent/Young Adult Cancer Survivors(CAYACS) Program. Cancer 2009;115:2234-2245.

38. Langeveld NE, Grootenhuis MA, VoutePA, et al. Posttraumatic stress symptomsin adult survivors of childhood cancer.


ABSTRACT: An audit of data from

1996 found a high rate of local recur-

rence in patients treated for rectal

cancer in British Columbia. The Col-

orectal Sur gical Tumour Group of the

Surgical Oncology Network of the BC

Cancer Agency addressed the high

rate of local recurrence with treat-

ment stra tegies of short-course pre-

operative radiation and total meso -

rectal excision. Education sessions

were given for surgeons, oncologists,

and pathologists. Initial outcomes

following implementation of this

management plan indicate a reduc-

tion in local recurrence in BC. Issues

identified that require further im -

provement include facilitation of pre -

operative MRI staging and stra tegies

to decrease high positive re section

margin rates for distal third rectal

cancer location. This communica-

tion to the BC medical community

completes the feedback loop for this

quality improvement project using a

multidisciplinary approach.

In 1996 a high local recurrence rate

for rectal cancer was identified in

an audit of outcomes for patients

treated for rectal cancer in BC.1 Pelvic

recurrence at 4 years occurred in 16%

of rectal cancer patients for all stages

and in 27% of Stage 3 patients. In con-

trast, local recurrence from colon can-

cer is estimated at 5% to 10%.

Factors contributing to a higher

rate of local recurrence after surgical

resection of rectal cancer than after

resection of colon cancer include more

difficult surgical anatomy in the pelvis

compared with the abdomen, nonstan-

dardized technique for resection of the

rectum, and poor adherence to inter-

national standards in the provision of

adjuvant radiotherapy.

Management planHaving recognized this significant

problem for rectal cancer patients, the

Colorectal Surgical Tumour Group

of the Surgical Oncology Network

(SON) of the BC Cancer Agency de -

signed a management plan aimed at

standardiz ing care across the province

and reducing local recurrence. The

plan included an outcomes review

to define the problem, strategy devel-

opment to address the problem, an

education program for specialists,

implementation of the strategy includ-

ing an in formation campaign to raise

awareness among family doctors, out-

comes ana lysis using data from pa -

tient follow-up, and provision of feed-

back to parti cipating specialists and

family physicians.

Step 1: Outcomes reviewOur review of 1996 rectal cancer man-

agement in BC1 determined that only

about 10% of operative reports includ-

ed statements that the rectal cancer

was resected with clear gross radial

margins and that all mesorectal lymph

nodes were removed in keeping with

the tenants of oncological surgical

resection. Only about 50% of pathol-

ogy reports assessed whether radial

margins were histologically free of

cancer. The mean number of lymph

nodes identified at pathology evalua-

tion was 6 instead of 12, the minimum

recommended for accurate staging.

Revisiting rectal cancermanagement in British ColumbiaA high local recurrence rate for rectal cancer has been reduced withthe help of new clinical practice guidelines.

P. Terry Phang, MD, R. Cheifetz, MD, C.J. Brown, MD, C.E. McGahan, MSc, Manoj Raval, MD

All authors are members of the ColorectalSurgical Tumour Group of the SurgicalOncology Network of the BC CancerAgency. Additionally, Dr Phang is an asso-ciate professor of surgery at the Universityof British Columbia; Dr Cheifetz is an assis-tant professor of surgery at UBC; Dr Brownis a clinical assistant professor of surgery atUBC; Dr Raval is chair of the Colorectal Sur-gical Tumour Group of the Surgical Oncolo-gy Network and clinical assistant professorof surgery at UBC.This article has been peer reviewed.


Adjuvant radiation was given to about

50% of eligible patients with Stages 2

and 3 disease.

Step 2: Strategy developmentAfter recognizing these management

deficiencies, we recommended a new

surgical technique, total mesorectal

excision (TME), for excision of the

rectal cancer and all mesorectal lymph

nodes within an intact mesorectal fas-

cial envelope.2 Local recurrence rates

at 10 years for curative resections using

TME were reported to be as low as

4%. A new protocol for preoperative

short-course radiation recommended

by Pahlman and colleagues in Sweden

reduced local recurrence to 11% from

27% after follow-up for a minimum

of 5 years.3 The combination of short-

course preoperative radiation and TME

resulted in a 2-year local recurrence

of 2.4% in a Dutch national trial.4 On

the basis of this and other studies, the

clinical guidelines for rectal cancer

management in BC (see ) were

chang ed to recommend short-course

preoperative radiation for Stages 2 and

3 rectal cancers follow ed by surgical

resection using TME. The guidelines

also include preoperative clinical stag-

ing using CT, MRI, and endorectal

ultrasound in order to recommend pre-

operative radiation where appropri-

ate. Guidelines for pathology report-

ing include assessment of the radial

resection margin and examination of

at least 12 lymph nodes. The recom-

mendations were not changed for long-

course preoperative chemoradiation

for clinically fixed tumors and lesions

having predicted close resection mar-

gins or for adjuvant postoperative

chemotherapy for Stage 3 cancers.5

Step 3: Education program To implement the new treatment strat -

egies, we designed an education pro-

gram for surgeons, pathologists, and

radiation oncologists involved in the

Figure

care of patients with rectal cancer.

Held in 2002 and 2003, the education

sessions consisted of lectures, live sur-

gery with a video link to the audience,

and hands-on dissection of the pelvis

in cadaver labs. Session topics includ-

ed preoperative imaging, radiation,

and chemotherapy in the preoperative

Revisiting rectal cancer management in British Columbia

Figure. Clinical guidelines for rectal cancer management in BC.

Adapted from BC Cancer Agency web site (www.bccancer.bc.ca).5

(neoadjuvant) and postoperative (ad -

ju vant) setting, pelvic anatomy, the

surgical technique of total mesorectal

ex cision,6 gross pathology of the re sect-

ed TME specimen, and standardized

operative reporting. A parallel course

of lectures and live demonstration was

held for pathologists, including TME

1. Diagnosis is made on biopsy obtained during sigmoidos -copy or colonoscopy.

2. Preoperative clinical stage is determined by CT (abdomen,pelvis) to assess distant spread (clinical stage M) and byMRI (pelvis) or endorectal ultrasound to assess localinvasion (clinical Stage T and N, and predicted radialresection margin).

3. Preoperative radiation is indicated for clinical Stages 2 and 3 (T3-4, N1-2).a.Short-course preoperative radiation over 5 days is

recommended for mobile lesions with clear predictedradial resection margins.

b.Long-course preoperative radiation (with concurrentchemo therapy) over 5 weeks is recommended forclinically fixed lesions or for close/involved predictedradial resection margins in order to maximize tumorshrinkage prior to surgery.

4. Postoperative adjuvant chemotherapy over 4 to 6 monthsis given for clinical Stages 2 and 3 lesions.a. Postoperative adjuvant radiation is given for clinical

Stages 2 and 3 lesions if radiation is not givenpreoperatively.

5. Surveillance is recommended in Stages 2 and 3 patients for 5 years: office visits for rectal examination andcarcinogenic embryonic antigen testing every 3 to 4months for 3 years, then every 6 months for years 4 and 5;liver imaging (ultrasound or CT) every 6 to 12 months inthe first 3 years, then annually for years 4 and 5; chest X-ray every 6 to 12 months; colonoscopy at year 1 andyear 4, then every 5 years thereafter. Flexible sigmoidos -copy every 6 to 12 months should also be considered.


specimen processing, gross and mi -

cro sopic findings, and standardized

pathology reporting.7,8 World experts

from the UK, Sweden, the Nether-

lands, and the US were invited to teach

at the sessions. Favorable feedback

from course participants regarding the

educational value of the sessions and

tests of knowledge retention suggest-

ed good knowledge transfer.9

Step 4: Implementation withinformation campaignOur next step was to implement the

treatment plan and to inform family

doctors in BC of the new rectal cancer

management strategy. This informa-

tion was transmitted via the BC Med-ical Journal in a two-part theme issue

in July-August and September of

2003.10-13

Step 5: Outcomes analysis Data on patient outcomes were col-

lected and analyzed by the Colorectal

Surgical Tumour Group of the SON.

We audited patients treated with cura-

tive-intent major resection of their

rectal cancer in the year after the edu-

cation courses. This group of patients

was compared with patients treated in

our initial study. The main finding of

this audit was a decrease in 2-year

pelvic recurrence from 18.2% to 9.2%

for Stage 3 rectal cancers and from

9.6% to 6.9% overall.14 Use of adju-

vant radiation increased to 65%, most-

ly given preoperatively. Negative

radial margins were achieved in 87%

of cases. Pathology reporting showed

increased assessment of the radial

margin to 97% of cases and an aver-

age of 12 lymph nodes per case. These

improvements were statistically and

clinically significant.

Step 6: Feedback The final step of the quality improve-

ment process involved providing feed-

back to participants. Ongoing reports

were provided to BC surgeons at their

annual spring meeting (BC Surgical

Society) and to oncologists at their

an nual fall meeting (BC Cancer Agen -

cy), as well as through the SON news -

letter. A rectal cancer education course

update was held in 2008 that reported

on the final outcomes.

Feedback to family doctors in BC

will continue to be provided through

the BC Medical Journal.

Further improvementsneededAs with many quality improvement

projects, important aspects of care

requiring further attention have been

identified.

Use of preoperative imaging mo -

dalities of MRI and endorectal ultra-

sound continue to be limited because

of resource limitations in BC and

because radiologists have not yet

adopted a standardized report form for

rectal cancer. BC Cancer Agency cen-

tres in Victoria, Vancouver, Surrey,

Kelowna, and Abbotsford, and soon

in Prince George, offer potential for

creating rectal cancer care pathways

to improve accessibility of MR scan-

ning and radiation. The Colorectal

Surgical Tumour Group of the Surgi-

cal Oncology Network has preopera-

tive MR imaging on its working agen-

da and invites radiologists to join the

community of family phy sicians, sur-

geons, oncologists, and pathologists

as integral contributors to the care of

rectal cancer patients.

Technical problems with surgical

resection of rectal cancer persist in

BC. Positive radial margins for rectal

cancer location in proximity to the

anal sphincter were recorded in 35%

of specimens with cancers in the

distal-third of the rectum (located less

than 5 cm from the anus).15 Also, the

rate of permanent colostomy for distal-

third rectal cancer location was not

decreased after the education courses.

It seems reasonable to recommend

that surgeons who operate for rectal

cancer less frequently should consid-

er referral of difficult distal-third rec-

tal cancers to subspecialist surgeons

in higher-volume centres.16

ConclusionsQuality improvement in rectal cancer

treatment will ideally continue in cy -

cles of assessment, strategy, and execu -

tion. We have identified im provements

needed in the care of rectal cancer

patients and hope to use the recently

developed cancer surgeon network to

promote these. With a multidisciplinary

approach to care, physicians and sur-

geons continue seeking to improve


Use of preoperative imaging mo dalities

of MRI and endorectal ultrasound

continue to be limited because of

resource limitations in BC and

because radiologists have not yet

adopted a standardized report

form for rectal cancer.


pa tient outcomes. However, limita-

tions in resources and geography pose

challenges for quality im provement in

our large province. Patient awareness,

ed ucation, and ad vocacy will be im -

portant drivers in the quest to beat col-

o rectal cancer in British Columbia.

Competing interests

None declared.

References

1. Phang PT, MacFarlane J, Taylor RH, et al.Effects of positive resection margin andtumour distance from anus on rectal can-cer treatment outcomes. Am J Surg2002;183:504-508.

2. Heald RJ, Moran BJ, Ryall RDH, et al.Rectal cancer: The Basingstoke experi-ence of total mesorectal excision, 1978-1997. Arch Surg 1998;133:894-899.

3. Pahlman L, Glimelius B, and the SwedishRectal Cancer Trial investigators. Improv -ed survival with preoperative radiothera-py in resectable rectal cancer. N Engl JMed 1997;336:980-987.

4. Kapiteijn E, Marijnen CA, Nagtegaal ID,et al.; Dutch Colorectal Cancer Group.Preoperative radiotherapy combined withtotal mesorectal excision for res pectablerectal cancer. N Engl J Med 2001;234:638-646.

5. BC Cancer Agency. Management guide-lines for rectal cancer. www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Gastrointestinal/06.Rectum/Management (accessed 8 October 2010).

6. Phang PT. Total mesorectal excision: Tech-nical aspects. Can J Surg 2004;47:130-137.

7. Quirke P, Durdey P, Dixon MF, et al. Localrecurrence of rectal adenocarcinoma dueto inadequate surgical resection. Histo -pathological study of lateral tumourspread and surgical excision. Lancet1986;2(8514):996-999.

8. Nagtegaal ID, van de Velde CJ, van derWorp E, et al.; Cooperative Clinical Inves-tigators of the Dutch Colorectal CancerGroup. Macroscopic evaluation of rectalcancer resection specimen: Clinical sig-nificance of the pathologist in quality con-trol. J Clin Oncol 2002;20:1729-1734.

9. Cheifetz R, Phang PT. Evaluating learningand knowledge retention after a continu-ing medical education course on totalmesorectal excision for surgeons. Am JSurg 2006;191:687-690.

10. Phang PT, MacFarlane J, Taylor RH, et al.Practice patterns and appropriateness ofcare for rectal cancer management in BC.BCMJ 2003;45:324-329.

11. Malfair D, Brown JA, Phang PT. Pre-

operative rectal cancer imaging. BCMJ2003;45:259-261.

12. Phang PT, Law J, Toy E, et al. Pathologyaudit of 1996 and 2000 reporting for rec-tal cancer in BC. BCMJ 2003;45:319-323.

13. Phang PT, Strack T, Poole B. Proposal toimprove rectal cancer outcomes in BC.BCMJ 2003;45:330-335.

14. Phang PT, McGahan CE, McGregor G, etal. Effects of change in rectal cancer man-agement on outcomes in British Colum-bia. Can J Surg 2010;53:225-231.

15. Phang PT, Kennecke H, McGahan CE, etal. Predictors of positive radial margin sta-tus in a population-based cohort of pa -tients with rectal cancer. Curr Oncol2008;15:1-6.

16. Martling AL, Holm T, Rutqvist LE, et al.Effect of a surgical training programmeon outcome of rectal cancer in the Coun-ty of Stockholm. Lancet 2000;356(9224):93-96.


Surgeons who operate for rectal

cancer less frequently should

consider referral of difficult distal-

third rectal cancers to subspecialist

surgeons in higher-volume centres.



Catherine Elliott MD, CCFP,FRCPC, Tom Kosatsky, MD

In 2010 British Columbia had an ex -

ceptional forest fire season. The

smoke was thicker and the number

of communities affected was greater

than in previous years. In the Interior,

communities experienced two smoky

periods, each lasting several days. The

first began in late July and the second

in early August. The highest measured

daily mean fine particulate matter in the

province occurred in Williams Lake,

with a peak of 258 ug/m3 on 19 August,

more than 20 times normal background

levels. Since forest fire smoke travels

long distances, populations through-

out the province were exposed.

Forest fire smoke contains a mix-

ture of pollutants including fine partic -

ulate matter (PM 2.5) and many tox ic

compounds.1 Exposure to forest fire

smoke has well-documented health ef -

fects,1 including asthma exacerbations2

and other respiratory complaints.3 This

summer, British Columbia was smoky

enough to observe these effects.

Indeed, MSP billings for physician

visits for COPD and asthma increased

following smoky days. The propor-

tional increase in visits is most pro-

nounced for regions where particulate

matter was highest, like Cariboo-

Chilcotin Health Service Area (Wil -

liams Lake) ( ). After almost

a week of smoky days in Cariboo-

Chilcotin, starting in mid-August, the

daily number of visits increased by

100% (four visits) above the 10-year

mean. An increase in visits was also

Figure 1

the increase in the number of visits

was greater (15 visits, ). This

increase in visits following smoky

days was consistently observed in

smokier regions (data not shown).

While this is only a first glimpse at the

data, it does illustrate an important

Figure 2

bc centre fordisease control

Smoky air and respiratory health in the 2010 forest fire season,British Columbia


Dr Elliott is a federal field epidemiologist inEnvironmental Health Services at the BCCDC.Dr Kosatsky is the medical director of Envi-ronmental Health Services at the BCCDC.

observed during the same period in

the Fraser North Health Service Area,

which includes New Westminster,

Burnaby, and Coquitlam, even though

PM 2.5 reached only 17.6 ug/m3

( ). Although the proportional

increase in visits above the 10-year

mean was lower in Fraser North (14%),

Figure 2

Phys

icia

n se

rvic

es fo

r CO

PD a

nd a

sthm

a(7

day

rolli

ng a

vera

ge)

Daily m

ean PM 2.5 (ug/m

3)

29

8

6

4

2

0

June July August03 07 11 15 19 23 27 31 04 08 12 16 20 24 28

400

300

200

100

0

Daily PM 2.5258 ug/m3

8 visits/day (10-year mean 4.5)

Date 2010

Figure 1. Physician services for respiratory illness and daily mean fine particulate matter inthe Cariboo-Chilcolten region of BC, 2010.

Phys

icia

n se

rvic

es fo

r CO

PD a

nd a

sthm

a(7

day

rolli

ng a

vera

ge)

Daily m

ean PM 2.5 (ug/m

3)

29

150

100

50

0

June JulyDate 2010

August03 07 11 15 19 23 27 31 04 08 12 16 20 24 28

30

20

20

0

Daily PM 2.517.5 ug/m3

114 visits/day(10-year mean 99)

Figure 2. Physician services for respiratory illness and daily mean fine particulate matter inthe Fraser North region of BC, 2010.


PM 2.5 = fine particulate matter



The WorkSafeBC Evidence-

Based Practice Group (EBPG)

conducted a review of system-

atic reviews investigating the efficacy

of treatments for chronic noncancer

pain. The systematic literature search

of medical databases, including Coch -

rane Database of Systematic Reviews,

Cochrane Library’s Health Technolo-

gy Assessment Database, BIOSIS,

Embase, and Medline, was done in

April 2010.

The extended summary of the chron -

ic pain report can be viewed at www

.worksafebc.com/health_care_provid

ers/Assets/PDF/poster-presentations/

ChronicPainTreatmentsEvidence.pdf.

No limitation was employed in this

search. The results are summarized below.

worksafebc

Evidence-based treatment of chronic pain

TreatmentEvidence

CommentsPositive Negative Conflicting

Pharmacological management

Topical 1-6 �For topical capsaicin, salicylate-based rubefacients, and topical lidocaine

� For topical ibuprofen for knee pain, especially in the elderly

Anticonvulsants2,7-12 �For Carbamazepine, Clonazepam, Phenytoin, Lamotrigine, Sodium Valproate

� For Lorazepam, Oxcarbazepine, Topiramate, Gabapentin, PregabalinAntidepressants13

Tricyclic antidepressants2,9,14

Selective serotonin reuptake inhibitors2

Serotonin-norepinephrine reuptake inhibitors2,9,14,15

�—�

�

— —

In general, for nonspecific low back painExcept for HIV-related neuropathiesNo available evidenceFor diabetic neuropathy and post-herpetic neuralgia

Antipsychotics (as ADD ON)16 � In chronic and resistant pain

Ketamine17 ��

For acute relief of chronic pain For long-term treatment of chronic pain

Muscle relaxants18 �For acute low back pain for short-term pain relief, although adverseeffects are frequent

Non anticonvulsants19 � For trigeminal neuralgia

Opioids2,20-22

Opioid switching23

Hydromorphone24

Tramadol2,25-28

�

�

�

�

�

For reducing pain, not for quality of life or functional status inchronic low back pain. Adverse effects are common

For long-term management of chronic low back painIn patients with inadequate pain relief or with intolerable opioid-

related adverse effectsHowever, analgesic efficacy and tolerability are similar to morphineThe effect size is small, side effects are common, and may not be

better than less expensive analgesics

Multimodal Pain Rehabilitation Program29-32 � Except for neck and shoulder pain in adults

Cognitive behavioral therapy and behavioral therapy30,33,34 �

The effect is small, but can be retained up to 6 months in reducing painand disability, altering mood and social function. The best content, du-ration, intensity, and format of the treatment delivery are still unclear

Invasive/surgical management

Systemic application of local anesthetics35 �For IV lidocaine; however, the effectiveness is short and may not beclinically significant

Extracorporeal shock wave therapy36 � For low energy in treating lateral epicondylitis

Spinal cord stimulators37,38

�

�

For short-term pain relief, but not on function or return to work incomplex regional pain syndrome

For failed back surgery syndromeFor all, adverse effects are common

Sympathectomy(39) �

Trigger point injection(40,41) �As the sole treatment in patients with chronic head, neck, or shoulder pain, as well as whiplash-associated disorders




principle in the relationship between

air pollution and health: a small in -

crease in exposure in large populations

(Fraser North, population 597 659)

can affect larger numbers of people

than a large increase in exposures in

small populations (Cariboo-Chilcotin,

population 26 646).

The evidence we present from this

season serves as a reminder that forest

fire smoke affects people all over the

province, even those distant from the

fires. Physicians and public health prac-

titioners across BC can (and did) work

together to reduce the health effects of

exposure to forest fires, particularly

among those most at risk: firefight -

ers, young children, the elderly, and

those with chronic respiratory disease.

Physicians play a key role in ensuring

that patients with chronic res piratory

conditions such as COPD and asthma

have rescue medication and emer-

gency response plans, and know when

to seek medical help. Public health res -

ponses include issuing air quality health

advisories, establishing air shelters, and

evacuating those at risk during severe

smoke events. Partnerships be tween

physicians and public health practi-

tioners become particularly ad vanta-

geous when novel scenarios arise, such

as how to manage patients in hospitals

when the indoor air becomes smoky.

Forest fires are the norm in British

Columbia, and we can anticipate that

they will increase with global climate

change. Physicians and public health

practitioners must continue to work

together to reduce the health impacts

of forest fires.

Acknowledgments

Thank you to Population Health Surveil-lance and Epidemiology, BC Ministry ofHealthy Living and Sport, the Office of theProvincial Health Officer, and Sarah Hen-derson, environmental health scientist, BCCentre for Disease Control.

References

1. Naeher LP, Brauer M, Lipsett M, et al.Woodsmoke health effects: A review.Inhal Toxicol 2007;19:67-106.

2. Brauer M, Hisham-Hashim M. Fires inIndonesia. Environment Science Technol1998;32S:404S-407S.

3. Moore D, Copes R, Fisk R, et al. Popula-tion health effects of air quality changesdue to forest fires in British Columbia in2003: Estimates from physician-visitbilling data. Can J Pub Health 2006;97:105-108.

worksafebc

TreatmentEvidence

CommentsPositive Negative Conflicting

Physical therapyTraction or spinal decompression42,43 � As a single treatment for any low back pain, with or without sciaticaPhotonic stimulation44 �

Interferential stimulation45 �

Superficial heat or cold46 � Short-term with small effectElectromagnetic fields47 � For knee osteoarthritis; however, the effect is not clinically significantElectrotherapy48 � In treating neck pain

Conservative therapy49 �For active or passive treatments in whiplash-associated disorders,Grades 1 or 2

Transcutaneous electrical nerve stimulation50-54 �

For knee osteoarthritis or chronic low back pain, or in reducing painamong patients with rheumatoid arthritis of the hand

Low-level laser therapy55,56 � In reducing pain among patients with nonspecific low back or neck painComplementary and alternative medicineTouch therapy, including healing touch,reiki, therapeutic touch57 � In reducing pain; however, the effect is not clinically significant

Neuroreflexotherapy58 � Short-term effect for nonspecific low back pain

Massage59,60�

� For nonspecific neck painSmall effect for subacute or chronic nonspecific low back pain

Acupuncture61-63�

�Evidence, short-term effect in acute headache or chronic

nonspecific low back painIn treating shoulder pain

Herbal64,65 � For rheumatoid arthritis and maybe low back painVitamin D66 �

References

Available on request by e-mailing [email protected] or calling 604 232-5883. An extended summary of

this review is accessible from the Evidence-based Medicine page on WorkSafeBC.com (www.worksafebc.com/evidence.)

—Kukuh Noertjojo, MD, MHSc, MSc; Craig Martin, MD, MHSc; Celina Dunn, MD, CCFP

WorkSafeBC Evidence-Based Practice Group


bccdc

INDEX TO BRITISH COLUMBIA MEDICAL JOURNALVOLUME 52—JANUARY–DECEMBER 2010

Index includes the title of the article. Asterisk (*) indicates a clinical review article. Back Page (bp), BC Centre for Disease Control (cdc), Editorials(ed), correspondence (c), Council on Health Promotion (cohp), opinions (op), General Practice Services Committee (gpsc), Good Guys (gg), In Memo-riam (im), Insurance Corporation of British Columbia (icbc), Library of the College of Physicians & Surgeons of British Columbia (lib), Medical stu-dent column (md2b), Physician Information Technology Office (pito), Point•Counterpoint (pcp), Pulsimeter (pu), Special Feature (sf), and WorkSafeBC(wsbc) items are noted by abbreviations. Location of article is by issue number followed by beginning page number.

2010 author index


AhPin C: Individual pension plans for incorpo-rated professionals (pu) 3:134

Andrade J: Cardiovascular risk factors andmodels of risk prediction: Recognizing theleadership of Dr Roy Dawber* 7:342

Arruda W: Family physicians and specialistsunite! A collaborative approach to managingADHD in the office (cohp) 1:46; Are routinechild visits really necessary? The state of chil-dren’s development in BC (cohp) 10:503

Atkinson KG: Dr Hugh Richard Williams (im)7:339

Barr RG: New shaken baby program (pu) 1:39Bass F: Training the inner alligator (sf) 1:23Battershill J: Nosocomial or iatrogenic infec-

tions (c) 8:386Bayliss M: Does an Aspirin a day keep the doc-

tor away? Acetylsalicylic acid for the primaryprevention of cardiovascular disease* 6:298

Bell NJ: Vulnerability to pedestrian trauma:Demographic, temporal, societal, geograph-ic, and environmental factors* 3:136

Benedet JL: Dr David Stewart Allan (im) 5:262Boggie A: Re: Attitude (c) 2:66Bolton P: Dr David McNiell Bolton (im) 7:339Bowering R: Family physicians and specialists

unite! A collaborative approach to managingADHD in the office (cohp) 1:46

Braid S: BCMA Insurance Department responds(c) 1:9; Water damage: An ounce of preven-tion is worth a pound of cure (pu) 2:102; Trav-el insurance rules for visitors to Cuba (pu)6:295; Core-Plus Plan reminder (pu) 8:416

Brar R: Conflict of interest (c) 1:9Brcic V: Conflict of interest (c) 1:9Brodie B: The 2010 Winter Olympic Games are

inspirational (op) 1:6; Programs for special-ists are on the way (op) 2:64; Numbers speakvolumes (op) 3:120; East Vancouver YouthMental Health Project (op) 4:177; Presiden-tial musings: End-of-term reflections (op)5:243

Brown CJ: Revisiting rectal cancer manage-ment in British Columbia * 10:510

Buczkowski AK: Liver transplantation: Cur-rent status in British Columbia* 4:203

Burnett RSJ: Total hip arthroplasty: Techniquesand results* 9:455

Busser J: Re: AGM article (c) 8:387Cadario B: New resource: Falls among elderly

(pu) 5:268Cadenhead K: Out with the old, in with the

“new” WHO growth charts (cohp) 3:152Capler R: Re: Medical marijuana (c) 9:435Chamberlain E: Emergency departments: Are

they considered a safe haven from prosecu-

tion for impaired drivers involved in fatal orpersonal injury crashes? (cohp) 9:477

Chapman DB: Lost and found (ed) 2:62; Theend of an era (ed) 9:433

Cheifetz R: Revisiting rectal cancer manage-ment in British Columbia * 10:510

Chung SW: Liver transplantation: Current sta-tus in British Columbia* 4:203

Clarke A: The physical and mental health statusand health practices of physicians in BritishColumbia* 7:349

Clay MG: Dr Gordon Gatward (Bud) Lott (im)3:150

Cochrane DD: Thank you, Dr Benton: Ration-ale for using a surgical checklist in BritishColumbia* 5:254

Corbett WJ: Dr George Edward Cragg (im)3:150

Dagg P: Guidelines for sedating psychiatricpatients flawed (pcp) 1:20

Dalal B: Guidelines and Protocols Committee(pu) 5:266

Dale J: Re: Euthanasia (c) 4:172Daniels J: Book review: The Pain Detective:

Every Ache Tells a Story (pu) 2:67Davis M: Cardiovascular risk factors and mod-

els of risk prediction: Recognizing the lead-ership of Dr Roy Dawber* 7:342

Day B: In government we trust (ed) 4:170de Couto J: Member survey results (c) 5:244De Smet M: MSF malaria awareness (pu) 6:295DeGirolamo K: MWIA conference (pu) 8:414;

Lights, Camera, Surgery: Take 2 (md2b)10:501

Deyell MW: The implantable cardioverter-defibrillator: From Mirowski to its currentuse* 5:248

Draper J: 2010 BCMA Annual Meeting Report(sf) 6:290; Interview with Dr Ian Gillespie—BCMA president 2010–2011 (sf) 7:333

Dujela CE: New study: Cholinesterase inhi -bitors (pu) 4:223

Dunn C: WorkSafeBC medical advisors arehere to help (wsbc) 2:100; Evidence-basedtreatment of chronic pain (wsbc) 10:515

Elliott C: Smoky air and respiratory health inthe 2010 forest fire season, British Columbia(cdc) 10:514

Elwood K: Screening renal failure patients fortuberculosis (cdc) 8:413

Erb SR: Liver transplantation: Current status inBritish Columbia* 4:203

Etches N: Conflict of interest (c) 1:9Evoy B: Attachment and integration: Collabo-

ration at work (gpsc) 5:246; Divisions of

Family Practice address community needs,improve care at local level (gpsc) 9:470

Finlayson ND: Dr Gordon Gatward (Bud) Lott(im) 3:150

Frank E: The physical and mental health statusand health practices of physicians in BritishColumbia* 7:349

Fraser GC: Frimer M: BCMA benefits decision (c) 1:8Fryer C: The need for long-term follow-up of

childhood cancer survivors in British Colum-bia * 10:504

Galanis E: Tularemia in British Columbia: Acase report and review* 6:303

Gallagher R: The resuscitation conversation(cohp) 4:218

Garbuz DS: Total knee arthroplasty: Techniquesand results* 9:447

Gilbert M: Don’t wait to test for HIV (cdc)6:308

Giligson A: Re: Legalization of euthanasia (c)4:174; Proust questionnaire (bp) 8:426

Gillespie I: Looking forward to a new year (op)6:286; BCMA leads country with 16 resolu-tions at CMA (op) 7:330; Proust question-naire: Ian Gillespie, MD (bp) 7:378; All in aday’s work (or perhaps a couple of weeks)(op) 8:389; Determining fitness to drive: Atroublesome task (op) 9:434; Setting the stagefor the next several years (op) 10:498

Green SA: Resident work hours: Examiningattitudes toward work-hour limits in generalsurgery, orthopaedics, and internal medicine*2:84

Greenstone G: The history of bloodletting (op)1:12; Captain Vancouver and medicine in theAge of Sail (sf) 10:504

Grist R: CME costs (c) 2:65Gross EL: Mild traumatic brain injury (wsbc)

6:297Haigh SE: Care of the aging (ed) 1:5; Type 2

diabetes in youth (ed) 8:385Hameed SM: Vulnerability to pedestrian trau-

ma: Demographic, temporal, societal, geo-graphic, and environmental factors* 3:136

Hamill J: BC Genome Sciences Centre advan -ces (pu) 9:473

Haque M: Liver transplantation: Current statusin British Columbia* 4:203

Hasan M: Clinical features and pathogeneticmechanisms of osteoarthritis of the hip andknee* 8:393

Hawkeswood J: Evidence-based guidelines forthe nonpharmacological treatment of osteo -arthritis of the hip and knee* 8:399


Haynes S; Popping the cork (bp) 2:110; Hammyand Hector (gg) 8:410

Hendry K: Conflict of interest (c) 1:9Heuchert T: The future is clear now: Expert evi-

dence under the new civil rules (icbc) 1:17Hill R: Dr J. Michael Rigg (im) 5:263Hoang L: Tularemia in British Columbia: A case

report and review* 6:303Ignaszewski A: Dr Edward Freis: A pioneer in

evidence-based treatment of hypertension*3:144; Cardiac transplantation in BritishColumbia* 4:197; The implantable car-dioverter-defibrillator: From Mirowski to itscurrent use* 5:248; Does an Aspirin a daykeep he doctor away? Acetylsalicylic acid forthe primary prevention of cardiovascular dis-ease * 6298; Cardiovascular risk factors andmodels of risk prediction: Recognizing theleadership of Dr Roy Dawber* 7:342

Isaac-Renton J: Pandemic influenza: Postpan-demic laboratory analysis (cdc) 3:124

Isaac-Renton M: Tularemia in British Colum-bia: A case report and review* 6:303

Isaacs G: Colorectal cancer screening (c) 10:499

Jensen L: Dr Jensen responds (c) 2:66; Seniordrivers (icbc) 2:97; Driver assessment andthe duty to report (icbc) 3:122; Aids for MVAinjury management and documentation (icbc)4:185

Johnston J: Screening renal failure patients fortuberculosis (cdc) 8:413

Kallstrom L: GP learning session focuses onimproving care for adolescent depression(gpsc) 2:96; Innovative group medical visitsbenefit both dementia patients and their care-givers (gpsc) 4:181; PSP developments forthis autumn (gpsc) 6:310

Kendall PRW: Physicians: Protect yourself (pu)10:531

Kennedy S: Pharmacological treatment of osteo -arthritis of the hip and knee* 8:404

Keyes M: BC Cancer Agency prostate brachy -therapy experience: Indications, procedure,and outcomes* 2:76

King DJ: Don Rix remembered (gg) 2:72Klein M: Conflict of interest (c) 1:9Ko J: Legalization of euthanasia violates the

principles of competence, autonomy, andbeneficence (md2b) 2:92

Kosatsky T: Hot day deaths, summer 2009:What happened and how to prevent a recur-rence (cdc) 5:261; Smoky air and respiratoryhealth in the 2010 forest fire season, BritishColumbia (cdc) 10:514

Kozoriz K: Re: Resident work hours (c) 5:244Krajden M: Don’t wait to test for HIV (cdc)

6:308Lamsdale AM: Thank you, Dr Benton: Ration-

ale for using a surgical checklist in BritishColumbia* 5:254

Landsberg DN: Kidney, pancreas, and pancre-atic islet transplantation* 4:189

Lawson LM: Lung attack: A call to arms (ed)3:118; Geriatric denial (ed) 10:497

Leduc E: Re: Medical authorizations and re -ports (c) 2:65; Mitufala dokta lanem plantilong Vanuatu! We two doctors learned a lot inVanuatu! (sf) 3:126

Levy RD: The hope and promise of transplan-tation * 4:186; Lung transplantation in BritishColumbia: A breath of fresh air * 4:211

Leyen J: Special Care Services offers enhancedcare for BC’s most seriously injured workers(wsbc) 4:217

Li D: Update on antibiotic resistance in BritishColumbia (cdc) 4:226

Lord SE: Vulnerability to pedestrian trauma:Demographic, temporal, societal, geograph-ic, and environmental factors* 3:136

Loyola V: Tularemia in British Columbia: Acase report and review* 6:303

Lucas P: Re: Medical marijuana (c) 9:435MacDonald L: The need for long-term follow-

up of childhood cancer survivors in BritishColumbia * 10:504

MacDonell K: Learning at your convenience(lib) 1:18; A thousand words (lib) 5:270; E-vailability of e-books (lib) 7:368; Best evi-dence: The tip of the information iceberg (lib)9:437

Mackie B: Antibiotic use in our livestock (cohp)6:309; Your irresistible personal portrait: Away to reduce antibiotic resistance? (cdc)9:465

Maclure M: Your irresistible personal portrait:A way to reduce antibiotic resistance? (cdc)9:465

Mahli L: Emergency departments: Are theyconsidered a safe haven from prosecution forimpaired drivers involved in fatal or person-al injury crashes? (cohp) 9:477

Mak S: Tularemia in British Columbia: A casereport and review* 6:303

Malebranche AD: Lost in translation (md2b)1:11; Private health care with public deliv-ery? (md2b) 7:358

Mammen A: New shaken baby program (pu)1:39

Marois J: Receiving gifts from patients: A prag-matic shade of grey (op) 3:129

Martin C: What’s new in the literature: Non-specific neck pain (wsbc) 3:123; Researchteam explores new bone and tendon-relatedtreatments (wsbc) 8:391; Evidence-basedtreatment of chronic pain (wsbc) 10:515

Martin S: Determining fitness to work at safety-sensitive jobs (wsbc) 1:48

Masri BA: Guest editorial: Osteoarthritis of thehip and knee, Part 1: Pathogenesis and non-surgical management* 8:392; Guest editori-al: Osteoarthritis of the hip and knee, Part 2:Surgical interventions* 9:438; Total kneearthroplasty: Techniques and results* 9:447

Masterson M: Re: Resident work hours (c)5:244

McBride ML: The need for long-term follow-up of childhood cancer survivors in BritishColumbia * 10:504

McCarthy L: Dr Kerry Margaret Telford Mor-rissey (im) 5:263

McComb P: Dr Basil Ho Yuen (im) 4:225McCormack R: The role of arthroscopy in the

treatment of degenerative joint disease of theknee* 9:439

McElhaney J: The resuscitation conversation(cohp) 4:218

McGahan CE: Revisiting rectal cancer man-agement in British Columbia * 10:510

McGregor M: Conflict of interest (c) 1:9McKay R: Update on antibiotic resistance in

British Columbia (cdc) 4:226; Your irre-sistible personal portrait: A way to reduceantibiotic resistance? (cdc) 9:465

McKenzie M: BC Cancer Agency prostatebrachytherapy experience: Indications, pro-cedure, and outcomes* 2:76

McLaren WJ: Proust questionnaire (bp) 10:542McNabb A: Pandemic influenza: Postpandem-

ic laboratory analysis (cdc) 3:124Meloche G: Special Care Services offers

enhanced care for BC’s most seriously injur -ed workers (wsbc) 4:217; Mild traumaticbrain injury (wsbc) 6:297

Meloche M: The hope and promise of trans-plantation * 4:186

Melrose R: Learning at your convenience (lib)1:18; A thousand words (lib) 5:270; E-vail-ability of e-books (lib) 7:368; Best evidence:The tip of the information iceberg (lib) 9:437

Metzger DL: Diabetic ketoacidosis in childrenand adolescents: An update and revised pro-tocol* 1:24

Moffat L: Free insurance? (pu) 10:530Molavi I: Lights, Camera, Surgery: Take 2

(md2b) 10:501Montgomerie A: Improving the way we work

with you (wsbc) 5:265Moran M: Pharmacological treatment of

osteoarthritis of the hip and knee* 8:404Morris J: BC Cancer Agency prostate brachy -

therapy experience: Indications, procedure,and outcomes* 2:76

Morshed M: Tularemia in British Columbia: Acase report and review* 6:303

Muir R: Dr Peter Finden Stonier (im) 2:98Naus M: Human Papillomavirus Vaccine

Program in BC: A good start with room forimprovement (cdc) 2:95

Neill J: Learning at your convenience (lib) 1:18;A thousand words (lib) 5:270; E-vailabilityof e-books (lib) 7:368; Best evidence: The tipof the information iceberg (lib) 9:437

Noertjojo K: What’s new in the literature: Non-specific neck pain (wsbc) 3:123; Researchteam explores new bone and tendon-relatedtreatments (wsbc) 8:391; Evidence-basedtreatment of chronic pain (wsbc) 10:515

O’Meara P: Dr Trevor J.G. Thompson (im)10:533

Oberg E: The physical and mental health statusand health practices of physicians in BritishColumbia* 7:349

Ogilvie G: Human Papillomavirus Vaccine Program in BC: A good start with room forimprovement (cdc) 2:95

Oppel L: Drug-dispensing machines (pu) 1:37;Clinical prevention—docs lead the way (pu)2:68; Allopathy—a term that diminishes theprofession (cohp) 2:91; Assistants needed totreat doctor shortage (pu) 5:267; HealthCanada allows 10 000 unproven remediesonto shelves (cohp) 8:411; Body Worlds andthe Brain exhibition (pu) 9:479

Paterson ET: Proust questionnaire: Erik T.Paterson, MD (bp) 9:490

author index, h–p


Pankratz E: Re: Attitude (c) 1:10Patrick DM: Update on antibiotic resistance in

British Columbia (cdc) 4:226; Your irre-sistible personal portrait: A way to reduceantibiotic resistance? (cdc) 9:465

Pauls H: Dr John W. Dueck (im) 7:340Petric M: Pandemic influenza: Postpandemic

laboratory analysis (cdc) 3:124Phang PT: Revisiting rectal cancer management

in British Columbia * 10:510Pickles T: BC Cancer Agency prostate brachy -

therapy experience: Indications, procedure,and outcomes* 2:76

Pink D: Dr John (Jack) Henry Baldwin (im)3:151

Pinton S: Signs of Stroke materials availablefor physicians (pu) 9:479

Pollock SL: Why you should get to know yourlocal veterinarian (cdc) 1:15

Poole GD: Resident work hours: Examiningattitudes toward work-hour limits in generalsurgery, orthopaedics, and internal medicine* 2:84

Pride S: Dr Basil Ho Yuen (im) 4:225Pritchard S: The need for long-term follow-up

of childhood cancer survivors in BritishColumbia * 10:504

Purssell R: Emergency departments: Are theyconsidered a safe haven from prosecution forimpaired drivers involved in fatal or person-al injury crashes? (cohp) 9:477

Prystajecky N: Pandemic influenza: Postpan-demic laboratory analysis (cdc) 3:124

Purych D: Update on antibiotic resistance inBritish Columbia (cdc) 4:226

Racette N: Early Pregnancy Assessment Clinic(pu) 2:101

Rae A: Russell Palmer: Forgotten champion(gg) 9:466

Raja S: Out with the old, in with the “new”WHO growth charts (cohp) 3:152

Raval M: Revisiting rectal cancer managementin British Columbia * 10:510

Richardson DR: Gold medal rant (ed) 1:4; Con-flict of interest (c) 1:9; My hospital (ed) 2:60;I was naked in Hawaii when I felt the earthmove (ed) 3:117; Signs (ed) 4:168; Keep thechange (ed) 5:241; Correction: PITO 5:245;Pinch me (ed) 6:284; Proust questionnaire:David R. Richardson, MD (bp) 6:322; Lastchance (ed) 7:328; Patient self-management(ed) 8:384; Invasion of the body scanners (ed)9:432; Re: Medical marijuana CMPA—posi-tion (c) 9:436; Linked, tagged, or poked:What’s your status? (ed) 10:496

Robinson D: Dr Cecil “Cec” Ernest GordonRobinson (im) 2:98

Rogers PC: The need for long-term follow-upof childhood cancer survivors in BritishColumbia * 10:504

Romalis G: Dr Kenneth Glenwright Nickerson(im) 5:264

Rothfels P: What’s new in the literature: Non-specific neck pain (wsbc) 3:123; Physician’sresource (wsbc) 7:356

Rowe TC: How to treat patients (ed) 6:285Sarbit G: Tobacco reduction resources (pu)

7:369Schachter M: BCPRA education course for GPs

(pu) 9:473Schonfeld M: Dr Donald B. Rix (im) 1:35; Dr

David McNiell Bolton (im) 7:339Schuurman N: Vulnerability to pedestrian trau-

ma: Demographic, temporal, societal, geo-graphic, and environmental factors* 3:136

Schweigel RC: Partial knee replacement* 9:442Scott V: New resources: Falls among elderly

(pu) 5:268Scrase P: Scotiabank offers custom package

(pu) 6:294Scudamore CH: Liver transplantation: Current

status in British Columbia* 4:203Segura C: The physical and mental health sta-

tus and health practices of physicians inBritish Columbia* 7:349

Shearer C: Injuries in youth sport: An evidence-based injury prevention warm-up (cohp)5:260

Shen H: The physical and mental health statusand health practices of physicians in BritishColumbia* 7:349

Shepherd R: Re: Bloodletting (c) 3:119; Claritybetween colleagues (c) 4:175; Re: Driverassessment (c) 8:386; Abbreviations (c) 10:500

Shuckett R: Clinical features and pathogeneticmechanisms of osteoarthritis of the hip andknee* 8:393

Simons RK: Vulnerability to pedestrian trau-ma: Demographic, temporal, societal, geo-graphic, and environmental factors* 3:136

Smith D: Swirski-type interviews: An ethicaldilemma for physicians* 1:32

Smith J: Communities of Practice: Leadershipin practice (pito) 2:70; Getting connected:Electronic delivery of lab, radiology, and hos-pital reports (pito) 4:179; An EMR story thatspans five decades (sf) 4:220; GP adoption ofelectronic medical records (pito) 6:288

Solomon R: Emergency departments: Are theyconsidered a safe haven from prosecution forimpaired drivers involved in fatal or person-al injury crashes? (cohp) 9:477

Stadnick E: Cardiac transplantation in BritishColumbia* 4:197

Steinbrecher UP: Liver transplantation: Cur-rent status in British Columbia* 4:203

Stephen C: Why you should get to know yourlocal veterinarian (cdc) 1:15

Swinkels H: Conflict of interest (c) 1:9; DrKerry Margaret Telford Morrissey (im) 5:263

Tarzwell R: Conflict of interest (c) 1:9Taylor C: Cardiovascular risk factors and mod-

els of risk prediction: Recognizing the lead-ership of Dr Roy Dawber* 7:342

Tee M: Re: Resident work hours (c) 5:244Tisdale JM: Dr Roger John Tudor Ball (im) 1:36Tung S: The implantable cardioverter-

defibrillator: From Mirowski to its currentuse* 5:248

Van Schagen C: Dr Kerry Margaret TelfordMorrissey (im) 5:263

Verchere C: I am supposedly a teacher (ed)5:242; Book review: The Estrogen Errors(pu) 5:266; Book reviews: Oxygen (pu)6:294; The Boy in the Moon (pu) 6:294

Verma Pamela: Connecting the dots: An inter-view with Dr Arun Garg (gg) 4:182; MWIAconference (pu) 8:414

Verma Pretty: Connecting the dots: An inter-view with Dr Arun Garg (gg) 4:182

Vroom: WR: Book review: Sumac’s Red Arms(pu) 5:266; Medical marijuana (ed) 7:329;Re: Medical marijuana (c) 9:435

Walton L: Re: Evidence-based medicine (c)3:119

Wheeler S: Guidelines reflect philosophy ofrespect for psychiatric patients (pcp) 1:21

White RF: Conflict of interest (c) 1:9Wignall N: Dr Norman Wignall (im) 9:472Williams DH: Total knee arthroplasty: Tech-

niques and results* 9:447Wilson JM: Lung transplantation in British

Columbia: A breath of fresh air * 4:211Wilson R: Walk with your patients (pu) 3:135Wong HCG: Trouble in toyland: Potential source

of lead (c) 1:10; Re: Potential allergic drugreaction from residual antibiotics present inlivestock (c) 8:388

Wong WT: Re: Flu protection (c) 1:10Woollard R: Conflict of interest (c) 1:9Yee J: Lung transplantation in British Colum-

bia: A breath of fresh air * 4:211Yoshida EM: Liver transplantation: Current sta-

tus in British Columbia* 4:203Youakim S: Asbestosis: A persistent nemesis

(wsbc) 9:476Young RN: Personal development and the

BCMA (sf) 5:247Zentner A: Dr Edward Freis: A pioneer in

evidence-based treatment of hypertension*3:144

author index, p–z

INDEX TO BRITISH COLUMBIA MEDICAL JOURNALVOLUME 52—JANUARY–DECEMBER 2010

An asterisk (*) indicates a clinical or review article. Letters to the editor (c), Editorials (ed), Back Page (bp), BC Centre for Disease Control (cdc), CollegeLibrary (lib), Comment (op), Council on Health Promotion (cohp), In Memoriam (im), Insurance Corporation of BC (icbc), Medical Student Column(md2b), Physician Information Technology Office (pito), Point•Counterpoint (pcp), Premise (op), Pulsimeter (pu), Special Feature (sf), and WorkSafeBC(wsbc) are noted by abbreviations. Subentries are listed alphabetically. Location of articles is by issue number followed by beginning page number.

2010 subject index

BC DRUG AND POISON INFORMATIONCENTRE

BC Drug and Poison Information Centre hasmoved 10:540

BCMA2010 BCMA Annual Meeting Report (sf)

(Draper J) 6:290All in a day’s work (or perhaps a couple of

weeks) (op) (Gillespie I) 8:389BCMA benefits decision (c) (Frimer M) 1:8BCMA Insurance Department responds (c)

(Braid S) 1:9BCMA leads country with 16 resolutions at

CMA (op) (Gillespie I) 7:330BCMA submits HST report to government (pu)

1:38Call for nominations (pu) 1:39; 7:341; 8:415;

9:475; 10:500Call for nominations: BCMA and CMA special

awards (pu) 7:341; 8:415; 9:475; Changes to Pregnancy Leave Program (pu) 1:38Colorectal cancer screening (c) (Isaacs G)

10:499Free insurance? (pu) (Moffat L) 10:530GPSC launches new web site (pu) 1:39Guidelines and Protocols Committee (pu)

(Dalal B) 5:266Individual pension plans for incorporated pro-

fessionals (pu) (AhPin C) 3:134Interview with Dr Ian Gillespie BCMA presi-

dent 2010-2011 (sf) (Draper J) 7:333Looking forward to a new year (op) (Gillespie

I) 6:286Member survey results (c) (de Couto J) 5:244New BC-wide surgery booking system (pu)

9:472New Specialist Services Committee initiatives

underway (pu) 3:133Numbers speak volumes (op) (Brodie B) 3:120Parental Leave Program reminder (Braid S)

8:425Personal development and the BCMA (sf)

(Young R) 5:247Pregnancy Leave becomes the Parental Leave

(pu) 3:134Presidential musings: End-of-term reflections

(op) (Brodie B) 5:243Programs for specialists are on the way (op)

(Brodie B) 2:64Re: AGM article (c) (Busser J) 8:387Re: Flu protection (c) (Wong WT) 1:10Save the date: BCMA Annual Convention (pu)

1:38Scotiabank offers custom package (pu) (Scrase

P) 6:294

Re: Potential allergic drug reaction from resid-ual antibiotics present in livestock (c) (WongHCG) 8:388

Update on antibiotic resistance in BritishColumbia (cdc) (Li D, McKay R, Purych D,et al.) 4:226

Your irresistible personal portrait: A way toreduce antibiotic resistance? (cdc) (PatrickDM, Maclure M, Mackie B, et al.) 9:465

ARTHRITIS See OSTEOARTHRITIS

ASBESTOSISAsbestosis: A persistent nemesis (wsbc) (Youa -

kim S) 9:476

ARTHROPLASTY—ARTHROSCOPY SeeOSTEOARTHRITIS

AWARDS See ACCOLADES ANDAWARDS

BACTERIAL TESTINGSFU speeds bacterial testing in rural India (pu)

10:532

BANKINGScotiabank offers custom package (pu) (Scrase

P) 6:294

BC AMBULANCE SERVICEGuidelines for sedating psychiatric patients

flawed (pcp) (Dagg P) 1:20Guidelines reflect philosophy of respect for

psychiatric patients (pcp) (Wheeler S) 1:21

BC CANCER AGENCY See CANCER

BC CENTRE FOR DISEASE CONTROLDon’t wait to test for HIV (Gilbert M, Krajden

M) 6:308Hot day deaths, summer 2009: What happened

and how to prevent a recurrence (Kosatsky T)5:261

Human Papillomavirus Vaccine Program in BC:A good start with room for improvement(Naus M, Ogilvie G) 2:95

Pandemic influenza: Postpandemic laboratoryanalysis (Prystajecky N, Petric M, McNabbA, et al.) 3:124

Screening renal failure patients for tuberculosis(Johnston J, Elwood K) 8:413

Smoky air and respiratory health in the 2010forest fire season, British Columbia (ElliottT, Kosatsky T) 10:514

Update on antibiotic resistance in British Colum-bia (Li D, McKay R, Purych D, et al.) 4:226

Why you should get to know your local veteri-narian (Pollock SL, Stephen C) 1:15

Your irresistible personal portrait: A way toreduce antibiotic resistance? (Patrick DM,Maclure M, Mackie B, et al.) 9:465

ABBREVIATIONSAbbreviations (c) (Shepherd R) 10:500ACCIDENTS See also INSURANCE

CORPORATION OF BRITISHCOLUMBIA, WORKSAFEBC

Aids for MVA injury management and docu-mentation (icbc) (Jensen L) 4:185

Vulnerability to pedestrian trauma: Demo-graphic, temporal, societal, geographic, andenvironmental factors * (Lord SE, HameedSM, Schuurman N, et al.) 3:136

ACCOLADES AND AWARDSBC Family Physician of the Year: Dr Ronald

Wilson (pu) 10:530Bill Mackie honored 5:277Call for nominations (pu) 1:39; 7:341; 8:415;

9:475; 10:500Connecting the dots: An interview with Dr Arun

Garg (gg) (Verma P, Verma P) 4:182Dance wins writing award (pu) 10:533Don Rix leadership award announced (pu) 9:474Don Rix remembered (gg) (King DJ) 2:72UBC alumni awards (pu) 6:294ACUPUNCTUREEvidence-based guidelines for the nonpharma-

cological treatment of osteoarthritis of thehip and knee * (Hawkeswood J, Reebye R)8:399

ADDICTIONTraining the inner alligator (sf) (Bass F) 1:23ADHDFamily physicians and specialists unite! A colla -

borative approach to managing ADHD in theoffice (cohp) (Arruda W, Bowering R) 1:46

AIDS See HIVAIR QUALITYSmoky air and respiratory health in the 2010

forest fire season, British Columbia (cdc)(Elliott C, Kosatsky T) 10:514

Stairclimb for clean air (pu) 1:38ALTERNATIVE MEDICINEAllopathy—a term that diminishes the profes-

sion (Oppel L) 2:91Evidence-based treatment of chronic pain (wsbc)

(Noertjojo K, Martin C, Dunn C) 10:515ALLERGIESRe: Potential allergic drug reaction from resid-

ual antibiotics present in livestock (c) (WongHCG) 8:388

Why you should get to know your local veteri-narian (cdc) (Pollock SL, Stephen C) 1:15

ANTIBIOTICS—ANTIBIOTIC USEAntibiotic use in our livestock (cohp) (Mackie

B) 6:309


subject index, b–c

CIRRHOSISLiver transplantation: Current status in British

Columbia * (Haque M, Scudamore CH, Stein-brecher UP, et al.) 4:203

CLIMATE CHANGEDoctors tackle climate change (pu) 1:37CLINICAL PREVENTIONClinical prevention—docs lead the way (pu)

(Oppel L) 2:68COLLEGE LIBRARYA thousand words (lib) (MacDonell K, Melrose

R, Neill J) 5:270Best evidence: The tip of the information ice-

berg (lib) (MacDonnell K, Neill, J) 9:437E-vailability of e-books (lib) (MacDonell K,

Melrose R, Neill J) 7:368Learning at your convenience (lib) (MacDonell

K, Melrose R, Neill J) 1:18COMMENTAll in a day’s work (or perhaps a couple of

weeks) (Gillespie I) 8:389BCMA leads country with 16 resolutions at

CMA (Gillespie I) 7:330Determining fitness to drive: A troublesome

task (Gillespie I) 9:434East Vancouver Youth Mental Health Project

(Brodie B) 4:177Looking forward to a new year (Gillespie I)

6:286Numbers speak volumes (Brodie B) 3:120Presidential musings: End-of-term reflections

(Brodie B) 5:243Programs for specialists are on the way (Brodie

B) 2:64Setting the stage for the next several years

(Gillespie I) 10:498The 2010 Winter Olympic Games are inspira-

tional (Brodie B) 1:6CONFLICT OF INTERESTCompeting interests: Anything to declare?

(Richardson DR) 3:119Conflict of interest (Brar R, Brcic V, Etches N,

et al) 1:9Drug-dispensing machines (pu) (Oppel L) 1:37The editor responds (c) (Richardson DR) 1:10COPDLung attack: A call to arms (ed) (Lawson LM)

3:118CORONARY See CARDIACCOUNCIL ON HEALTH PROMOTIONAllopathy—a term that diminishes the profes-

sion (Oppel L) 2:91Antibiotic use in our livestock (Mackie B)

6:309Are routine child health visits really necessary?

The state of children’s development in BC(Arruda W) 10:503

Emergency departments: Are they considered asafe haven from prosecution for impaireddrivers involved in fatal or personal injurycrashes? (Purssell, R, Mahli L, Solomon R, etal.) 9:477

Family physicians and specialists unite! A col-laborative approach to managing ADHD inthe office (Arruda W, Bowering R) 1:46

Health Canada allows 10 000 unproven reme-dies onto shelves (Oppel L) 8:411

New provincial breast health strategy (pu) 10:531Ovarian cancer prevention: Practice changes

(pu) 10:532Participants sought for landmark health study

(pu) 10:532Prostate cancer drug developed in BC (pu) 7:366Revisiting rectal cancer management in British

Columbia * (Phang PT, Cheifetz R, BrownCJ, et al.) 10:510

The need for long-term follow-up of childhoodcancer survivors in British Columbia * (Mac-Donald L, Fryer C, McBride ML, et al.)10:504

CAPTAIN VANCOUVERCaptain Vancouver and medicine in the Age of

Sail (sf) (Greenstone G) 10:504CARDIAC—CARDIOVASCULARBCPRA education course for GPs (pu) (Schach -

ter M) 9:473Cardiac transplantation in British Columbia *

(Stadnick E, Ignaszewski A) 4:197Cardiovascular risk factors and models of risk

prediction: Recognizing the leadership of DrRoy Dawber * (Davis M, Andrade J, TaylorC, et al.) 7:342

Does an Aspirin a day keep the doctor away?Acetylsalicylic acid for the primary preven-tion of cardiovascular disease * (Bayliss M,Ignaszewski A) 6:298

Dr Edward Freis: A pioneer in evidence-basedtreatment of hypertension * (Zentner A, Ignas -zewski A) 3:144

New study: Valve-in-valve implants (pu) 5:269The implantable cardioverter-defibrillator: From

Mirowski to its current use * (Deyell MW,Tung S, Ignaszewski A) 5:248

CESAREAN SECTIONDifferences in C-section rates (pu) 6:296CHARITY—CHARITABLE CAUSESI was naked in Hawaii when I felt the earth move

(ed) (Richardson DR) 3:117Last chance (ed) (Richardson DR) 7:328Mitufala dokta lanem planti long Vanuatu! (We

two doctors learned a lot in Vanuatu!) (sf)(Leduc E) 3:126

Volunteers needed—medical triage in Guate -mala (pu) 7:369

Walk with your patients (pu) (Wilson R) 3:135CHECKLISTSThank you, Dr Benton: Rationale for using a

surgical checklist in British Columbia *(Cochrane DD, Lamsdale AM) 5:254

CHILD AND YOUTH HEALTH SeePEDIATRIC

CHILD SAFETYTrouble in toyland: Potential source of lead (c)

(Wong HCG) 1:10CHOLINESTERASE INHIBITORSNew study: Cholinestrase inhibitors (pu) (Du -

jela CE) 4:223CHRONIC DISEASEChronic disease counseling program (pu) 3:133CHRONIC PAINEvidence-based treatment of chronic pain

(wsbc) (Noertjojo K, Martin C, Dunn C)10:515

Setting the stage for the next several years (op)(Gillespie I) 10:498

The 2010 Winter Olympic Games are inspira-tional (op) (Brodie B) 1:6

Travel insurance rules for visitors to Cuba (pu)(Braid S) 6:295


BCMD2BLegalization of euthanasia violates the princi-

ples of competence, autonomy, and benefi-cence (Ko J) 2:92

Lost in translation (Malebranche D) 1:11BC MEDICAL JOURNAL2010 Author Index 10:5172010 Subject Index 10:520Competing interests: Anything to declare?

(Richardson DR) 3:119Conflict of interest (Brar R, Brcic V, Etches N,

et al) 1:9Guidelines for authors 1:40; 2:89; 6:311; 7:365;

8:412; 10:529Linked, tagged, or poked: What’s your status?

(ed) (Richardson DR) 10:496Medical writing prize 1:45; 6:285; 7:359 The editor responds (c) (Richardson DR) 1:10bcmj.orgbcmj.org health notes 3:162Linked, tagged, or poked: What’s your status?

(ed) (Richardson DR) 10:496BEARING SURFACESTotal hip arthroplasty: Techniques and results *

(Burnett RSJ) 9:455BILLING See also BCMA, GENERAL

PRACTICE SERVICES COMMITTEEFee changes now effective (pu) 3:133Re: Flu protection (c) (Wong WT) 1:10BLOODLETTINGRe: Bloodletting (c) (Shepherd R) 3:119The history of bloodletting (op) (Greenstone G)

1:12BONE AND TENDON-RELATED

TREATMENTSResearch team explores new bone and tendon-

related treatments (wsbc) (Noertjojo K, Mar-tin C) 8:391

BOOK REVIEWSOxygen (pu) (Verchere C) 6:294Sumac’s Red Arms (pu) (Vroom WR) 5:266The Boy in the Moon (pu) (Verchere C) 6:294The Estrogen Errors (pu) (Verchere C) 5:266The Pain Detective: Every Ache Tells a Story

(pu) (Daniels J) 2:67BRAINAll in a day’s work (or perhaps a couple of

weeks) (op) (Gillespie I) 8:389Mild traumatic brain injury (wsbc) (Gross EL,

Meloche G) 6:297CANCERBC Cancer Agency prostate brachytherapy

experience: Indications, procedure, and out-comes * (Keyes M, Morris J, Pickles T, et al.)2:76

BC Genome Sciences Centre advances (pu) 9:473Colorectal cancer screening (c) (Isaacs G) 10:499Last chance (ed) (Richardson DR) 7:328



Injuries in youth sport: An evidence-basedinjury prevention warm-up (Shearer C) 5:260

Out with the old, in with the “new” WHOgrowth charts (Cadenhead K, Raja S) 3:152

The resuscitation conversation (Gallagher R,McElhaney J) 4:218

CPRThe resuscitation conversation (cohp) (Gal-

lagher R, McElhaney J) 4:218CROSSWORDMedical crossword (bp) 5:278DAWBER, DR THOMAS ROYLE (ROY)Cardiovascular risk factors and models of risk


DEATH—DYINGHot day deaths, summer 2009: What happened

and how to prevent a recurrence (cdc) (Ko -satsky T) 5:261

The implantable cardioverter-defibrillator: FromMirowski to its current use * (Deyell MW,Tung S, Ignaszewski A) 5:248

The resuscitation conversation (cohp) (Gal-lagher R, McElhaney J) 4:218

DEMENTIAInnovative group medical visits benefit both

dementia patients and their caregivers (gpsc)(Kallstrom L) 4:181

DEPRESSIONGP learning session focuses on improving care

for adolescent depression (gpsc) (KallstromL) 2:96

DIABETESBCPRA education course for GPs (pu) (Schach -

ter M) 9:473Diabetic ketoacidosis in children and adoles-

cents: An update and revised treatment pro-tocol * (Metzger D) 1:24


Kidney, pancreas, and pancreatic islet trans-plantation * (Landsberg DN, Shapiro RJ)4:189

Type 2 diabetes in youth (ed) (Haigh SE) 8:385DIALYSISRussell Palmer: Forgotten champion (gg) (Rae

A) 9:466DISABILITY See BCMA, INSURANCE,

WORKSAFEBCDIVISIONS OF FAMILY PRACTICE See

GENERAL PRACTICE SERVICESCOMMITTEE

DRIVING—DRIVERSDetermining fitness to drive: A troublesome

task (op) (Gillespie I) 9:434Driver assessment and the duty to report (icbc)

(Jensen L) 3:122Emergency departments: Are they considered a

safe haven from prosecution for impaireddrivers involved in fatal or personal injurycrashes? (cohp) (Purssell R, Mahli L, Solo -mon R, et al.) 9:477

Re: Driver assessment (c) (Shepherd R) 8:386Senior drivers (icbc) (Jensen L) 2:97


DRUGS—DRUG DISPENSINGAnti-cholesterol drugs could help prevent

seizures (pu) 10:531Drug-dispensing machines (pu) (Oppel L) 1:37EDITORIALSCare of the aging (Haigh SE) 1:5Geriatric denial (Lawson LM) 10:497Gold medal rant (Richardson DR) 1:4How to treat patients (Rowe TC) 6:285I am supposedly a teacher (Verchere C) 5:242I was naked in Hawaii when I felt the earth move

(Richardson DR) 3:117In government we trust (Day B) 4:170Invasion of the body scanners (Richardson DR)

9:432Keep the change (Richardson DR) 5:241Last chance (Richardson DR) 7:328Linked, tagged, or poked: What’s your status?

(Richardson DR) 10:496Lost and found (Chapman DB) 2:62Lung attack: A call to arms (Lawson LM) 3:118Medical marijuana (Vroom WR) 7:329My hospital (Richardson DR) 2:60Patient self-management (Richardson DR) 8:384Pinch me (Richardson DR) 6:284Signs (Richardson DR) 4:168The end of an era (Chapman DB) 9:433Type 2 diabetes in youth (Haigh SE) 8:385ELECTRONIC MEDICAL RECORDS See

also INFORMATION TECHNOLOGYAn EMR story that spans five decades (sf)

(Smith J) 4:220Communities of Practice: Leadership in prac-

tice (pito) (Smith J) 2:70Getting connected: Electronic delivery of lab,

radiology, and hospital reports (pito) (SmithJ) 4:179

GP adoption of electronic medical records (pito)(Smith J) 6:288

EMERGENCY DEPARTMETNS—EMERGENCY MEDICINE

BCMA leads country with 16 resolutions atCMA (op) (Gillespie I) 7:330

Emergency departments: Are they considered asafe haven from prosecution for impaireddrivers involved in fatal or personal injurycrashes? (cohp) (Purssell R, Mahli L, Solo -mon R, et al.) 9:477

ENVIRONMENTSmoky air and respiratory health in the 2010



EPIDEMIOLOGYVulnerability to pedestrian trauma: Demo-

graphic, temporal, societal, geographic, andenvironmental factors * (Lord SE, HameedSM, Schuurman N, et al.) 3:136

ETHICSReceiving gifts from patients: A pragmatic

shade of grey (op) (Marois J) 3:129

EUTHANASIALegalization of euthanasia violates the princi-

ples of competence, autonomy, and benefi-cence (md2b) (Ko J) 2:92

Re: Euthanasia (c) (Dale J) 4:172Re: Legalization of euthanasia (c) (Giligson A)

4:174EVIDENCE-BASED MEDICINEAids for MVA injury management and docu-

mentation (icbc) (Jensen L) 4:185Best evidence: The tip of the information ice-

berg (lib) (MacDonnell K, Neill, J) 9:437Evidence-based guidelines for the nonpharma-

cological treatment of osteoarthritis of the hipand knee * (Hawkeswood J, Reebye R) 8:399

Evidence-based treatment of chronic pain (wsbc)(Noertjojo K, Martin C, Dunn C) 10:515

Re: Evidence-based medicine (c) (Walton L)3:119

EXHIBITIONBody Worlds and the Brain exhibition (pu)

(Oppel L) 9:479FALLSGeriatric denial (ed) (Lawson LM) 10:497New resource: Falls among elderly (pu) (Cadar -

io B, Scott V) 5:268FAMILY PRACTICEFamily practice web site (pu) 3:133FLU See INFLUENZAFRAMINGTON RISK SCORECardiovascular risk factors and models of risk


FREIS, DR EDWARDDr Edward Freis: A pioneer in evidence-based

treatment of hypertension * (Zentner A, Ignas -zewski A) 3:144

GENERAL PRACTICE—FAMILYPRACTICE See PRACTICE OFMEDICINE

GENERAL PRACTICE SERVICESCOMMITTEE See also BCMA

Attachment and integration: Collaboration atwork (Evoy B) 5:246

Divisions of Family Practice address commu-nity needs, improve care at local level (EvoyB) 9:470

East Vancouver Youth Mental Health Project(op) (Brodie B) 4:177

GP learning session focuses on improving carefor adolescent depression (Kallstrom L) 2:96

GPSC launches new web site (pu) 1:39Innovative group medical visits benefit both

dementia patients and their caregivers (Kall-strom L) 4:181

Pinch me (ed) (Richardson DR) 6:284PSP developments for this autumn (Kallstrom

L) 6:310GENOMIC TECHNOLOGIESBC Genome Sciences Centre advances (pu)

(Hamill J) 9:473GEOGRAPHIC INFORMATION SCIENCEVulnerability to pedestrian trauma: Demo-


subject index, c–g


GERIATRICSCare of the aging (Haigh SE) 1:5Senior drivers (icbc) (Jensen L) 2:97New resource: Falls among elderly (pu) (Cadar -

io B, Scott V) 5:268Geriatric denial (ed) (Lawson LM) 10:497GILLESPIE, IANInterview with Dr Ian Gillespie BCMA presi-

dent 2010-2011 (sf) (Draper J) 7:333GOVERNMENTBCMA submits HST report to government (pu)

1:38Determining fitness to drive: A troublesome

task (op) (Gillespie I) 9:434Guidelines and Protocols Committee (pu)

(Dalal B) 5:266Health Canada allows 10 000 unproven reme-

dies onto shelves (cohp) (Oppel L) 8:411HIV prevention strategy (pu) 7:366In government we trust (ed) (Day B) 4:170New BC-wide surgery booking system (pu)

9:472New provincial breast health strategy (pu)

10:531Pinch me (ed) (Richardson DR) 6:284Programs for specialists are on the way (op)

(Brodie B) 2:64Provincial palliative care line (pu) 5:266Re: Potential allergic drug reaction from resid-


GROWTH—GROWTH CHARTSOut with the old, in with the “new” WHO growth

charts (cohp) (Cadenhead K, Raja S) 3:152GUIDELINES See PROTOCOLSHEALTH CARE—HEALTH CARE SYSTEMAre routine child health visits really necessary?

The state of children’s development in BC(cohp) (Arruda W) 10:503

Attachment and integration: Collaboration atwork (gpsc) (Evoy B) 5:246

BCPRA education course for GPs (pu) (Schach -ter M) 9:473

Canadian nutrition labeling initiative (pu) 10:531Care of the aging (Haigh SE) 1:5Determining fitness to drive: A troublesome

task (op) (Gillespie I) 9:434Drug-dispensing machines (pu) (Oppel L) 1:37In government we trust (ed) (Day B) 4:170Innovative group medical visits benefit both


Keep the change (ed) (Richardson DR) 5:241My hospital (ed) (Richardson DR) 2:60One-stop care for kidney patients (pu) 4:223Patient self-management (ed) (Richardson DR)

8:384Physicians: Protect yourself (c) (Kendall PRW)

10:531Private health care with public delivery? (md2b)

(Malebranche AD) 7:358Re: Attitude (c) (Pankratz E) 1:10Re: Potential allergic drug reaction from resid-


Revisiting rectal cancer management in BritishColumbia * (Phang PT, Cheifetz R, BrownCJ, et al.) 10:510

Setting the stage for the next several years (op)(Gillespie I) 10:498

Signs (ed) (Richardson DR) 4:168Special Care Services offers enhanced care for

BC’s most seriously injured workers (wsbc)(Leyen J, Meloche G) 4:217

The need for long-term follow-up of childhoodcancer survivors in British Columbia * (Mac-Donald L, Fryer C, McBride ML, et al.)10:504

HEALTHY EATING/LIVINGClinical features and pathogenic mechanisms

of osteoarthritis of the hip and knee * (HasanM, Shuckett R) 8:393

Evidence-based guidelines for the nonpharma-cological treatment of osteoarthritis of thehip and knee * (Hawkeswood J, Reebye R)8:399

Geriatric denial (ed) (Lawson LM) 10:497Patient self-management (ed) (Richardson DR)

8:384HEART See CARDIAC—

CARDIOVASCULARHELMETSHelmets reduce injuries by 85% (pu) 5:269HEPATITISLiver transplantation: Current status in British

Columbia * (Haque M, Scudamore CH,Steinbrecher UP, et al.) 4:203

HIP—HIP RESURFACINGClinical features and pathogenic mechanisms



Guest editorial: Osteoarthritis of the hip andknee, Part 1: Pathogenesis and nonsurgicalmanagement * (Masri BA) 8:392

Guest editorial: Osteoarthritis of the hip andknee, Part 2: Surgical interventions * (MasriBA) 9:438

Pharmacological treatment of osteoarthritis ofthe hip and knee * (Kennedy S, Moran M)8:404

Total hip arthroplasty: Techniques and results *(Burnett RSJ) 9:455

HISTORY OF MEDICINEAllopathy—a term that diminishes the profes-

sion (cohp) (Oppel L) 2:91An EMR story that spans five decades (sf)

(Smith J) 4:220Captain Vancouver and medicine in the Age of

Sail (sf) (Greenstone G) 10:504Re: Bloodletting (c) (Shepherd R) 3:119The history of bloodletting (op) (Greenstone G)

1:12HIVBC to seek and treat HIV patients (pu) 3:135Don’t wait to test for HIV (cdc) (Gilbert M,

Krajden M) 6:308Gay men still more likely to contract HIV (pu)

4:223HIV prevention strategy (pu) 7:366Stephen Lewis AIDS Foundation AfriGrand

Caravan (pu) 8:414

HOSPITALSDivisions of Family Practice address commu-

nity needs, improve care at local level (gpsc)(Evoy B) 9:470

Keep the change (ed) (Richardson DR) 5:241My hospital (ed) (Richardson DR) 2:60Signs (ed) (Richardson DR) 4:168Thank you, Dr Benton: Rationale for using a sur-

gical checklist in British Columbia * (Coch -rane DB, Lamsdale AM) 5:254

The end of an era (ed) (Chapman DB) 9:433HOSPITALIZATIONRe: Attitude (c) (Pankratz E) 1:10Re: Attitude (c) (Boggie A) 2:66HUMAN PAPILLOMAVIRUSHuman Papillomavirus Vaccine Program in

BC: A good start with room for improvement(cdc) (Naus M, Ogilvie, G) 2:95

New HPV study (pu) 3:133Signs (ed) (Richardson DR) 4:168HYPERTENSIONDr Edward Freis: A pioneer in evidence-based

treatment of hypertension * (Zentner A, Ignas -zewski A) 3:144

ICBCRe: Medical authorizations and reports (c)

(Leduc E) 2:65IMMUNIZATION See VACCINEIMPLANTABLE CARDIOVERTER-

DEFIBRILLATORThe implantable cardioverter-defibrillator: From


INFANT HEALTH See PEDIATRICINFLUENZARe: Flu protection (c) (Wong WT) 1:10Pandemic influenza: Postpandemic laboratory

analysis (cdc) (Prytajecky N, Petric M, Mc -Nabb A, et al.) 3:124

Physicians: Protect yourself (c) (Kendall PRW)10:531

INFORMATION TECHNOLOGYAn EMR story that spans five decades (sf)

(Smith J) 4:220Communities of Practice: Leadership in prac-

tice (pito) (Smith J) 2:70E-vailability of e-books (lib) (MacDonell K,

Melrose R, Neill J) 7:368Getting connected: Electronic delivery of lab,



Lights, Camera, Surgery: Take 2 (md2b) (De -Girolamo K, Molavi I) 10:501

Linked, tagged, or poked: What’s your status?(ed) (Richardson DR) 10:496

INJURY See also INSURANCECORPORATION OF BRITISHCOLUMBIA; WORKSAFEBC

All in a day’s work (or perhaps a couple ofweeks) (op) (Gillespie I) 8:389

Geriatric denial (ed) (Lawson LM) 10:497Helmets reduce injuries by 85% (pu) 5:269Injuries in youth sport: An evidence-based

injury prevention warm-up (cohp) (ShearerC) 5:260

subject index, g–i


Mild traumatic brain injury (wsbc) (Gross EL,Meloche G) 6:297

New resource: Falls among elderly (pu) (Cada -rio B, Scott V) 5:268


IN MEMORIAM See OBITUARIESINSURANCE See also BCMABCMA benefits decision (c) (Frimer M) 1:8BCMA Insurance Department responds (c)

(Braid S) 1:9Free insurance? (pu) (Moffat L) 10:530Parental Leave Program reminder (Braid S)

8:425Private health care with public delivery? (md2b)

(Malebranche AD) 7:358Travel insurance rules for visitors to Cuba (pu)

(Braid S) 6:295Water damage: An ounce of prevention is worth

a pound of cure (pu) (Braid S) 2:102INSURANCE CORPORATION OF BRITISH

COLUMBIAAids for MVA injury management and docu-

mentation (Jensen L) 4:185Driver assessment and the duty to report (Jensen

L) 3:122Senior drivers (Jensen L) 2:97The future is clear now: Expert evidence under

the new civil rules (Heuchert T) 1:17JOINT REPLACMEENT See

OSTEOARTHRITISKIDNEY—KIDNEY CAREKidney, pancreas, and pancreatic islet trans-

plantation * (Landsberg DN, Shapiro RJ) 4:189One-stop care for kidney patients (pu) 4:223Russell Palmer: Forgotten champion (gg) (Rae

A) 9:466KNEEClinical features and pathogenic mechanisms






The role of arthroscopy in the treatment ofdegenerative joint disease of the knee *(McCormack R) 9:439

Total knee arthroplasty: Techniques and results* (Williams DH, Garbuz DS, Masri BA) 9:447

LANGUAGE SKILLSLost in translation (md2b) (Malebranche AD)

1:11LEADTrouble in toyland: Potential source of lead (c)

1:10

LEECHThe history of bloodletting (op) (Greenstone G)

1:12Re: Bloodletting (c) (Shepherd R) 3:119LEG LENGTHClinical features and pathogenic mechanisms


LIBRARY See COLLEGE LIBRARYLUNG—LUNG HEALTHLung transplantation in British Columbia: A

breath of fresh air * (Wilson JM, Yee J, LevyRD) 4:211

Stairclimb for Clean Air (pu) 1:38MALARIAMSF malaria awareness (pu) (De Smet M) 6:295MAMMOGRAPHYMammography fast-tracking (pu) 2:102New provincial breast health strategy (pu)

10:531MARIJUANACMPA position (op) (Richardson DR) 9:436Dr Vroom responds (c) (Vroom WR) 9:436Medical marijuana (ed) (Vroom WR) 7:329Re: Medical marijuana (c) (Capler R, Lucas P)

9:435MÉDECINS SANS FRONTIÉRESMSF malaria awareness (pu) (De Smet M)

6:295MEDICAL AUDITMedical audit inspectors needed (pu) 7:367MEDICAL EDUCATIONBody Worlds and the Brain exhibition (pu)

(Oppel L) 9:479CME costs (c) (Grist R) 2:65I am supposedly a teacher (ed) (Verchere C)

5:242Learning at your convenience (lib) (MacDonell

K, Melrose R, Neill J) 1:18Lights, Camera, Surgery: Take 2 (md2b) (De -

Girolamo K, Molavi I) 10:501Lost in translation (md2b) (Malebranche AD)

1:11Revisiting rectal cancer management in British

Columbia * (Phang PT, Cheifetz R, BrownCJ, et al.) 10:510

MEDICAL EQUIPMENTInvasion of the body scanners (ed) (Richardson

DR) 9:432MEDICAL HISTORYHammy and Hector (gg) (Haynes S) 8:410Popping the cork (bp) (Haynes S) 2:110Russell Palmer: Forgotten champion (gg) (Rae

A) 9:466MEDICAL-LEGALAids for MVA injury management and docu-

mentation (icbc) (Jensen L) 4:185Dr Jensen responds (c) (Jensen L) 2:66Emergency departments: Are they considered a

safe haven from prosecution for impaireddrivers involved in fatal or personal injurycrashes? (cohp) (Purssell R, Mahli L, Sol -omon R, et al.) 9:477

Legalization of euthanasia violates the princi-ples of competence, autonomy, and benefi-cence (md2b) (Ko J) 2:92

Re: Medical authorizations and reports (c)(Leduc E) 2:65

Swirski-type interviews: An ethical dilemmafor physicians * (Smith DH) 1:32

The future is clear now: Expert evidence underthe new civil rules (icbc) (Heuchert T) 1:17

MEDICAL LIBRARY See COLLEGELIBRARY

MEDICAL LITERATURE See COLLEGELIBRARY

MEDICAL RECORDS/REPORTS See alsoINFORMATION TECHNOLOGY

Dr Jensen responds (c) (Jensen L) 2:66GP adoption of electronic medical records (pito)

(Smith J) 6:288Re: Medical authorizations and reports (c)

(Leduc E) 2:65The future is clear now: Expert evidence under

the new civil rules (icbc) (Heuchert T) 1:17MEDICAL SERVICES PLANFee changes now effective (pu) 3:133MENTAL HEALTH See also

PSYCHIATRY—PSYCHOTHERAPYChronic disease counseling program (pu) 3:133East Vancouver Youth Mental Health Project

(op) (Brodie B) 4:177GP learning session focuses on improving care

for adolescent depression (gpsc) (KallstromL) 2:96

The physical and mental health practices ofphysicians in British Columbia (Frank E,Oberg E, Segura C, et al.) 7:349

MINISTRY OF HEALTH SERVICESGPSC launches new web site (pu) 1:39Innovative group medical visits benefit both


New Specialist Services Committee initiativesunderway (pu) 3:133

Pinch me (ed) (Richardson DR) 6:284Your irresistible personal portrait: A way to

reduce antibiotic resistance? (cdc) (PatrickDM, Maclure M, Mackie B, et al.) 9:465

MIROWSKI, DR MIECZYSLAW (MICHEL)The implantable cardioverter-defibrillator:

From Mirowski to its current use * (DeyellMW, Tung S, Ignaszewski A) 5:248

MIXED MARTIAL ARTSAll in a day’s work (or perhaps a couple of

weeks) (op) (Gillespie I) 8:389MOTOR VEHICLES/ACCIDENTS See

DRIVERS—DRIVING, INSURANCECORPORATION OF BRITISHCOLUMBIA

NATUROPATHY See ALTERNATIVEMEDICINE

NAUTICAL Captain Vancouver and medicine in the Age of

Sail (sf) (Greenstone G) 10:504NECK PAINClarification re: “What’s new in the literature:

nonspecific neck pain” (wsbc) (MontgomerieA) 5:265

What’s new in the literature: Nonspecific neckpain (wsbc) (Rothfels P, Martin C, NoertjojoK) 3:123

subject index, i–n


NORTHERN HEALTH—See RURAL HEALTHNUTRITIONCanadian nutrition labeling initiative (pu)

10:531Nutrition information (pu) 7:377OBITUARIESAllan, Dr David Stewart (Benedet JL) 5:262Baldwin, Dr John (Jack) Henry (Pink D) 3:151Ball, Dr Roger John Tudor (Tisdale JM) 1:36Bolton, Dr David McNiell (Bolton P) 7:339Correction (im) 9:472Cragg, Dr George Edward (Corbett WJ) 3:150Dueck, Dr John W. (Pauls H) 7:340Lott, Dr Gordon Gatward (Bud) (Clay MG,

Finlayson ND) 3:150Morrissey, Dr Kerry Margaret Telford (Van

Schagen C, Swinkels H, McCarthy L) 5:263Nickerson, Dr Kenneth Glenwright (Romalis

G) 5:264Recently deceased physicians 3:151; 8:390; See

also Correction (im) 9:472Rigg, Dr J. Michael (Hill R) 5:263Rix, Dr Donald B (Schonfeld M) 1:35Robinson, Dr Cecil “Cec” Ernest Gordon

(Robinson, D) 2:98Stonier, Dr Peter Finden (Muir, R) 2:98Thompson, Dr Trevor J.G. (O’Meara P) 10:533Wignall, Dr Norman (Wignall Jr N) 9:472Williams, Dr Hugh Richard (Atkinson KG)

7:339Yuen, Dr Basil Ho (Pride S, McComb P) 4:225OCCUPATIONAL INJURY/DISEASE See

WORKSAFEBCOLYMPICS See SPORT—SPORT

MEDICINE—INJURIESBCMA Pacemakers 2010 Winter Olympics

Torch Relay Team (photo) 2:109Gold medal rant (ed) (Richardson DR) 1:4The 2010 Winter Olympic Games are inspira-

tional (op) (Brodie B) 1:6ONCOLOGY See CANCERORGAN DONATION—See

TRANSPLANTATIONORTHOPAEDICS See OSTEOARTHRITISOSTEOARTHRITISClinical features and pathogenic mechanisms








Total knee arthroplasty: Techniques and results* (Williams DH, Garbuz DS, Masri BA) 9:447

OSMVDetermining fitness to drive: A troublesome

task (op) (Gillespie I) 9:434Driver assessment and the duty to report (icbc)

(Jensen L) 3:122PALLIATIVE CAREProvincial palliative care line (pu) 5:266PAP TESTSLACE campaign promotes Pap testing (pu) 5:269PATIENT CARE See HEALTH CARE—

HEALTH CARE SYSTEM, PATIENTSAFETY, PRACTICE OF MEDICINE,WORKSAFEBC

PATIENT CONSENTEmergency departments: Are they considered a

safe haven from prosecution for impaireddrivers involved in fatal or personal injurycrashes? (cohp) (Purssell R, Mahli L, Solo -mon R, et al.) 9:477

Swirski-type interviews: An ethical dilemmafor physicians * (Smith DH) 1:32

PATIENT SAFETYDetermining fitness to drive: A troublesome

task (op) (Gillespie I) 9:434Determining fitness to work at safety-sensitive

jobs (wsbc) (Martin S) 1:48Hot day deaths, summer 2009: What happened

and how to prevent a recurrence (cdc)(Kosatsky T) 5:261

Nosocomial or iatrogenic infections (c) (Bat-tershill J) 8:386

Ovarian cancer prevention: Practice changes(pu) 10:532

PSP developments for this autumn (gpsc) (Kall-strom L) 6:310

Revisiting rectal cancer management in BritishColumbia * (Phang PT, Cheifetz R, BrownCJ, et al.) 10:510

Thank you, Dr Benton: Rationale for using asurgical checklist in British Columbia *(Cochrane DD, Lamsdale AM) 5:254


PEDESTRIAN TRAUMAVulnerability to pedestrian trauma: Demo-


PEDIATRIC Are routine child health visits really necessary?


Diabetic ketoacidosis in children and adoles-cents: An update and revised treatment pro-tocol * (Metzger D) 1:24

Diagnosing children with TB (pu) 5:271Family physicians and specialists unite! A collab-

orative approach to managing ADHD in theoffice (cohp) (Arruda W, Bowering R) 1:46

Injuries in youth sport: An evidence-basedinjury prevention warm-up (cohp) (ShearerC) 5:260

New shaken baby program (pu) (Mammen A,Barr RG) 1:39

Out with the old, in with the “new” WHO growthcharts (cohp) (Cadenhead K, Raja S) 3:152

The need for long-term follow-up of childhoodcancer survivors in British Columbia * (Mac-

Donald L, Fryer C, McBride ML, et al.)10:504

Type 2 diabetes in youth (ed) (Haigh SE) 8:385PERINATAL HEALTHBC Perinatal Health Program revises provincial

perinatal forms (pu) 4:223PETSWhy you should get to know your local veteri-

narian (cdc) (Pollock SL, Stephen C) 1:15PHARMACOLOGYHealth Canada allows 10 000 unproven reme-

dies onto shelves (cohp) (Oppel L) 8:411Pharmacological treatment of osteoarthritis of

the hip and knee * (Kennedy S, Moran M)8:404


PHYSICAL ACTIVITYType 2 diabetes in youth (ed) (Haigh SE) 8:385Walk with your patients (pu) (Wilson R) 3:135PHYSICIAN ASSISTANTSAssistants needed to treat doctor shortage (pu)

(Oppel L) 5:267PHYSICIAN COMPENSATIONBCMA leads country with 16 resolutions at

CMA (op) (Gillespie I) 7:330Pinch me (ed) (Richardson DR) 6:284PHYSICIAN HEALTHChanges to Pregnancy Leave Program (pu) 1:38Physician Health Program report on medicine

and motherhood (pu) 4:224Physicians: Protect yourself (c) (Kendall PRW)

10:531PHYSICIAN HEALTH PROGRAMPhysician Health Program report on medicine

and motherhood (pu) 4:224The physical and mental health practices of

physicians in British Columbia (Frank E,Oberg E, Segura C, et al.) 7:349

PHYSICIAN-PATIENT RELATIONSHIPHow to treat patients (ed) (Rowe TC) 6:285Last chance (ed) (Richardson DR) 7:328Patient self-management (ed) (Richardson DR)

8:384Re: Driver assessment (c) (Shepherd R) 8:386PHYSICIAN SUPPLYAssistants needed to treat doctor shortage (pu)

(Oppel L) 5:267Divisions of Family Practice address commu-


In government we trust (ed) (Day B) 4:170PITO See also ELECTRONIC MEDICAL

RECORDS, INFORMATIONTECHNOLOGY

Communities of Practice: Leadership in prac-tice (pito) (Smith J) 2:70

Correction 5:245Getting connected: Electronic delivery of lab,



PLASTINATIONBody Worlds and the Brain exhibition (pu)

(Oppel L) 9:479

subject index, n–p


PRACTICE MANAGEMENT SeePRACTICE OF MEDICINE

PRACTICE OF MEDICINEAllopathy—a term that diminishes the profes-

sion (cohp) (Oppel L) 2:91Antibiotic use in our livestock (cohp) (Mackie

B) 6:309Are routine child health visits really necessary?


BC to seek and treat HIV patients (pu) 3:135BCPRA education course for GPs (pu) (Schach -

ter M) 9:473Clarity between colleagues (c) (Shepherd R)

4:175CMPA position (op) (Richardson DR) 9:436Colorectal cancer screening (c) (Isaacs G) 10:499Communities of Practice: Leadership in prac-

tice (pito) (Smith J) 2:70Determining fitness to drive: A troublesome

task (op) (Gillespie I) 9:434Determining fitness to work at safety-sensitive

jobs (wsbc) (Martin S) 1:48Divisions of Family Practice address commu-



Don’t wait to test for HIV (cdc) (Gilbert M,Krajden M) 6:308

Dr Vroom responds (c) (Vroom WR) 9:436Driver assessment and the duty to report (icbc)

(Jensen L) 3:122Drug-dispensing machines (pu) (Oppel L) 1:37East Vancouver Youth Mental Health Project

(op) (Brodie B) 4:177Family physicians and specialists unite! A col-

laborative approach to managing ADHD inthe office (cohp) (Arruda W, Bowering R) 1:46

Getting connected: Electronic delivery of lab,radiology, and hospital reports (pito) (SmithJ) 4:179


Guidelines for sedating psychiatric patientsflawed (pcp) (Dagg P) 1:20

Guidelines reflect philosophy of respect forpsychiatric patients (pcp) (Wheeler S) 1:21

Hammy and Hector (gg) (Haynes S) 8:410Hot day deaths, summer 2009: What happened

and how to prevent a recurrence (cdc) (Ko -satsky T) 5:261

How to treat patients (ed) (Rowe TC) 6:285Improving the way we work with you (wsbc)

(Montgomerie A) 5:265Innovative group medical visits benefit both


Invasion of the body scanners (ed) (RichardsonDR) 9:432

Legalization of euthanasia violates the princi-ples of competence, autonomy, and benefi-cence (md2b) (Ko J) 2:92

Medical marijuana (ed) (Vroom WR) 7:329Mitufala dokta lanem planti long Vanuatu! (We

two doctors learned a lot in Vanuatu!) (bp)(Leduc E) 3:126

My hospital (ed) (Richardson DR) 2:60New BC-wide surgery booking system (pu) 9:472Nosocomial or iatrogenic infections (c) (Bat-

tershill J) 8:386Patient self-management (ed) (Richardson DR)

8:384Pinch me (ed) (Richardson DR) 6:284Programs for specialists are on the way (op)

(Brodie B) 2:64PSP developments for this autumn (gpsc) (Kall-

strom L) 6:310RACE program expands (pu) 7:367Re: Attitude (c) (Boggie A) 2:66Re: Bloodletting (c) (Shepherd R) 3:119Re: Driver assessment (c) (Shepherd R) 8:386Receiving gifts from patients: A pragmatic

shade of grey (op) (Marois J) 3:129Senior drivers (icbc) (Jensen L) 2:97Setting the stage for the next several years (op)

(Gillespie I) 10:498Signs (ed) (Richardson DR) 4:168Swirski-type interviews: An ethical dilemma

for physicians * (Smith DH) 1:32The history of bloodletting (op) (Greenstone G)

1:12The need for long-term follow-up of childhood

cancer survivors in British Columbia * (Mac-Donald L, Fryer C, McBride ML, et al.)10:504

Training the inner alligator (sf) (Bass F) 1:23What’s new in the literature: Nonspecific neck

pain (wsbc) (Rothfels P, Martin C, NoertjojoK) 3:123

WorkSafeBC medical advisors are here to help(Dunn C) 2:100


PRACTICE SUPPORT PROGRAM SeeGENERAL PRACTICE SERVICESCOMMITTEE

PREGNANCYChanges to Pregnancy Leave Program (pu) 1:38Early Pregnancy Assessment Clinic (pu) (Ra -

cette, N) 2:101Physician Health Program report on medicine

and motherhood (pu) 4:224Pregnancy Leave becomes Parental Leave (pu)

3:134Tobacco reduction resources (pu) 7:369PRESCRIBING PRACTICES See

PRACTICE OF MEDICINEPREVENTIVE MEDICINEClinical prevention—docs lead the way (pu)

(Oppel L) 2:68Nosocomial or iatrogenic infections (c) (Bat-

tershill J) 8:386PRIVACYDr Jensen responds (c) (Jensen L) 2:66PROTOCOLSAids for MVA injury management and docu-

mentation (icbc) (Jensen L) 4:185Diabetic ketoacidosis in children and adoles-

cents: An update and revised treatment pro-tocol * (Metzger D) 1:24

Evidence-based guidelines for the nonpharma-cological treatment of osteoarthritis of the hipand knee * (Hawkeswood J, Reebye R) 8:399

Guidelines and Protocols Committee (pu)(Dalal B) 5:266

Guidelines for sedating psychiatric patientsflawed (pcp) (Dagg P) 1:20

Guidelines reflect philosophy of respect forpsychiatric patients (pcp) (Wheeler S) 1:21

New resource: Falls among elderly (pu) (Cada -rio B, Scott V) 5:268

Screening renal failure patients for tuberculosis(cdc) (Johnston J, Elwood K) 8:413

PROUST QUESTIONNAIREGiligson, Ari (bp) (Giligson A) 8:426Gillespie, Ian (bp) (Gillespie I) 7:378McLaren, William J. (bp) (McLaren WJ) 10:542Paterson, Erik T. (bp) (Paterson ET) 9:490Richardson, David R. (bp) (Richardson DRR)

6:322PSYCHIATRY—PSYCHOTHERAPYGuidelines for sedating psychiatric patients


psychiatric patients (pcp) (Wheeler S) 1:21PUBLIC HEALTH See also BC CENTRE

FOR DISEASE CONTROLTularemia in British Columbia: A case report

and review * (Isaac-Renton M, Morshed M,Galanis E, et al.) 6:303

QUALITY OF CARELung attack: A call to arms (ed) (Lawson LM)

3:118The resuscitation conversation (cohp) (Gal-

lagher R, McElhaney J) 4:218QUALITY OF LIFEThe resuscitation conversation (cohp) (Gal-

lagher R, McElhaney J) 4:218Gold medal rant (ed) (Richardson DR) 1:4Care of the aging (Haigh SE) 1:5RACE PROGRAMRACE program expands (pu) 7:367RENAL DISEASE See also

TRANSPLANTATIONBCPRA education course for GPs (pu) (Schach -

ter M) 9:473Kidney, pancreas, and pancreatic islet transplan-

tation * (Landsberg DN, Shapiro RJ) 4:189Russell Palmer: Forgotten champion (gg) (Rae

A) 9:466Screening renal failure patients for tuberculosis

(cdc) (Johnston J, Elwood K) 8:413RESIDENTSResident work hours: Examining attitudes

toward work-hour limits in general surgery,orthopaedics, and internal medicine * (GreenS, Poole GD) 2:84

RESOURCESBC Drug and Poison Information Centre has

moved 10:540Family practice web site (pu) 3:133New HPV study (pu) 3:133New resource: Falls among elderly (pu) (Cadar -

io B, Scott V) 5:268Nutrition information (pu) 7:377Online stroke information (pu) 9:472Physician’s resource (wsbc) 7:356Provincial palliative care line (pu) 5:266RACE program expands (pu) 7:367Tobacco reduction resources (pu) 7:369

subject index, p–r


RESPIRATORYLung attack: A call to arms (ed) (Lawson LM)

3:118Smoky air and respiratory health in the 2010


RETIREMENTBCMA benefits decision (c) (Frimer M) 1:8BCMA Insurance Department responds (c)

(Braid S) 1:9Geriatric denial (ed) (Lawson LM) 10:497Setting the stage for the next several years (op)

(Gillespie I) 10:498RETURN TO WORK See WORKSAFEBCRURAL HEALTHSFU speeds bacterial testing in rural India (pu)

10:532SAFETYOvarian cancer prevention: Practice changes

(pu) 10:532Resident work hours: Examining attitudes toward

work-hour limits in general surgery, ortho -paedics, and internal medicine * (Green S,Poole GD) 2:84

Thank you, Dr Benton: Rationale for using asurgical checklist in British Columbia * (Coch -rane DB, Lamsdale AM) 5:254

Trouble in toyland: Potential source of lead (c)(Wong HCG) 1:10

SCREENING See MAMMOGRAPHYSEDATIONGuidelines for sedating psychiatric patients


psychiatric patients (pcp) (Wheeler S) 1:21SEIZURESAnti-cholesterol drugs could help prevent

seizures (pu) 10:531SHAKEN BABYNew shaken baby program (pu) (Mammen A,

Barr RG) 1:39SIMON FRASER UNIVERSITYSFU speeds bacterial testing in rural India (pu)

10:532SMOKING—SMOKING CESSATIONTraining the inner alligator (sf) (Bass F) 1:23SPECIALIST SERVICES COMMITTEENew Specialist Services Committee initiatives

underway (pu) 3:133Programs for specialists are on the way (op)

(Brodie B) 2:64SPORT—SPORT MEDICINE—INJURIESGold medal rant (ed) (Richardson DR) 1:4Helmets reduce injuries by 85% (pu) 5:269Injuries in youth sport: An evidence-based

injury prevention warm-up (cohp) (ShearerC) 5:260

The 2010 Winter Olympic Games are inspira-tional (op) (Brodie B) 1:6

STROKEOnline stroke information (pu) 9:472Signs of Stroke materials available for physi-

cians (pu) (Pinton S) 9:479STUDIES—SURVEYS—TRIALS—

QUESTIONNAIRESAnti-cholesterol drugs could help prevent

seizures (pu) 10:531

BC Cancer Agency prostate brachytherapyexperience: Indications, procedure, and out-comes * (Keyes M, Morris J, Pickles T, et al.)2:76

BC to seek and treat HIV patients (pu) 3:135Cardiovascular risk factors and models of risk



Dr Edward Freis: A pioneer in evidence-basedtreatment of hypertension * (Zentner A, Ignas -zewski A) 3:144

HIV prevention strategy (pu) 7:366Human Papillomavirus Vaccine Program in BC:

A good start with room for improvement(cdc) (Naus M, Ogilvie, G) 2:95

Injuries in youth sport: An evidence-basedinjury prevention warm-up (cohp) (ShearerC) 5:260

LACE campaign promotes Pap testing (pu) 5:269Member survey results (c) (de Couto J) 5:244New HPV study (pu) 3:133New study: Cholinestrase inhibitors (pu) (Dujela

CE) 4:223New study: Valve-in-valve implants (pu) 5:269Numbers speak volumes (op) (Brodie B) 3:120Ovarian cancer prevention: Practice changes

(pu) 10:532Participants sought for landmark health study

(pu) 10:532Resident work hours: Examining attitudes

toward work-hour limits in general surgery,orthopaedics, and internal medicine * (GreenS, Poole GD) 2:84

The physical and mental health practices ofphysicians in British Columbia (Frank E,Oberg E, Segura C, et al.) 7:349


SURGERYGuest editorial: Osteoarthritis of the hip and

knee, Part 2: Surgical interventions * (MasriBA) 9:438

I am supposedly a teacher (ed) (Verchere C)5:242

Lights, Camera, Surgery: Take 2 (md2b)(DeGirolamo K, Molavi I) 10:501

Lost in translation (md2b) (Malebranche AD)1:11

New BC-wide surgery booking system (pu)9:472

New study: Valve-in-valve implants (pu) 5:269Thank you, Dr Benton: Rationale for using a

surgical checklist in British Columbia *(Cochrane DD, Lamsdale AM) 5:254



Total knee arthroplasty: Techniques and results* (Williams DH, Garbuz DS, Masri BA)9:447

SURVEYS See STUDIES—TRIALSTOBACCOTobacco reduction resources (pu) (Sarbit G)

7:369Training the inner alligator (sf) (Bass F) 1:23TOYSTrouble in toyland: Potential source of lead (c)

(Wong HCG) 1:10TRANSPLANTATIONCardiac transplantation in British Columbia *

(Stadnick E, Ignaszewski A) 4:197Kidney, pancreas, and pancreatic islet trans-

plantation * (Landsberg DN, Shapiro RJ)4:189

Liver transplantation: Current status in BritishColumbia * (Haque M, Scudamore CH, Stein-brecher UP, et al.) 4:203

Lung transplantation in British Columbia: Abreath of fresh air * (Wilson JM, Yee J, LevyRD) 4:211

Organ donation: Register today (pu) 5:269The hope and promise of transplantation *

(Levy RD, Meloche M) 4:186TRIALS See STUDIESTRIBUTESConnecting the dots: An interview with Dr Arun

Garg (gg) (Verma P, Verma P) 4:182Don Rix remembered (gg) (King DJ) 2:72TUBERCULOSISDiagnosing children with TB (pu) 5:271Screening renal failure patients for tuberculosis

(cdc) (Johnston J, Elwood K) 8:413TULAREMIATularemia in British Columbia: A case report

and review * (Isaac-Renton M, Morshed M,Galanis E, et al.) 6:303

UNIVERSITY OF BCLights, Camera, Surgery: Take 2 (md2b) (De -

Giro lamo K, Molavi I) 10:501UBC alumni awards (pu) 6:294URINARY TRACT INFECTIONSYour irresistible personal portrait: A way to

reduce antibiotic resistance? (cdc) (PatrickDM, Maclure M, Mackie B, et al.) 9:465

VACATIONLost and found (ed) (Chapman DB) 2:62VACCINEHuman Papillomavirus Vaccine Program in BC:

A good start with room for improvement(cdc) (Naus M, Ogilvie, G) 2:95

VANUATUMitufala dokta lanem planti long Vanuatu! (We

two doctors learned a lot in Vanuatu!) (bp)(Leduc E) 3:126

VENTRIBULAR ARRHYTHMIASThe implantable cardioverter-defibrillator: From


VETERINARIAN—VETERINARYMEDICINE

Antibiotic use in our livestock (cohp) (MackieB) 6:309

Re: Potential allergic drug reaction from resid-ual antibiotics present in livestock (c) (WongHCG) 8:388


subject index, r–v


VOLUNTEERSMitufala dokta lanem planti long Vanuatu!

(We two doctors learned a lot in Vanuatu!)(bp) (Leduc E) 3:126

Volunteers needed—medical triage in Guat -e mala (pu) 7:369

WAIT LISTSNew BC-wide surgery booking system (pu)

9:472WEB SITES See also bcmj.org,

INFORMATION TECHNOLOGYFamily practice web site (pu) 3:133WOMEN’S HEALTHMWIA conference (pu) 8:414WORK—WORK HOURSPhysician Health Program report on medi-

cine and motherhood (pu) 4:224Presidential musings: End-of-term reflec-

tions (op) (Brodie B) 5:243Re: Resident work hours (c) (Tee M, Ko -

zoriz K, Masterson M) 5:244Resident work hours: Examining attitudes

toward work-hour limits in general sur-gery, orthopaedics, and internal medicine* (Green S, Poole GD) 2:84

WORKSAFEBCAsbestosis: A persistent nemesis (Youakim

S) 9:476Determining fitness to work at safety-sensi-

tive jobs (Martin S) 1:48Improving the way we work with you (Mont -

gomerie A) 5:265Mild traumatic brain injury (Gross EL,

Meloche G) 6:297Physician’s resource 7:356Re: Medical authorizations and reports (c)

(Leduc E) 2:65Research team explores new bone and ten-

don-related treatments (Noertjojo K, Mar-tin C) 8:391

Special Care Services offers enhanced carefor BC’s most seriously injured workers(Leyen J, Meloche G) 4:217

What’s new in the literature: Nonspecificneck pain (Rothfels P, Martin C, Noertjo-jo K) 3:123

WorkSafeBC medical advisors are here tohelp (Dunn C) 2:100

subject index, v–w

BCMA Board officers anddelegates contact list

President Ian Gillespie [email protected]

Past President Brian Brodie [email protected]

President-Elect Nasir Jetha [email protected]

Chair of the GeneralAssembly Shelley Ross [email protected]

Honorary SecretaryTreasurer William Cunningham [email protected]

Chair of the Board Alan Gow [email protected]

District #1 William Cavers [email protected]

District #1 Robin Saunders [email protected]

District #1 Carole Williams [email protected]

District #2 Robin Routledge [email protected]

District #2 Michael Morris [email protected]

District #3 James Busser [email protected]

District #3 Bradley Fritz [email protected]

District #3 Charles Webb [email protected]

District #3 Duncan Etches [email protected]

District #3 Lloyd Oppel [email protected]

District #3 David Wilton [email protected]

District #3 Mark Godley [email protected]

District #4 Kevin McLeod [email protected]

District #4 Nigel Walton [email protected]

District #5 Bruce Horne [email protected]

District #6 Todd Sorokan [email protected]

District #7 Yusuf Bawa [email protected]

District #7 Barry Turchen [email protected]

District #8 Gordon Mackie [email protected]

District #9 Jannie du Plessis [email protected]

District #10 Shirley Sze [email protected]

District #11 Jean-Pierre Viljoen [email protected]

District #12 Charl Badenhorst [email protected]

District #13 Mark Corbett [email protected]

District #13 Philip White [email protected]

District #15 Trina Larsen Soles [email protected]

District #16 Luay Dindo [email protected]

District #16 Evelyn Shukin [email protected]


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ual activity with patients: A survey of BCphysicians. Presented at the 52nd AnnualMeeting of the Canadian Psychiatric Associ-ation, Winnipeg, MB, 5 October 2008.

2. Kim-Sing C, Kutynec C, Harris S, et al. Breastcancer and risk reduction: Diet, physical activ-ity, and chemoprevention. CMAJ. In press.

Personal communications are not included inthe reference list, but may be cited in the text,with type of communication (oral or written)communicant’s full name, affiliation, and date(e.g., oral communication with H.E. Marmon,director, BC Centre for Disease Control, 12November 2007). Material submitted for publication but notaccepted should not be included.

Permissions It is the author’s responsibility to obtain writtenpermission from both author and publisher formaterial, including figures and tables, taken oradapted from other sources. Permissions shouldaccompany the article when submitted.

Tables and figures Tables and figures should supplement the text,not duplicate it. Keep length and number oftables and figures to a minimum. Include adescriptive title and units of measure for eachtable and figure. Obtain permission and acknowl-edge the source fully if you use data or figuresfrom another published or unpublished source.Tables. Please adhere to the following guidelines: • Submit tables electronically so that they may

be formatted for style. • Number tables consecutively in the order of

their first citation in the text and supply a brieftitle for each.

• Place explanatory matter in footnotes, not inthe heading.

• Explain all nonstandard abbreviations in foot-notes.

• Ensure each table is cited in the text. Figures (illustrations). Please adhere to the fol-lowing guidelines: • Have figures drawn and photographed profes-

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• Number figures consecutively in the order oftheir first citation in the text and supply a brieftitle for each.

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Units Report measurements of length, height, weight,and volume in metric units. Give temperaturesin degrees Celsius and blood pressures in mil-limetres of mercury. Report hematologic andclinical chemistry measurements in the metricsystem according to the International System ofUnits (SI).

Abbreviations Except for units of measure, we discourageabbreviations. However, if a small number arenecessary, use standard abbreviations only, pre-ceded by the full name at first mention, e.g., invitro fertilization (IVF). Avoid abbreviations inthe title and abstract.

Drug names Use generic drug names. Use lowercase forgeneric names, uppercase for brand names, e.g.,venlafaxine hydrochloride (Effexor).

guidelines for authors(short form)


mary care provider. This group cares

for approximately 1000 women each

year and provides 80% of the medical

student core program teaching in ante -

partum outpatient care at the Univer-

sity of British Columbia.

A champion of health promotion,

Dr Wilson has been the chair of the

British Columbia Medical Associa-

tion Athletics and Recreation Com-

mittee since 2003 and has organized

numerous physical fitness programs

including Vancouver’s Walk With Your

Doc and the CFPC’s Doctors Promot-

ing Active Living.

He and his wife, Helen Wilson,

have five children, Theresa, Myra, Eric,

Michael, and Stephanie. Passionate

about sports, Dr Wilson is an avid

marathon runner and enjoys watching

his elder son play for the national rug -

by team.

Dr Wilson received the award from

the Canadian College of Family Phy -

sicians, which awards the Reg L.

Perkin Awards to one family physi-

cian from each province in recogni-

tion of exceptional care for patients,

meaningful contributions to the health

and well-being of communities, and

dedication to research and teaching.

pulsimeter

BC Family Physicianof the Year: Dr RonaldWilson Recognized for his tremendous devo-

tion to his patients, Ron Wilson, MD,

CCFP, has been recognized as BC

Family Physician of the Year. Dr Wil-

son is dedicated to underserviced pop-

ulations while being innovative and

committed to teaching, mentoring,

and providing leadership in collabora-

tive multidisciplinary care.

After completing his medical

degree at the University of British

Columbia in 1978, Dr Wilson became

a certificant of the CFPC in 1982. His

scope of practice extends beyond the

spectrum of office and hospital medi-

cine to include emergency obstetrics

and newborn care. He is currently a

clinical assistant professor at the Uni-

versity of British Columbia, where he

teaches medical students, family prac-

tice residents, and midwives.

Dr Wilson is highly regarded for

his instrumental role in helping estab-

lish the Vancouver Family Practice

Maternity Service (FPMS), a group of

dedicated family doctors passionate

about providing sustainable maternity

care, especially to those without a pri-

Free insurance?Well… almost. Did you know the Phy -

sicians’ Disability Insurance (PDI)

program that is administered by the

BCMA is 100% paid for by the pro -

vincial government? And that it’s

available to all nonsalaried physicians

who are under age 65, receive fee-for-

service, sessional, or nonsalaried serv-

ice contract income? It’s true. British

Columbia is the only province in

Canada that has such a program.

What’s the catch? Well, there are

two of them. The first is that you must

apply for this coverage—it’s not auto-

matic. Proof of good health at the time

of application is required by the insur-

ance company. The second is that the

premium paid on your behalf by the

provincial government is considered a

taxable benefit by Canada Revenue

Agency. This means the T4A that the

BCMA issues to you for the premium

must be included in your personal tax

return as income. Using our 2009 rec -

ords, a GP insured under the PDI pro-

gram with a disability benefit amount

of $6100 would have received a T4A

in the amount of $2541. Using the

highest tax bracket in BC of 43.7%,

this GP would have paid $1110 in tax

for a monthly disability benefit of

$6100.

Benefits in this program begin

after 14 days of total or partial disa -

bility (or from the first day of hospi-

talization) and the benefit amount is

determined using your prior calendar-

year earnings. Want to learn more?

Contact our insurance administrators

for more information:

Lorie Lynch: 604 638-2882

1 800 665-2262, extension 2882

[email protected]

Karen Paul: 604 638-2836

1 800 665-2262, extension 2836

[email protected]

—Lori Moffat

BCMA Insurance Manager

Ronald Wilson, MD

home runThe all-new bcmj.org

connects you with yourcolleagues across BC

and beyond.

bcmj.org


web extra

Watch a video inter -view with Dr Wilson at www.bcmj.org

bcmj.org


New provincial breasthealth strategyIn October the provincial government

unveiled a new Provincial Breast

Health Strategy with a goal of increas-

ing breast cancer survival rates by pro-

viding more timely access to screening,

diagnostic, and prevention services.

The Provincial Breast Health Strat-

egy unites government, health author-

ities, and key community partners to

fight breast cancer. Over the past 4

years BC has increased spending on

screening mammography by $5.48

million and almost doubled the over-

all budget for the Screening Mammo -

graphy Program since 2001 to $23.5

million.

Although BC has the lowest inci-

dence of breast cancer in the country

and the best survival outcomes for

women who do get breast cancer, 2800

BC women were diagnosed with the

disease in 2009.

Canadian nutritionlabeling initiativeOn 22 October Health Canada and

Food and Consumer Products of Can -

ada (FCPC) announced the launch of

the Nutrition Facts Education Cam-

paign to help Canadians make inform -

ed food choices.

The campaign focuses on increas-

ing Canadians’ understanding of the

nutrition facts table and, in particular,

the “% Daily Value” (% DV).

The initiative includes a multi-

faceted approach to explain % DV to

consumers through messages to ap -

pear on food packages, in stores, and

in national media. Consumers will be

directed to Health Canada’s educa-

tional web site, www.healthcanada.gc

.ca/dailyvalue, which contains tips on

how to use % DV to make healthier

food choices.

Anti-cholesterol drugscould help preventseizuresA new statistical study by a drug safe-

ty expert at the University of Bri tish

Columbia and Vancouver Coastal

Health Research Institute shows that

statins, the family of drugs used to

lower cholesterol, might also reduce

the risk of epileptic seizures in people

with cardiovascular disease. The find-

ings could provide the basis for ran-

domized, controlled clinical trials to

test the efficacy of the drugs as anti-

epileptic medication.

The study was based on a database

of 2400 Quebec residents aged 65 and

older, culling the data from a larger

database of 150 000 cardiovascular

patients in that province. Data showed

that those taking statins were 35% less

likely to be hospitalized with a diag-

nosis of epilepsy than those not taking

the drug.

The study was published 25 Octo-

ber 2010 in the journal Neurology.

This observational study does not

prove causation, but reveals an asso-

ciation between use of statins and the

incidence of epilepsy. This is the first

large study involving humans to show

a correlation between statins and

seizures.

Physicians: ProtectyourselfAs the influenza season approaches, I

am once again writing to you to draw

your attention to the need to protect

health care workers from influenza in

order to safeguard their own health,

the health of their families, and that of

their vulnerable patients.

As you are aware, influenza is a

significant cause of morbidity and

mortality in Canada, especially among

the elderly and frail. Because frail

people develop less protection from

influenza immunization than young,

healthy adults, those who may expose

the elderly and frail to the influenza

virus can play a critical role in pre-

venting outbreaks by being immu-

nized. I am, therefore, asking for your

cooperation and support in our push to

increase influenza vaccination cover-

age among all health care workers in

BC.

Despite our efforts in the past few

years to promote influenza immuniza-

tion in BC, only 64% of health care

workers in our long-term care, extend-

ed care, and intermediate-care facili-

ties were immunized during the 2008/

09 influenza season. This is a decrease

of almost 2% from the previous sea-

son, moving us further from our goal.

Rates of staff vaccination in acute care

facilities are lower (42% in 2008/09,

a decrease of 3% from the previous

season). Rates in both long-term care

and acute care were even lower during

the 2009/10 season, with a drop to

49% for seasonal vaccine and 45%

for pandemic H1N1 vaccine in long-

term care and 35% for seasonal and

46% pandemic vaccine in acute care.

I would like to reach the provincial

goal of 80% this season. In addition,

we also aim to increase coverage in

high-risk groups in the community—

seniors and people with chronic health

conditions—as well as their informal

caregivers and family.

Complete details on eligibility cri-

teria for publicly funded influenza

vaccine are available from your local

health unit or on the ImmunizeBC web

site at: www.immunizebc.ca/Vacc

Sched/Vaccine+Schedules.htm.

I would like to acknowledge the

good work you have done toward this

effort in previous years and your com-

mitment to this vital program for pro-

tecting those at risk from this serious

but preventable illness. I greatly

appreciate your continued assistance

in reaching your patients with this

important public health message. And,

of course, I encourage you and your

staff to get your influenza shots as

well.

—P.R.W. Kendall, MBBS

Provincial Health Officer

pulsimeter

Pulsimeter continued on page 532

With a donation from a private donor

to VGH and the UBC Hospital Foun-

dation, they developed and produced

an educational DVD, which has been

delivered to all gynecologists in BC.

The message is twofold: remove the

fallopian tube during surgery, and

refer ovarian cancer patients who have

a serous tumor to the Hereditary Can-

cer Program at the BCCA.

The education outreach program

is led by Dr Sarah Finlayson, gyneco-

logic oncologist, Ovarian Cancer Re -

search Program, and assistant profes-

sor, University of British Columbia

Faculty of Medicine.

Participants soughtfor landmark healthstudy If you’re a BC resident between the

ages of 40 to 69, the BC Cancer Agen -

cy wants you to be part of the largest

health research project in Canadian

history.

The BC Generations Project was

launched last year as part of a nation-

al study to recruit and follow 300 000

Canadians over the next 20 to 30 years.

BC Cancer Agency researchers want

to investigate how a person’s environ-

ment, lifestyle, and genes contribute

to cancer and other chronic diseases,

like heart disease and stroke, so they

can learn more about prevention for

the benefit of future generations.

Alberta, Ontario, Quebec, and the

Atlantic provinces are also taking part,

and similar large-scale, long-term stud-

ies are being conducted in the UK and

other countries.

“It’s a huge opportunity for the

current generation to do something for

future generations,” says Richard Gal-

lagher, the BC Generations Project

principal investigator and senior sci-

entist in the BC Cancer Agency’s can-

cer control research program. “This

could help protect your children, or

your children’s children, from getting

cancer or chronic disease.”

Anyone within the 40- to 69-year

age range is encouraged to participate,

regardless of whether they are healthy

or have health problems or disabili-

ties, and regardless of where in BC

they live.

Call 604 675-8221, toll free 1 877

675-8221, e-mail bcgenerationsproject

@bccrc.ca, or visit www.bcgenerations

project.ca to request a questionnaire.

SFU speeds bacterialtesting in rural IndiaSimon Fraser University engineering

science researchers, collaborating with

two research institutes in India, have

created a simple way to treat bacteria-

infected newborns in rural India.

Bacterial testing in rural India is

carried out in labs many miles away,

so the process of nailing down the cor-

rect antibiotic can take days. Working

with researchers at Bangalore’s Raman

Research Institute and the Centre for

Biotechnology at Anna University in

Chennai, SFU professor Ash Parame -

swaran and a trio of graduate students

have developed a class of plastic

microfluidic chips that can determine

the right antibiotic within a few hours

using a simple LED light source.

The process uses a textbook ap -

proach called an “antibiogram.” The

microfluidic chips contain tiny cham-

bers to hold bacteria samples (from

the feces) along with a food mixture

containing the antibiotic and a dye

material, which the bacteria consume.

The bacteria consume the food in

the presence of the antibiotic and the

digestion byproduct can be seen using

the fluorescence technique. If the bac-

teria live in spite of the antibiotic, then

that sample glows green. If the antibi-

otic is effective, then the bacteria die

and that sample does not glow.

There are eight different antibi-

otics available to address infantile

diarrhea in developing countries, and

it’s crucial to administer the correct

antibiotic for the type of bacteria that

have infected the infant.

Currently physicians in rural India

pulsimeter

Ovarian cancerpreven tion: Practicechanges Gynecologic oncologists with the

Ovar ian Cancer Research Program at

Vancouver General Hospital (VGH)

and the BC Cancer Agency (BCCA)

have begun a campaign to reduce

deaths from ovarian cancer.

They are asking all BC gynecolo-

gists to change surgical practice to

fully remove the fallopian tube when

performing hysterectomy or tubal lig-

ation. Current practice leaves the fal-

lopian tube in place for many types of

hysterectomy and tubal ligation. This

is a matter of convention, not need.

The request stems from new re -

search by the Ovarian Cancer Research

Program at VGH and BCCA. The BC

research team and others have recent-

ly discovered that the majority of

high-grade serous tumors, the most

deadly form of ovarian cancer, actual-

ly arise in the fallopian tube, not the

ovary. The British Columbia data were

published in 2009 in the InternationalJournal of Gynecological Cancer.

The importance of the discovery

was furthered by information con-

tained in the Cheryl Brown Ovarian

Cancer Outcome Unit at VGH and

BCCA. The data demonstrated that

18% of women who developed ovari-

an cancer had a prior hysterectomy.

The research team, which is made

up of surgeons, oncologists, and

pathologists, also made a related dis-

covery. They found one in five ser -

ous cancer tumors occur because of a

germline BRCA genetic mutation,

meaning that in 20% of cases they are

discovering the index case—a woman

may have no prior history of ovarian

cancer in her family, but will now

know that her children and their chil-

dren could be at risk. Physicians will

have the ability to screen them genet-

ically and act proactively.

The research team is translating

their findings to benefit patient care.



pulsimeter cohp

must either send the sample to a

centralized testing facility, which

can take several days, or make an

educated judgment and administer

an antibiotic cocktail. Both options

have serious negative and occa-

sionally fatal consequences.

SFU graduate students Mona

Rah bar and Suman Chhina develop -

ed the first set of prototypes, which

were tested in labs in India last year.

The researchers from India vis-

ited SFU and spent two weeks work-

ing with the graduate students and

performing tests using nonpatho-

genic bacterial strains provided by

SFU researcher Fiona Brinkman.

The prototype chips were then

tested in India using the real bacte-

rial strains, and the results helped

formulate the next generation of

chips. The new chips have been

sent to India for more detailed test-

ing and may move on to field trial.

Dance winswriting awardThe BCMJ is pleased to announce

the winner of the 2009 J.H. Mac-

Dermot Prize for Excellence in

Medical Journalism: Dr Derry

Dance. Dr Dance was a UBC med-

ical student when he was the lead

author of “Removal of ear canal

foreign bodies: What can go wrong

and when to refer” (2009;51[1]:20-

24), coauthored with Drs M. Riley

and J.P. Ludemann.

The MacDermot Prize, which

comes a $1000 cheque, honors Dr

John Henry MacDermot (1883–

1969), who became the editor of

the Vancouver Medical Bulletin at

its formation in 1924. He remained

at the helm until 1959, when it

became the BC Medical Journal.He was editor of the BCMJ until he

retired in 1967. Dr MacDermot

was also past president of both the

VMA and the BCMA.

Congratulations, Dr Dance.

Dr Trevor J.G. Thompson1925–2010 Trevor Thompson was born in King -

ston, Ontario, and graduated in

medicine from Queen’s University

in 1950. He was a life member in

the College of Family Physicians

of Canada. He studied tropical

medicine in Portugal, served as a

missionary in Kenya, and on return

to Canada worked in BC and

Ontario. He retired many times, but

continued to make house calls and

worked most recently with the Tril-

lium Gift of Life. He enjoyed work-

ing with people from all over the

world, from different backgrounds,

cultures, and religions. He is sur-

vived by Patricia, his wife of 55

years, five sons, 16 grandchildren,

and two great-grandchildren. His

main interest and passion outside

of medicine was the love of his

family and church. He also lov ed

music, theatre, and ballroom danc-

ing. He was a member of the Chris-

tian Medical and Dental Associa-

tion, the Chess Association of

Canada, Kin Can ada, and Rotary

International, being a Paul Harris

Fellow. He loved the things many

of us take for granted.

—Patricia O’Meara

Kingston, ON

in memoriam

Trevor J.G. Thompson, MD

for Health Supervision of Infants,Children, and Adolescents, third edi-

tion, which includes helpful screening

questionnaires.6

As a pediatrician in British Col -

umbia, I only encounter those chil-

dren who have been referred to me by

my family physician colleagues. As

such, I am limited in my ability to

reduce childhood developmental vul-

nerability. I look to you to help in this

regard. Children may be only 25% of

the population, but are 100% of our

future.

—Wilma Arruda, MD, FRCPC

Chair, Child and Youth Committee

References

1. Kershaw P, Anderson L, Warburton B, etal. 15 by 15 A Comprehensive PolicyFramework for Early Human CapitalInvestment in BC. Vancouver: HumanEarly Learning Partnership, University ofBritish Columbia; 2009:1.

2. Human Early Learning Partnership(HELP). Early Development InstrumentFact Sheet. www.earlylearning.ubc.ca/wp-uploads/web.help.ubc.ca/2010/09/EDI-Fact-Sheet-PDF_2010-09-03.pdf(accessed 5 November 2010).

3. Human Early Learning Partnership(HELP). Nearly one in three BC childrenenter kindergarten vulnerable [newsrelease]. 27 October 2009. www.earlylearning.ubc.ca/wp-uploads/web.help.ubc.ca/2010/01/News-Release-3rd-data-collection-Oct-27-09-2.pdf(accessed 5 Nov ember 2010).

4. Sutherland N. Children in English-Cana-dian Society, Framing the Twentieth-Cen-tury Consensus. Toronto: University ofToronto Press; 1978:39.

5. Strong-Boag V. Intruders in the nursery:Childcare professionals reshape theyears one to five, 1920-1940. In: Parr J(ed). Childhood & Family in Canadian His-tory. Toronto: McClelland and Stewart;1982:160-178.

6. American Academy of Pediatrics. Rec-ommendations for Preventive PediatricHealth Care. Pediatr 2000;105:645-646.




Gerry Greenstone, MD

The Age of Sail was roughly the

period from the 16th to the mid-

19th century when naval war-

fare and international trade were dom-

inated by sailing ships. In those times

illness and accidents were by far the

main cause of mortality among sailors,

significantly outnumbering deaths

due to warfare. A study of 5183 deaths

by the Royal Navy in 18101 revealed

81.5% were ascribed to these causes

whereas only 8.3% were secondary to

enemy action; the remaining 10.2%

were miscellaneous factors.

Sailors’ diseasesLife on the high seas was hard and

demanding, with few pleasures or dis-

tractions. As Bown2 states, “sanitary

conditions aboard ships were as bad

or worse than the filthiest slums in

London, Amsterdam, Paris, or Seville.

The cramped, stifling, congested fore-

castle where the crew slept was dark

and dingy. The air was clouded with

noxious bilge gases and congested

with the sweet cloying reek of rot and

sweat.”

Such conditions created a fertile

breeding ground for respiratory and

gastrointestinal infections that could

spread easily through the crew. Also,

the infected clothing and filthy bed-

ding allowed the rapid spread of ty -

phus, which carried a high mortality.

The other main infectious diseases of

sailors were tuberculosis, dysentery,

malaria, yellow fever and STDs—

especially syphilis.

Although the origins of syphilis

have been debated for centuries, there

is no doubt that its spread was greatly

increased by sailors traveling to dis-

tant lands. Its protean manifestations

and different clinical stages made it

very difficult for physicians to com-

pre hend. The virulence of syphilis

reach ed its peak in the 16th and 17th

centuries; it is estimated that “by the

end of the 19th century… 10% of the

population of Europe had syphilis.”3

Other conditions very common

among sailors were nutritional defi-

ciencies such as pellagra and scurvy.

Scurvy, manifested by swollen, bleed-

special feature

Captain Vancouverand medicine in theAge of Sail

Captain George Vancouver’sremarkable voyage is set in itsmedical-historical context: An age of filthy living conditions and TB, malaria, and syphilis.

This article has been peer reviewed.

Dr Greenstone is a family physician in Surrey, BC.

Figure 1. George Vancouver, from painting in National PortraitGallery, London, by Charles William Jefferys. Courtesy of the National Archives of Canada.


ing gums, joint pain, generalized bruis-

ing, loss of teeth, fatigue, discomfort,

and poor wound healing, was a major

scourge in the Age of Sail.

Scurvy continued to decimate sea-

men despite that fact that remedies for

its prevention were known as early as

1601 when Captain James Lancaster

observed a lack of scurvy on his ship

supplied with lemon juice while the

other three ships in his expedition

without juice had numerous deaths

from the disease.4 In 1747 Dr James

Lind carried out his famous experi-

ment on board HMS Salisbury in which

he also demonstrated the curative

powers of fresh citrus fruits against

scurvy.5 However, it was Dr Gilbert

Blane who finally convinced the

Ad miralty to supply naval ships with

lemon juice and thus dramatically

reduced the incidence of this devas-

tating disease.

The Surgeon’s MateThe first therapeutic manual for Bri -

tish naval doctors was The Surgeon’sMate by John Woodall (1556–1643),

surgeon-general to the East India

Company. Written primarily for nov -

ice surgeons, it contained a detailed

inventory of the medicines and instru-

ments required for treating emer-

gencies at sea. His treatments were

mostly herbal in the form of plasters,

ointments, salts, oils, elixirs, and

laxatives, but he also used minerals

including antimony, copper sulfate,

lead carbonate, zinc oxide, and sever-

al salts of mercury.

For surgical techniques such as

am putations, suturing, cauterizing, and

disimpacting, his “surgeon’s chest”

contained about 100 instruments in -

cluding various knives, razors, saws,

forceps, probes, spatulas, and syringes.

He was very proud of his spatulum

mondani, which he designed for severe

cases of impaction. Also, Dr Woodall

had his own special recipe for the

important analgesic laudanum—which

contained about 25% opium. Cleverly

he called it “this laudable medicine,”

and avowed that “If were upon my life

tomorrow to undertake a voyage to the

East Indies in any great ship I would

renounce all other compositions of that

kind whatsoever rather than miss it.”6

Vancouver’s greatexpeditionBritain’s interest in the Pacific North-

west increased considerably in the late

18th century when it realized the

area’s potential as a commercial and

strategic centre. Based upon previous

exploration, the Spanish had laid claim

to vast areas of territory, which the

British found unacceptable. The dis-

pute centred around Nootka Sound,

which at the time was the main port of

the northwest coast. Direct conflict

was avoided when the two countries

sign ed the first Nootka Convention in

October 1790. However, the situation

was far from clarified, and the Admi-

ralty decided that something had to be

done to resolve this issue.

In April 1791 Captain George Van-

couver (Figure 1) sailed from England

with 153 men on two ships, the sloop

HMS Discovery and the tender HMS

Chatham. In addition to resolving the

dispute with Spain over ter ritorial

rights, Vancouver was also charged

with the task of surveying the north-

west coast from Washington to Alas-

ka and settling the question of the exis-

tence of a northwest passage from the

Pacific to the Atlantic.7

After traveling to South Africa

(Cape Town), Australia, New Zealand,

and Tahiti, the expedition arrived on

the coast of North America and enter -

ed the Strait of Juan de Fuca on 29

April 1792. Vancouver decided to use

small boats for detailed exploration

and surveying because it was too

special feature

Figure 2. A circa 1890 representation of the ships of Vancouver and Quadra at Friendly Cove, Nootka, 1792, by Charles William Jefferys. Courtesyof the National Archives of Canada.



dangerous for the large unwieldy

ships. Over the next few days in two

such boats he and his men charted

many points and inlets such as Birch

Bay, Point Roberts, Point Grey, Bur-

rard Inlet, and Howe Sound.

After arriving back at the two larg-

er ships they continued north through

Johnstone Strait and Queen Charlotte

Strait, around the north end of Van-

couver Island and down to Nootka

Sound. There Captain Vancouver met

Spanish Naval Captain Bodega y

Quad ra (Figure 2), with whom he had

a very cordial relationship. The two

captains began negotiations regarding

the sovereignty of their respective

nations over the lands in the Pacific

Northwest but were unable to complete

any agreement because of the lack of

adequate instructions from home.

From 1792 to 1794 Vancouver’s

crews explored and surveyed the Pacif-

ic coast (Figure 3) as far north as Cook

Inlet near present-day Anchorage, rul-

ing out the possibility of a northwest

passage. During these explorations

many locales such as inlets, bays,

and towns were named by Vancouver.

His lieutenants—Joseph Baker, Peter

Pug et, and Joseph Whidbey—were

memorialized in well-known place

names in the Pacific Northwest. Place

names were also taken from ships and

important personages back home:

Queen Charlotte Islands (wife of King

George III), Burrard Inlet (friend of

Captain Vancouver), Burke Channel

(eminent statesman), Gardner Inlet

(Royal Navy rear admiral). In total

Vancouver named about 200 places in

the Pacific Northwest during this his-

toric voyage. Finally, in September

1794, they sailed for home via Cali-

fornia, Mexico, and Chile, then around

Cape Horn and up the Atlantic Ocean

to St. Helena to arrive back in England

in October 1795.

Homecoming: Vancouver scornedVancouver’s expedition was indeed

remarkable. “The voyage produced an

impressively accurate nautical chart

of over 1700 miles of unknown coast-

line and effectively disproved one of

the greatest geographical myths of the

era while solidifying British claims of

sovereignty against Spain.”7

Despite this Vancouver did not

receive much welcome upon return-

ing to England. His great achievement

was overshadowed by the country’s

conflict with France, which had de -

clared war in 1793. And while many

of his allies were away at sea, his ene-

mies at home were making his life

miserable. Thomas Pitt launched per-

sonal attacks, challenged him to a

duel, and even assaulted him on a Lon-

don street. In addition, the Admiralty

delayed paying Vancouver for 2 years

and did not even reimburse him for his

special feature

Continued from page <None>

Figure 3. Vancouver Island as charted by Captain George Vancouver. Courtesy of Department of National Defence.


ConclusionCaptain Vancouver’s account of his

voyage was completed by his brother

and published in 1798.10 After his

death Vancouver received many hon-

ors that eluded him in life.

Statues of Vancouver are proudly

displayed in his hometown of King’s

Lynn, England, at Vancouver City

Hall, and atop the parliament build-

ings in Victoria, British Columbia. In

addition to the places that carry his

name in the Pacific Northwest there

is Mount Vancouver on the Yukon-

Alaska border, Cape Vancouver and

Vancouver Peninsula in Western Aus-

tralia, and Vancouver Arm in Dusky

Sound, New Zealand.

On 22 June 2007 a ceremony at

the Vancouver Maritime Museum

com memorated the 250th anniversary

of his birth and a stamp was unveiled

in his honor. Age of Sail explorer Cap-

tain George Vancouver had finally

received the recognition he deserved.

References

1. Broadside: Life, Death and Health in theNavy. www.nelsonsnavy.co.uk/broadside2.html (accessed 30 May 2009).

2. Bown S. Scurvy: How a Surgeon, A Mar -in er and a Gentleman Solved the Great-

est Medical Mystery of the Age of Sail.Toronto: Thomas Allen & Son; 2003:15.

3. Sherman IW. Twelve Diseases ThatChanged Our World. Washington, DC:ASM Press; 2007:92.

4. Anderson MR. A Short History of Scurvy.2000 www.riparia.org/Medical%20History/scurvy_hx.html (accessed 2 June2009).

5. Hammerschmidt DE. 250 years of con-trolled trials: Where it all began. J LabClin Med 2004;143:68-69.

6. Druett J. Rough Medicine, New York, NY:Routledge; 2000:65.

7. Bown S. Madness, Betrayal and theLash: The Epic Voyage of Captain GeorgeVancouver. Vancouver, BC: Douglas &McIntyre; 2008:232.

8. Watt J. The voyage of Captain GeorgeVancouver 1791-95: The interplay ofphys ical and psychological pressures.Can Bull Med Hist 1987;4:33-51.

9. Naish JM. The Interwoven Lives ofGeorge Vancouver, Archibald Menzies,Joseph Whidbey and Peter Puget.Lewiston, NY: The Edwin Mellen Press;1996:371-372.

10. Vancouver Captain G. A Voyage of Dis-covery to the North Pacific Ocean andRound the World. London: GG & J Robin-son; 1798.

special feature

own expenses on the voyage. So at the

end of a great seafaring expedition

lasting 41/2 years, Captain Vancouver

came home not to fame and fortune

but to humiliation and poverty.

Vancouver’s health:Diagnostic speculationThe medical record of the crews aboard

HMS Discovery and HMS Chathamwas remarkable; there was only one

fatality due to poisoning and one due

to dysentery on the entire voyage, and

the men arrived home in general good

health. Unfortunately the same could

not be said for Captain Vancouver,

who suffered numerous medical and

psychologic problems during and after

the voyage.

Vancouver’s symptoms of lethar-

gy, weight gain, puffiness, coarse skin,

and hair loss strongly suggest a diag-

nosis of hypothyroidism with possi-

bly associated Addison’s disease.8 He

also suffered from episodes of “bil-

ious colic,” a term that in those days

did not necessarily mean biliary colic

but instead attacks of severe abdomi-

nal pain of any cause. Therefore he

likely had irritable bowel syndrome,

gallstones, or both, while his fever and

joint pain suggest the possibility of

inflammatory bowel disease or con-

nective tissue disorder. Naish9 also

suggests the possibility of renal dis-

ease, which may have been secondary

to a streptococcal or viral infection

contracted during Vancouver’s earlier

stint in the Caribbean.

The treatments Vancouver receiv -

ed during the voyage from the ship

doctor would likely have contained

toxic substances such as mercury and

arsenic, so one must also consider

iatrogenic factors as another cause of

his medical problems. Whatever the

exact clinical diagnoses, it is very like-

ly that the psychological stresses that

Vancouver suffered contributed sig-

nificantly to his physical deterioration

and eventual death on 12 May 1798.

CME AT BIG WHITE

Kelowna, 2010–2011 ski season

SkiME is a daily CME program held

at the Big White Ski Resort for physi-

cians and medical staff. High-quality

recent lectures from international

speakers are shown from 8 a.m. to

noon weekdays during the ski season

at the Whitefoot Medical Clinic at Big

White Resort. Lectures are free to

watch. Certificate of Attendance cer-

tificates are available for a fee. For

complete programming information

or to pre-register (required by some

tax jurisdictions) see http://mybigwhite

.com/business/cme/. For more infor-

mation call 250 765-0544; e-mail cme

@mybigwhite.com.

FREE ACCREDITED

ONLINE CME

www.mdBriefCase.com

Looking for convenient and afford-

able ways to participate in accredited

CPD activities? Let mdBriefCase help!

Since 2002, www.mdBriefCase.com

has been the leading provider of online

continuing education for Canadian

physicians. Our courses are available

24/7, making it easy for busy physi-

cians to complete their requirements.

We develop more than 35 online learn-

ing programs each year in collabora-

tion with leading experts, profession-

al societies, and academic institutions.

All of our programs are Mainpro-M1

and Maintenance of Certification

(MOC) accredited and we offer easy-

to-print certificates. What are you wait-

ing for? Sign up today and start get-

ting your CME at www.mdBriefCase

.com!

CME ON THE RUN

Various dates, 4 Feb, 6 May (Fri)

Please join us for the third session of

the series on 3 Dec. The CME on the

Run conferences are held at the Paet-

zold Lecture Hall, Vancouver General

Hospital. There are opportunities to

participate via videoconference from

Prince George, Royal Columbian, and

Surrey Memorial hospitals. Each pro-

gram runs on Friday afternoons from

1 p.m. to 5 p.m. and includes great

speakers and learning materials. Top-

ics and dates: 4 Feb (diagnostics and

radiology), 1 Apr (ophthalmolo-

gy/ENT), 6 May (general internal

medicine/best topics). To register and

for more information, visit www.ubc-

cpd.ca, call 604 875-5101, or e-mail

[email protected].

UBC CPD FREE WEBINARS

Online, 9 Dec (Thu), 20 Jan (Thu)

UBC CPD’s webinars allow physi-

cians to take part in educational events

that can be viewed on any computer.

The benefits of a webinar include

being able to ask the presenter ques-

tions in real time and getting up-to-

date, convenient, and relevant CME

delivered to communities around BC.

Dementia Care with Dr Phil Lee will

be hosted from 7 p.m. to 8 p.m. PST,

9 Dec. Credits: 1.0 Mainpro-M1 and/

or Section 1 credits. “Doc, I Need a

Note for Work” Pesky Forms and

Practical Advice with Dr Paul Farnan

will be hosted from 7 p.m. to 8 p.m.

PST, 20 Jan, and will focus on dealing

with requests for medical information

and understanding the physician’s role

in the return-to-work process. Cred-

its: 1.0 Mainpro-M1 and/or Section 1

credits. Practice Survival Skills: What

I Wish I Knew in My First of Year

Practice will be held in Vancouver,

June 3 (Fri). Save the conference date!

To register and for more details visit

http://cpd.med.ubc.ca/Events/Web

inar_Program.htm or ubccpd.ca.

EMERGENCY MED UPDATE

Whistler, 20–23 Jan (Thur–Sun)

Sponsored by the University of Toron-

to, the 24th Annual Update in Emer-

gency Medicine will be held at the

Hilton Whistler Resort, Whistler, Bri -

calendar

CALENDAR ON THE WEB

The BCMJ Calendar section isavailable on the BCMA web site atwww.bcma.org. CME listings on theweb are updated once a week (onFridays), and once a month (whenpreparing copy for the upcomingBCMJ) all listings that will be timelyare gathered and printed in theJournal.

Rates: $75 for up to 150 words (maxi-mum), plus GST, for 1 to 30 days; there isno partial rate. If the course or event isover before an issue of the BCMJ comesout, there is no discount. VISA andMaster Card accepted.

Deadlines: Online: Every Thursday (list -ings are posted every Friday). Print: Thefirst of the month 1 month prior to theissue in which you want your notice toappear, e.g., 1 February for the Marchissue. The BCMJ is distributed bysecond-class mail in the second week ofeach month except Jan uary and August.We prefer that you send material by e-mail to [email protected], but we alsoaccept paper listings at BC MedicalJournal, #115-1665 West Broadway,Van couver, BC V6J 5A4, Canada. Tel:(604) 638-2815; fax: 604 638-2917.Please provide the billing address andyour com plete contact information.

Planning Your CME Listing: Planningto advertise your CME event severalmonths in advance can help improve at -tendance. Members need several weeksto plan to attend; we suggest that yourad be posted 2 to 4 months prior tothe event itself.


tish Columbia. The Office of Contin-

u ing Education and Professional Dev -

el opment (CEPD), Faculty of Medicine,

University of Toronto is fully accred-

ited by the Committee on Accredita-

tion of Continuing Medical Education

(CACME), a subcommittee of the

Committee on Accreditation of Cana-

dian Medical Schools (CACMS). This

standard allows the Office of CEPD to

assign credits for educational activi-

ties based on the criteria established

by the College of Family Physicians

of Canada, the Royal College of Phy -

sicians and Surgeons of Canada, the

American Medical Association, and

the European Accreditation Council

for Continuing Medical Education

(EACCME). Further information: The

Office of Continuing Education and

Professional Development, Faculty of

Medicine, University of Toronto, 650-

500 University Avenue, Toronto, ON,

M5G 1V7. Tel 416 978-2719, toll free

1 888 512-8173, fax 416 946-7028,

e-mail info-EMR1101@cepdtoronto

.ca, web site http://events.cepdtoronto

.ca/website/index/EMR1101.

EXOTIC CME CRUISES

Various dates and locations

16–30 Jan sailing to South America

from Santiago, Chile, around the Cape

Horn to Buenos Aires (CME: respirol-

ogy, cardiology, psychiatry); 21–28

Mar, sail onboard Royal Caribbean to

Dubai and UAE (CME: anti-aging and

esthetic medicine provided by AAAM).

Group rates and your companion cruis -

es free. Contact Sea Courses Cruises

at 604 684-7327, toll free 1 888 647-

7327, e-mail [email protected].

Visit www.seacourses.com for more

CME cruises.

NEPHROLOGY FOR FPs

Vancouver, 22 Jan (Sat)

Sponsored by the BC Renal Agency,

this 1-day course (7:30 a.m. to 3:30

p.m.) will be held at the Wosk Centre

for Dialogue. The conference aims to

help GPs improve care for their pa -

calendar

tients with kidney disease. In BC an

estimated 200 000 people have some

level of kidney disease. Learn about

methods for estimating renal function,

guidelines for managing chronic kid-

ney disease, evidence-based treatment

for hypertension, when and how to

refer patients to a nephrologist, and

strategies for enhancing end-of-life

care. Cost: $100. Participants will

receive 6.5 CFPC Mainpro CME cred-

its. For information or to register, visit

www.bcrenalagency.ca or e-mail bc

[email protected]. Registration limited to

first 50 respondents.

FOOT & ANKLE SYMPOSIUM

Vancouver, 28–29 Jan (Fri–Sat)

To be held at the SFU Harbour Con-

ference Centre, the Canadian Orthopae -

dic Foot & Ankle Society’s (COFAS)

biennial symposium will generate

another great turnout due to keynote

guest speakers Drs Gregory Berlet,

chief, division of foot and ankle sur-

Help patients bounce back from low mood, stress and anxiety

now in

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& MandarinDVD, CBT workbook andtelephone coaching

1-877-318-3098 www.bouncebackbc.ca

Free self-help program by doctor referral includes:

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esom low mood, strfr

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y ogram bee self-help prFreferral includes:doctor r

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SpecialistServicesCommittee

Developed to enhance Specialist Practice with a mandate to:

… improve the delivery of specialist services

… increase patient access to specialist care

… improve the health of British Columbians

Check us out at www.bcma.org/ssc



gery, Ohio State University; Roger

Mann, director, Foot & Ankle Fellow-

ship Program, Oakland, CA; and Beat

Hintermann, chairman, Clinic of Orth -

o paedic Surgery, Liestal, Switzerland.

This 2-day conference will focus on

the demonstration of cutting edge

industry technology in orthopaedics

in the subspecialty area of foot and

ankle, radiographs and other investi-

gations, maximizing non-operative

treatments, arthroscopic treatment of

ankle fractures, and many other top-

ics. It will also feature debates on who

does well and who does badly with

surgery, and Achilles tendon rup-

ture—what is the standard of care?

The organizing committee of Drs

Alastair Younger, Murray Penner,

Stephen Pinney, and Kevin Wing look

forward to hosting yet another suc-

cessful conference. Registration at

www.orthosurgery.ubc.ca, lower left-

hand column COFAS, or e-mail Sue

[email protected].

CLINICAL HYPNOSIS

WORKSHOP

Vancouver, 12–13 Feb (Sat–Sun)

To be held at UBC Robson Square,

this workshop will provide the basic

skills of clinical hypnosis including

demonstrations and practice sessions

for those who wish to add hypnosis to

their repertoire of therapeutic skills.

Intermediate/advanced skills in hyp-

nosis utilization techniques will be

provided to experienced hypnothera-

pists simultaneously and will cover

areas such as hypnosis for traumatic

experiences, stress, chronic pain, and

women’s common health conditions.

This workshop will also cover visual-

ization techniques to enhance hypno-

sis, rapid induction techniques for

emergency medicine, and methods of

integrating hypnosis into your medical

and dental practice. Register before

21 Jan for the early-bird rate. For more

details visit www.hypnosis.bc.ca, or

call 604 688-1714.

CLINICAL MEDICINE CRUISE

Caribbean, 19–27 Feb (Sun–Sun)

Sail onboard Royal Caribbean’s Lib-erty of the Seas from Miami to St.

Thomas, St. Maarten, Puerto Rico,

and a day at a private beach at La ba -

dee, Hispaniola, on this 8-day cruise.

This CME is ideal for hospitalists,

internists, rural physicians, and as a

general update for all physicians.

Approved for 17 hours of CME cred-

its. Optional workshop: a primer on

quality improvement (approved for 4

hours CME). Group rates and your

companion cruises free. Contact Sea

Courses Cruises at 604 684-7327, toll

free 1 888 647-7327, e-mail cruis-

[email protected]. Visit www.sea

courses.com for more CME cruises.

SPRING BREAK CRUISE

Caribbean, 12–19 Mar (Sat–Sat)

Sail onboard Holland America’s Eur -o dam to Grand Turk, Puerto Rico, St.

Thomas, and Half Moon Cay. CME

on this cruise focuses on diabetes

management and is ideally suited to

all physicians and allied health care

providers. Additional workshops will

be held on effective practice manage-

ment by MD Physician Services. Ap -

proved for 18.5 hours of CME. Group

rates and your companion cruis es free.

Contact Sea Courses Cruises at 604

684-7327, toll free 1 888 647-7327, e-

mail [email protected]. Visit

www.seacourses.com for more CME

cruises.

CDN GERIATRIC SOCIETY ASM

Vancouver, 14–16 Apr (Thu–Sat)

The 31st Annual Scientific Meeting of

the Canadian Geriatrics Society will

be held at the Four Seasons Hotel. This

year’s national conference in beauti-

ful Vancouver aims to attract geriatri-

cians, family physicians, fellows, res-

calendar

idents, students, and allied health care

professionals. A number of interna-

tional keynote presenters have been

secured, including Dr Edward R. Mar-

cantonio, associate professor of med-

icine, Harvard Medical School; Dr

John E. Morley, Saint Louis Universi-

ty; Dr Cheryl Phillips, American Geri-

atrics Society Board chair and clinical

professor, University of California;

Dr Kaveh G. Shojania, University of

Toronto; and Dr Roger Y. Wong, Uni-

versity of British Columbia. The meet-

ing’s comprehensive agenda has re -

sulted in a keen interest for this

conference. To register and for more

information visit www.CGS2011.ca,

call 604 875-5101, or e-mail cpd.info

@ubc.ca.

BCMJ CRUISE CONFERENCE

Rhine River, 22–29 Apr (Fri–Fri)

Cruise your way from Basel, Switzer-

land, to Amsterdam, Netherlands, on -

board the AMA Waterways ms Ama -legro. Enjoy castles, cobblestones,

cafes, and cathedrals on the free daily

shore excursions. Gourmet meals, free

local regional wine and beer with meals,

complimentary Internet, and use of

helmets and bikes as you explore these

fascinating medieval towns and cities!

Companion cruises free. Application

has been made for 14 hours of CME

credits. Faculty for this primary care

refresher include Drs Matt Black-

wood, Shannon Lee Dutchyn, Lind-

say Lawson, Colin Rankin, and David

Richardson. The cruise is now sold

out but there is a waiting list. More

information and photos at www.sea-

courses.com; to book call 604 684-

7327, toll free 1 888 647-7327, or

e-mail [email protected].


Visit

www.gpscbc.ca Visit

www.gpscbc.ca

Credit cards now requiredThe BC Medical Journal now requires a Visa or MasterCard

number for advertising.

BCMA members may still pay bycheque, but a credit card number willbe requested when you place your ad.


practices availableCURRENT ADS ONLINE

All classified ads are available online in an

easily searchable format at www.bcmj.org/

classified/list.

FP—KAMLOOPS

Family practice available in Kamloops. Located

two blocks from hospital. Lease in renovated

house with two congenial colleagues. Excel-

lent support staff. Availability flexible—late

2010 to early 2011. Phone 250 372-8568 or e-

mail [email protected].

FP/GP—VERNON

Established full-time solo family practice

available in Vernon in a modern, spacious two-

GP office with shared overhead. No OBS or

ER. Office hours are flexible; currently share 1

in 6 weekend in-patient call. Enjoy biking, ski-

ing, boating, and Okanagan sunshine. Contact

Dr Bill Charlton at 250 542-2887 or kbcharlton

@shaw.ca.

FP—VICTORIA

Family practice available in Victoria’s westerncommunities. Turnkey operation, no charge.Half-time but can go to full-time. Can applyfor partnership in doctor-run treatment centre.Contact Paul at [email protected] or 250479-0548.

FP—NEW WESTMINSTER

Well-established family practice available.Owner retiring. Ideally located opposite RoyalColumbian Hospital. Lab, X-ray, and pharma-cy in building. For more information [email protected].

FP—NORTH VANCOUVER

Three FPs have room for fourth, and will easi-ly support a new practice or absorb an estab-lished one. We have work for you. Lions GateHospital across the street. Privileges availableand FPs are welcome. OSTLER EMR. Sharedoverheads and excellent staff. Walk-in clinicsalways looking for help locally. Call MikeDavidson at 604 623-8800 or e-mail [email protected].

positions availablePHYSICIAN—NORTH VANCOUVER

Physician required for the busiest clinic/family

practice on the North Shore! Our MOAs are

known to be the best, helping your day run

smoothly. Lucrative 6-hour shifts and no head -

aches! For more information, or to book shifts

online, please contact Kim Graffi at kimgraf-

[email protected] or by phone at 604 987-0918.

CURRENT ADS ONLINE

All classified ads are available online in an

easily searchable format at www.bcmj.org/

classified/list.

LOCUM—VANCOUVER

Busy walk-in clinic shifts available in Yale-

town and the heart of Kitsilano at Khatsahlano

Medical Clinic—voted best independent med-

ical clinic in Vancouver in the GeorgiaStraight readers’ poll. Contact Dr Chris Watt at

[email protected].

classifieds

Rates: BCMA members $50 + GST perissue for each insertion of up to 50 words.Each additional word, 50¢ + GST per issue.Box number $5 + GST. We will invoice onpublication.Non-members $60+GST per issue for eachinsertion of up to 50 words. Each additionalword, 50¢ + GST. Box number $5 + GST perissue. Payment must accompany submission.Deadlines: Ads must be submitted or can-celled in writing by the first of the month pre-

ceding the month of publication, e.g., by 1 November for December publication. Pleasecall if you have questions.

Send material to: Kashmira Suraliwalla •BC Medical Journal • #115-1665 WestBroadway • Vancouver, BC V6J 5A4Canada • Tel: 604 638-2815; fax: 604 638-2917 • E-mail: [email protected] Provincial legislation prohibits ads that dis-criminate on the basis of sex. The BCMJ maychange wording of ads to comply.

C L A S S I F I E D A D V E RT I S I N G ( l i m i t e d t o 1 0 0 w o rd s )


Your forum to advance…

Specialist IssuesRepresentingBCMA specialists

GP—FORT ST. JAMES

GP required for busy family practice. Surround-ed by beautiful scenery and hundreds of lakes,Fort St. James has recreational opportunitiesfor everyone! We are recruiting two full-timephysicians to consult in the clinic and share ERon-call services and hospital in-patient care.High-income potential! For more informationplease contact our office manager, Kathy, [email protected] or call250 996-8291. Visit our web site at www.fsjamesmedicalclinic.com.

DOCTOR—SURREY

If the overhead cost is stopping you from hav-ing your own practice, or if you are looking tohave a very busy practice with guaranteedincome, we have the right office for you! Lo -cated in Surrey, on King George Blvd, twoblocks from SkyTrain station, next to a phar-macy and a dental clinic. Four exam rooms,physician’s office, reception, waiting area,storage, signage, computer networking, plentyof free parking, and more. Lease terms areflexible, and the rent is very low and nego-tiable. For more information please call MrZehtab at 604 306-4706, or e-mail [email protected].

GPs/LOCUMS—SURREY

Very busy walk-in clinic looking for physi-cians/locums to do Monday and Friday morn-ing shifts from 9 a.m. to 3 p.m. Coverage alsoneeded for April Sunday morning shifts from 9 a.m. to 3 p.m. or 10 a.m. to 3 p.m. Eveningsfrom Monday to Friday from 3 p.m. to 8 p.m.The split is 70/30 with $95 minimum. Alsolooking for physicians to move their practice.We can do it by a percentage or just flat fee.Please contact the manager at 778 688-5898,or e-mail [email protected].

FP—SURREY/GUILDFORD

Lucrative family practice/walk-in in Surrey,near Guildford. Physician needed full-time orpart-time. Split 75%. Busy practice. Mostlyyoung families. High-income potential. CallDr R. Manchanda at 604 580-5541, or [email protected].

GP—NANAIMO

General practitioner required for locum or per-manent positions. The Caledonian Clinic islocated in Nanaimo on beautiful VancouverIsland. Well-established, very busy clinic with24 general practitioners and four specialists.Two locations in Nanaimo; after-hours walk-inclinic in the evening and on weekends. Com-puterized medical records, lab, X-ray, andpharmacy on site. Contact Doris Gross at 250716-5360, or e-mail [email protected].

LOCUM—METRO VAN

Available Jan to Oct 2011 with possible exten-sion. This radiology practice involves tertiary,community, and clinic work, including generalX-ray, ultrasound, CT, MRI, mammography,and IR. Vascular interventional skills preferred

but not required. Excellent remuneration in aprogressive, dynamic group practice. For moreinformation, please contact Dr Ken Wong [email protected] or 778 231-5809.

PHYSICIANS—KELOWNA

Medi-Kel Clinics Ltd. seeks physicians fromacross Canada for well-established familypractice and walk-in clinic for full-time, part-time, and locum positions. Clinic is computer-ized (Osler EMR). Obstetrics and hospital priv-ileges optional but not required. We provide allthe administrative and operational support.Kelowna offers lots of recreational activities.Please contact office manager Maria Varga [email protected] or call 250 863-9555.

PEDIATRICS—BURNABY

Busy pediatric and multidisciplinary officeoffering walk-in and referral-based practice.Excellent location and competitive remunera-tion. Please contact Jeremy at 604 299-9769.

GP—CAMPBELL RIVER

Practice in beautiful, oceanside Campbell River.Seeking full-time physician to replace a col-league moving to another community. We are a thriving, multispecialty, full-service clinicoffering limited after-hours walk-in. Obstetricsand emergency encouraged. Central location,near hospital. Congenial medical community;

classifieds

WALK-IN—VICTORIA

Walk-in clinic shifts available in the heart of

lovely Cook St. Village in Victoria, steps from

the ocean, Beacon Hill Park, and Starbucks.

For more information contact Dr Chris Watt at

[email protected].

LOCUM—ABBOTSFORD

East Abbotsford walk-in clinic with congenial

staff and pleasant patient population is looking

for a flexible locum physician interested in

possible long-term opportunity with excellent

remuneration. Please call Cindy at 604 504-

7145 between 9 a.m. and 2 p.m., Monday to

Friday.

GPs/SPECIALISTS—LOWER

MAINLAND

Considering a change of practice style or loca-

tion, or considering selling your practice?

Group of eight established locations within

Surrey, Delta, and Abbotsford with opportuni-

ties for family, walk-in, or specialist physi-

cians. Full-time, part-time, or locum doctors

are guaranteed to be busy. We provide all the

administrative and operational support. En -

quiries to Paul Foster, 604 592-5527, or e-mail

[email protected].


Credit cards now required

The BC Medical Journalnow requires a Visa or MasterCard number for

advertising.

BCMA members may still pay by cheque, but a credit

card number will be requestedwhen you place your ad.


good specialist coverage. Outstanding four-season outdoor activities. This is a full-serviceclinic involving obstetrics, pediatrics, geriatrics,etc. Campbell River has a population of ap -proximately 40 000 people and a large drawingarea. In our clinic there are 15 general practi-tioners, one surgeon, two internists (one spe-cializing in cardiology and the other specializ-ing in gastrointestinal), two obstetricians, andtwo pediatricians. We have a variety of staffmembers including transcriptionists, MOAs,registered nurses, receptionists, and a billingdepartment. You can read more about Camp-bell River at www.campbellriver.ca. ContactMonica Strebel, office manager, at 250 287-7441 or e-mail [email protected].

PHYSICIANS—N DELTA/SURREY

Associateships and long-term locums avail-able immediately in a very busy and successfullong-established family practice and walk-inclinic with an excellent reputation and veryhigh income right away. Training provided;terms negotiable. Contact Dr Baldev S. Kahlonat 604 597-1606 at Scottsdale Medical Centre,or e-mail [email protected].

FP—PRINCETON

Family physician required immediately for es -tablished clinic and six-bed community hospi-tal that provides emergency, general medicine,and basic laboratory and diagnostic imagingservices. 9 a.m. to 5 p.m. plus 1:6 on-call for24/7 ER. Excellent remuneration. Generousrelocation allowance and funded recruitmentvisit available. Princeton is a family-orientedcommunity at the foothills of the CascadeMountains—the gateway to exceptional four-season recreation. Refer to www.betterhere.ca,call 1 877 522-9722, or e-mail [email protected].

FP—CRESTON

Physician needed to join one GP surgeon andthree OB physicians. We are a UBC residencyteaching clinic and host visiting specialists. Wehave transitioned to EMR, and offer friendlyand efficient staff. Creston Valley is a breath-taking combination of snowcapped mountainpeaks; deep, clear lakes; and wide-open spaces.A year-round playground for people who lovethe outdoors, with larger urban centres andworld-class alpine skiing nearby. Call 1 877 522-9722, e-mail [email protected], or visit betterhere.ca.

GPs/LOCUMS—ABBOTSFORD

Very busy walk-in clinic and GP practice look-ing for physicians/locums to do Monday toFriday 9 a.m. to 2 p.m. and 2 p.m. to 8 p.m.shifts. Open Saturdays 9 a.m. to 1 p.m. Cover-age also needed for 11 to 17 December. Pleasecontact the manager at 604 852-5878 or [email protected].

FP—GALIANO ISLAND

Opportunity for independent or shared practicein turnkey modern office with Wolf EMR,emergency treatment room, experienced staff,

and nurse practitioner. No obstetrics or hospi-

tal work. The position offers a generous al ter-

native payment contract, level 2 MOCAP

(shared), and attractive RSA benefits. Galiano

offers a quality of life second to none! Contact

Sheila Leversidge at 250 740-6972 or e-mail

[email protected].

FP—VANCOUVER

Large, high-profile medical clinic in beautiful

Vancouver is looking for family physicians to

join our dynamic group. We are located close

to Vancouver General Hospital and the Broad-

way corridor. This is a full EMR practice with

RN support for complex care. There is a mix-

ture of family physicians and specialists and a

great collegial atmosphere. We have a daily

walk-in clinic and a travel medicine clinic.

There is also physio, lab, X-ray, pharmacy, and

dental facilities in our building. If you are

interested in joining a great group of people,

please contact Kim Goodwin, clinic director,

Seymour Health Centre Ltd, at kim.good

[email protected].

medical office spaceCURRENT ADS ONLINE

Seeking readers to find what they’re looking

for in the BCMJ online classified ads. All ads

from this issue are available online in an easily

searchable format at www.bcmj.org/classi

fied/list.

classifieds

SPACE—VANCOUVERTwo psychiatrists looking for a third to sharesuite 902–601 W. Broadway. The office is gorgeous with a stunning floor-to-ceiling viewfacing north and west. The space is availableMon, Wed, and Fri (and weekends if desired).Call Trish Long at 604 872-3235 (Mon–Thur).

SPACE—ABBOTSFORDFully renovated medical clinic in Abbotsford islooking for family physicians for walk-in orprivate practice. The 1300 sq. ft. location is ina busy area. 15/85 split if we set up. Otherwise,free rent for up to 1 year. Contact 604 537-4464. E-mail [email protected].

SPACE—SURREYFully renovated medical clinic in Fleetwood islooking for family physicians for walk-in orprivate practice. Large 3000 sq. ft. centrallocation in a high-traffic area is adjacent toample free parking and a lab. 15/85 split if weset up. Otherwise, free rent for up to 1 year.Contact 604 537-4464. E-mail [email protected].

SPACE—VANCOUVERLarge 675 sq. ft. medical office is available forlease at the 1160 Burrard Health Centre, acrossfrom St. Paul’s Hospital. Designed for twospecialists, two GPs, or similar. For info pleasee-mail [email protected] or phone 1 604 896-1636.


Linda [email protected]

4550 Lougheed HwyBurnaby, BC

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SPACE—VANCOUVER

Fully renovated medical clinic in Vancouver islooking for family physicians for walk-in orprivate practice. Large 2000 sq. ft. central lo -cation in a high-traffic area. Free parking inback. 15/85 split if we set up. Otherwise, freerent for up to 1 year. Contact 604 537-4464. E-mail [email protected].

LEASE—PORT MOODY

St. Johns St., Main St. Level walk-in. Long-termlease available for medical practice. Choose1100 sq. ft. space, or large 2200 sq. ft. unit formultipractitioner clinic. Rear parking lot. Futurepharmacy or practice expansion will be avail-able. Extensive exterior/interior renovations inprogress. All medical use building. Separatemeters and HVAC. E-mail Larrie Forbes at RE-MAX All Points Realty at [email protected],or call 604 936-0422 (direct line 604 805-7606).

SPACE—NEW WEST

Due to the existence of a 11 300 patient basewith no close-by doctor, this advertisement is acommunity and local business supported ini-tiative. If you are looking to set up a new prac-tice in a rapidly growing affluent part of theLower Mainland please visit www.qbhdocsearch.com.

SPACE—NORTH VAN

Physician leaving province. Spacious five-doctor office. Beautiful location in profession-al building facing Grouse Mountain. Close toLions Gate Hospital. Equipped with electronic

classifieds

Continued from page 543 medical records. Adequate space for full-timeor part-time consultant/family physician prac-tice. Excellent, experienced medical office assis-tant. Awesome colleagues. Contact 778 888-7251 or [email protected].

vacation propertiesFRENCH VILLA

France/Provence. Les Geraniums, a 3-bedroom,3-bath villa. Terrace with pool and panoramicviews. Walk to market town. One hour to Aixand Nice. New, independent studio with terracealso available. 604 522-5196, [email protected].

FOR SALE—USA

After 46 years of having enjoyed a little bit ofheaven, age and declining health require thatowner finds a successor for this 3/4 acre, 90 ft.waterfront property which was developedbefore setback regulations took effect. This isone of a very few low-bank, no-slide proper-ties of that size and privacy between Blaineand Birch Bay. Tide goes out during daytime,spring, summer, and early fall, providing a mud-free sandy beach for walking and swimming,with good clamming and crabbing opportuni-ties. Swimming pool, golf, tennis, spa, andresort hotel just a couple of kilometres away.Contact [email protected].

FOR RENT—WHISTLER

Plan your next holiday, beautiful four-bedroomhouse, 5 minutes from Whistler Village. Quiet,private, ideal for groups of 8 to 10. All thecomforts of home. Contact Beth Watt or PeterVieira at [email protected] or 604 882-1965.

BC Association of

Clinical Counsellors ................ 542

Breivik and Company ................ 500

Cambie Surgery Centre/

Specialist Referral Clinic ..... 497

Canadian Mental Health

Association .................................... 539

Carter Auto ........................................ 543

General Practice

Service Committee

...................498, 501, 503, 540, 545

Marine Way Market ..................... 502

MCI Medical Clinics Inc. ........ 545

Optimed ............................................... 499

Society of Specialist

Physicians and Surgeons ...... 541

Speakeasy Solutions .................... 496

Specialist Services

Committee ..................................... 539

Wickaninnish Inn .......................... 545

advertiserindex

The BC Medical Association

thanks the following advertisers

for their support of this issue of the

BC Medical Journal.

Phone line Change? Old number New number

Poison Control Centre –Lower Mainland No 604 682-5050 604 682-5050

Poison Control Centre (toll free) No 1 800 567-8911 1 800 567-8911

Drug information for healthcare professionals – LowerMainland

Yes 604 806-9104 604 707-2787

Drug information for healthcare professionals (toll free) No 1 866 298-5909 1 866 298-5909

Administration Yes 604 682-2344 ext. 62126 604 707-2789

Fax Yes 604 806-8603 604 707-2807

Please note: Where telephone or fax numbers have changed, a recording will play request-ing you hang up and call the new number.

BC Drug and Poison Info Centre has movedThe BC Drug and Poison Information Centre relocated to the BC Centre

for Disease Control in October. The Centre’s address and some numbers

will change. New mailing address:

BC Drug and Poison Information Centre

Room 0063, BC Centre for Disease Control

655 W. 12th Ave., Vancouver BC V5Z 4R4

homesweethome

The all-new bcmj.org isyour gateway to BC

medical news.

bcmj.org



NEED A HOLIDAY IN PARADISE?

One bedroom beachfront condo in Puerto Val-larta, Mexico, overlooking Mismaloya Bay.Sleeps four. Full kitchen, fully furnished, A/C,satellite TV. Available weekly or monthly. Call604 542-1928, or e-mail [email protected].

FOR RENT—MAUI

Our oceanview 1 BR, 2 bath condominiumunit can accommodate up to four people inrelaxed surroundings. It is located in Kiheiacross the road from the Kamaole III BeachPark. Facilities include two swimming pools,two hot tubs, two tennis courts, BBQ, andhigh-speed Internet access. Rates US $120–$180 per day. Call 250 248-9527 or [email protected].

VACATION HOME—WHISTLER

Whistler holiday! Beautiful home in Bay -shores with five bedrooms and five bathrooms.Five minutes to Creekside gondola. Good fortwo to three families. Contact Dawn Galbraithor Pat Gallagher at [email protected], or call250 743-2979.

SUN PEAKS GETAWAY

Get away to beautiful Sun Peaks! Enjoy luxu-rious yet comfortable amenities in our two-bedroom and den ski-in, ski-out home. Thistownhome features a fully equipped gourmetkitchen, private hot tub, and washer/dryer.

Sleeps 6 to 8 comfortably. For info and to viewpictures go to SunPeaksslopes.directvacations.com or e-mail [email protected].

miscellaneousCURRENT ADS ONLINE

Seeking readers to find what they’re lookingfor in the BCMJ online classified ads. All adsfrom this issue are available online in an easi-ly searchable format at www.bcmj.org/classified/list.

PATIENT RECORD STORAGE—FREE

Retiring, moving, or closing your family orgeneral practice, physician’s estate? DOCU d-avit Medical Solutions provides free storagefor your paper or electronic patient recordswith no hidden costs. Contact Sid Soil atDOCUdavit Solutions today at 1 888 711-0083,ext. 105 or e-mail [email protected]. Wealso provide great rates for closing specialists.

BOOK OF POEMS AVAILABLE

Instinct-Science and Other Poems by GurdevS. Boparai is available through Chapters book-store, at www.chapters.ca.

FREE CME SPACE—VANCOUVER

New state-of-the-art facility with boardroomsavailable for CME events. No charge for phy -sicians; seats up to 35 guests. Easy access to

classifieds

GIFT CERTIFICATES AVAILABLE.

Visit

www.gpscbc.ca Visit

www.gpscbc.ca

“ MCI takes care of everything without telling me how to run my practice”.

Toronto – Calgary – Vancouver

MCI Medical Clinics Inc.

MCI means freedom:I remain independent

underground parking. For further informationcontact Lisa at 604 733-4407 or [email protected].

FOR SALE—HYSTEROSCOPY UNIT

Never used Storz Office Hysteroscopy Unit.Autoclavable 2 mm 30 degree telescope withenlarged view, 2.8 mm outer sheath. TricamZoom 3-chip camera head. 175 watt xenon lightsource and light cable. CO2 insufflator. 14"monitor. Storz endoscopy cart (36" high). Pur-chased in 2004 but never used. In excellentcondition. Asking $20 000 OBO; must sell aspractice is now closed. E-mail [email protected] or leave message at 604 872-2003.

TRANSCRIPTION SERVICES

Canada-wide since 2002. Telephone dictationand digital recorder files. We offer excellentquality, next business day service. Family prac-tices, clinics, and all specialties. Patient notes,letters, reports, medical-legal, and IMEs.PIPEDA compliant. Call 416 503-4003, tollfree 1 866 503-4003, or e-mail www.2ascribe.com. Check out our dictation tips at www.2ascribe.com/tips.


What profession might you havepursued, if not for medicine?Pilot

Which talent would you mostlike to have?Ability to play the piano.

What do you consider yourgreatest achievement?Marrying my beautiful wife.

Who are your heroes?My teacher Lord Russell Brock and

tennis player Roger Federer.

Dr Mclaren is a retired thoracic and gener-al surgeon in Kamloops, where he prac-tised for 35 years.

What is your idea of perfecthappiness?Ruminating in starlight at our Shuswap

Lake cottage.

What is your greatest fear?Dying before my handicapped wife.

What is the trait you mostdeplore in yourself?My inability to catch up.

What characteristic do yourfavorite patients share?A sense of trust that I was doing my

best.

Which living physician do youmost admire?Michael S. Wilson, my GP.

What is your favorite activity?Reading the New Yorker in bed when

not at tennis or skiing.

What medical advance do youmost anticipate?Voluntary euthanasia.

The Proust Questionnaire has its origins in a parlor game popularizedby Marcel Proust, the French essay-ist and novelist, who believed that, inanswering these questions, an indivi -dual reveals his or her true nature.

Tell us a bit about yourself. Please complete and submit aProust Questionnaire—your colleagues will appreciate it.

Onlinewww.bcmj.org/proust-questionnaire. Complete andsubmit it online.

[email protected]. E-mailus and we’ll send you ablank MS Word document to complete and return.

Printwww.bcmj.org/proust-questionnaire. Print a copy fromour web site, complete it, andeither fax (604 638-2917) or mailit (BCMJ 115-1665 West Broad-way, Vancouver BC V6J 5A4).

Mail604 638-2858. Call us andwe’ll mail you a copy to com-plete and return by mail (BCMJ115-1665 West Broad way,Vancouver BC V6J 5A4).

back page

What is your most markedcharacteristic?Sans froid.

On what occasion do you lie?Hopefully never now in retirement,

but at times to soften the blow of

telling bad news.

What do you most value in yourcolleagues?Their friendship.

Who are your favorite writers?Malcolm Gladwell and David Rem-

nick.

What is your greatest regret?That I did not recognize precursors to

my wife’s stroke.

How would you like to die?Suddenly from whatever.

What is your motto?In virtue are riches.

Proust questionnaire: William J. McLaren, MD


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british columbia medical journal, december 2010 full issue

Health & Medicine